Holt’s Syndrome
This post is a personal, work-in-progress record, distilling the most important information from my experience with a multitude of vestibular issues. These are loose notes.
Looking back at the compounding vestibular issues I was suffering with, and still do, I'm now fairly certain that I stumbled into something that hasn't been specifically recorded in the medical literature, but has been covered on a more general basis. Even though this is controversial, I will name it Holt’s Syndrome, just to give it a very specific definition.
PPPD is the term used as a cover-all for neurological maladaptation issues - with ‘dizziness’ persisting after vestibular events in a variety of confusing sensory scenarios, but the spectrum of symptoms is quite broad.
The specific symptoms I am referring to are:
After a period of maladaptation from inappropriate signals.
Or noisy signals from dehiscence.
Senses in conflict, creating definitive (often quick onset) mismatch sensations.
Often presenting with nystagmus or a sense of disconnect that quickly initiates a vestibular migraine.
Example 1:
Laying on a flat surface with hands down, but one hand is on an extra piece of cloth.
Eyes closed to remove visual reference.
Either the head will spin quickly, or nystagmus (eye spasming) will start to appear.
Brain expects a flat surface while laying down, but hand on cloth defies expectation.
Example 2:
Standing in a shower, floor is uneven with dents to prevent slipping.
Foot is placed over a dent, providing pressure on one foot.
Head down, eyes closed, mismatch sensation occurs (with or without nystagmus).
Becoming lightheaded, feeling the entry to a vestibular migraine.
Brain expects flat floor, but foot gives pressure signal which defies expectation.
Signal mismatch begins to trigger vestibular migraine event.
Example 3:
Sitting at a desk, looking at a computer monitor. The monitor screen and desk are stable.
Slouching in the chair, turning one foot sideways on the ground.
Taking the other foot and resting it on top of the sideways foot.
While eyes are open, pressure is applied to the sideways foot, and suddenly the head starts spinning.
Brain expects flat surface, as eyes are looking at a screen that is not moving, but feet are describing a world which has turned.
Example 3 (Reversed):
Sitting at a desk, looking at a computer monitor. The monitor screen and desk are stable.
There is a microphone hanging over the desk that is prone to wobbling.
As the user moves around, the microphone wobbles.
Despite looking at a stable screen, the wobbling microphone produces a fast-onset mismatch sensation (as though balance is separating from body).
Unlike example 3, the feet may be flat on the ground here. The conflict in this case may still be between the body and vision - the feet are stable, but the microphone is describing a world that is moving. The mismatch sensation is unlike motion sickness, instead onsetting with great speed and involuntarily adjusting vision.
I need to emphasize here that the mismatch sensations do not feel like motion sickness. They are definite, very obvious sensations of balance ‘separating from the body’.
Questions:
In the above examples, 'body' signals (kinetic) are a key factor in initiating a mismatch.
If the brain has experienced noisy, inappropriate signals from the inner ear, does it place a greater emphasis on the body to retrieve position?
Findings:
Yes, from personal study over the course of a year. Extended use of alcohol and caffeine substances changes the pattern of vestibular signals from the inner ear. This heightens the symptoms for a while until adaptation corrects the difference (from a period of being off the substances). When coming off the substances, the symptoms are worsened again until adaptation corrects the difference (this may take anywhere from a few days to a few weeks). Strictly speaking, being on or off substances on a daily basis does not cause the issues, rather: adjusting to the other state causes a change in expectation. The greater difference between mechanical signals and neural expectation is what causes symptoms to appear.
How much overlap does this have with Space Adaptation Syndrome?
The two core components in predicting these events are:
Mechanical signals (inner ear).
Neural expectations for signals (issues may be referred to as 'neural circuit dizziness', which is another cover-all term that has been used by others undergoing personal studies, or those providing help services to people who fall outside of the medical sphere).
Resolution:
Electrolyte supplementation to assist with the regulation of neurological signals (and promote inner ear fluid health).
Avoid substances that alter vestibular signals to reduce the corrective difference of adaptation.
Exposure. Vestibular rehabilitation is not actively required. Life itself will provide stimulation for adaptation.
Gratuitously, I will refer to this specific form of maladaptation-mismatch as Holt's Syndrome, until someone tells me off.