Motion sickness is linked to nystagmus-related trigeminal brain stem input: a new hypothesis.

Motion sickness is a common and distressing but poorly understood syndrome associated with nausea/vomiting and autonomic nervous system accompaniments that develops in the air or space as well as on sea or land. A bidirectional aetiologic link prevails between migraine and motion-sickness. Motion sickness provokes jerk nystagmus induced by both optokinetic and vestibular stimulation. Fixation of gaze or closure of eyes generally prevents motion sickness while vestibular otolithic function is eliminated in microgravity of space, indicating a predominant pathogenetic role for visuo-sensory input. Scopolamine, dimenhydrinate, and promethazine reduce motion-related nystagmus. Contraction of extraocular muscles generates proprioceptive neural traffic and can provoke an ocular hypertensive response. It is proposed that repetitive contractions of the extraocular muscles during motion-related jerk nystagmus rapidly augment brain stem afferent input by increasing proprioceptive neural traffic through connections of the oculomotor nerves with the ophthalmic nerve in the lateral wall of the cavernous sinus as well as by raising the intraocular pressure thereby stimulating anterior segment ocular trigeminal nerve fibers. This verifiable hypothesis defines the pathophysiological basis of individual susceptibility to motion sickness, elucidates the preventive mechanism of gaze fixation or ocular closure, advances the aetiologic link between MS and migraine, rationalizes the mechanism of known preventive drugs, and explores new therapeutic possibilities.

[1]  A Kuritzky,et al.  Vertigo, Motion Sickness and Migraine , 1981, Headache.

[2]  Gilles Clément,et al.  Alteration of eye movements and motion perception in microgravity , 1998, Brain Research Reviews.

[3]  J J Uri,et al.  Oculomotor function during space flight and susceptibility to space motion sickness. , 1991, Acta astronautica.

[4]  Martindale : the extra pharmacopoeia , 1996 .

[5]  Cognitive demand affects the gain of the torsional optokinetic response , 2004, Experimental Brain Research.

[6]  I. Pyykkö,et al.  Transdermally administered scopolamine vs. dimenhydrinate. II. Effect on different types of nystagmus. , 1985, Acta oto-laryngologica.

[7]  G M Halmagyi,et al.  Clinical signs of visual-vestibular interaction. , 1979, Journal of neurology, neurosurgery, and psychiatry.

[8]  S. Holm-jensen.  The significance of attention and duration of the stimulation in optokinetic nystagmus. , 1984, Acta oto-laryngologica.

[9]  J. Demer,et al.  The edrophonium-Hess screen test in the diagnosis of ocular myasthenia gravis. , 1992, American journal of ophthalmology.

[10]  H. Gray.  Gray's Anatomy , 1858 .

[11]  Crowley Js.  Simulator Sickness: A Problem for Army Aviation , 1987 .

[12]  P. Schraeder,et al.  A new goldfish model to evaluate pharmacokinetic and pharmacodynamic effects of drugs used for motion sickness in different gravity loads. , 2001, Acta astronautica.

[13]  B Cohen,et al.  Promethazine affects optokinetic but not vestibular responses in monkeys. , 2000, Aviation, space, and environmental medicine.

[14]  M F Reschke,et al.  Effects of microgravity on the interaction of vestibular and optokinetic nystagmus in the vertical plane. , 1992, Aviation, space, and environmental medicine.

[15]  A. Clarke,et al.  The anti-motion sickness mechanism of ginger. A comparative study with placebo and dimenhydrinate. , 1989, Acta oto-laryngologica.

[16]  Bernice B. Capusten,et al.  Gray's Anatomy. 37th ed , 1990 .

[17]  G. I. Samarin,et al.  [Interlabyrinthine asymmetry, vestibular dysfunction and space motion sickness]. , 1986, Kosmicheskaia biologiia i aviakosmicheskaia meditsina.

[18]  David J. Weatherall,et al.  Oxford textbook of medicine , 1996 .

[19]  J Wetzig,et al.  Effects of rectilinear acceleration, caloric and optokinetic stimulation of human subjects in the Spacelab D-1 mission. , 1986, Advances in space research : the official journal of the Committee on Space Research.

[20]  Martindale.,et al.  THE EXTRA PHARMACOPOEIA , 1937 .

[21]  H. J. Wyatt,et al.  Visual fixation of a target and suppression of optokinetic nystagmus: Effects of varying target feedback , 1995, Vision Research.

[22]  P. Drummond,et al.  Facial pain increases nausea and headache during motion sickness in migraine sufferers. , 2003, Brain : a journal of neurology.

[23]  Aparna,et al.  Prevalence and correlates of susceptibility to motion sickness. , 1997, Acta geneticae medicae et gemellologiae.

[24]  A. Cunningham,et al.  Intraocular pressure -physiology and implications for anaesthetic management , 1986, Canadian Anaesthetists' Society journal.

[25]  I. Howard,et al.  Visually-induced sickness in normal and bilaterally labyrinthine-defective subjects. , 1991, Aviation, space, and environmental medicine.

[26]  J. Dichgans,et al.  Differential effects of central versus peripheral vision on egocentric and exocentric motion perception , 1973, Experimental Brain Research.

[27]  V. Jäntti,et al.  A reduction of vestibulo-visual integration during transdermally administered scopolamine and dimenhydrinate. A presentation of gain control theory in motion sickness. , 1984, Acta oto-laryngologica. Supplementum.

[28]  Silverman,et al.  Patterns of III nerve synkinesis. , 1998, Strabismus.

[29]  Moskalenko YuE,et al.  The involvement of cerebrovascular reactivity in pathogenesis of space motion sickness. , 1991, Acta astronautica.

[30]  H W Leibowitz,et al.  The effects of fixation and restricted visual field on vection-induced motion sickness. , 1990, Aviation, space, and environmental medicine.

[31]  P. A. Zwieten,et al.  The influence of clonidine on intraocular pressure , 1979, Documenta Ophthalmologica.

[32]  S. red Duke-Elder,et al.  System of ophthalmologyVolIV:the physiology of the eye and of vision , 1968 .

[33]  F. O. Black,et al.  Optokinetic and vestibulo-ocular reflex responses to an unpredictable stimulus. , 1987, Aviation, space, and environmental medicine.

[34]  H. Neuhauser,et al.  Vertigo and Dizziness Related to Migraine: A Diagnostic Challenge , 2004, Cephalalgia : an international journal of headache.

[35]  F. Chang,et al.  Alteration in ocular function induced by phenylethylamine analogs of dopamine. , 1984, Current eye research.

[36]  C. Belmonte,et al.  Sensory nerve responses elicited by experimental ocular hypertension. , 1986, Experimental eye research.

[37]  H. Shojaku,et al.  Effect of transdermally administered scopolamine on the vestibular system in humans. , 1993, Acta oto-laryngologica. Supplementum.