Galvanic stimulation in bilateral vestibular failure: 3-D ocular motor effects

Bilateral galvanic vestibular stimulation (GVS) with current intensity of 3 mA was applied at mastoid level in 11 patients with chronic bilateral vestibular failure, in order to determine ocular motor responses by 3-D video-oculography. The following abnormal features were found: (1) a predominantly torsional or mixed torsional-horizontal nystagmus at the onset of stimulation with lower current intensities (1.0-3.0 mA) in nine patients; (2) a reduced amplitude of tonic ocular torsion by about 50% in nine patients (1.3 +/- 0.6 degrees at 3 mA); (3) a nystagmus in the opposite direction at stimulation offset in five patients (rebound); (4) no eye movements at all in a patient with bilateral nerve failure. GVS stimulates the vestibular nerve, thus allowing differentiation of nerve failure from labyrinthine failure. The low thresholds for initiating nystagmus and the rebound, which appear to be the most typical features of bilateral labyrinthine failure, can be explained by central compensation mechanisms.