Accepted Manuscript

Cooperation of the vestibular and cerebellar networks in anxiety

disorders and depression

Pascal Hilber, Jan Cendelin, Anne Le Gall, Marie-Laure

Machado, Jan Tuma, Stephane Besnard

PII: S0278-5846(18)30422-6
DOI: doi:10.1016/j.pnpbp.2018.10.004
Reference: PNP 9513
To appear in: Progress in Neuropsychopharmacology & Biological Psychiatry
Received date: 4 June 2018
Revised date: 25 September 2018
Accepted date: 4 October 2018

Please cite this article as: Pascal Hilber, Jan Cendelin, Anne Le Gall, Marie-Laure
Machado, Jan Tuma, Stephane Besnard , Cooperation of the vestibular and cerebellar
networks in anxiety disorders and depression. Pnp (2018), doi:10.1016/
j.pnpbp.2018.10.004

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 ACCEPTED MANUSCRIPT
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Cooperation of the vestibular and cerebellar networks in anxiety disorders and

depression

Pascal Hilber1 *, Jan Cendelin3,4 , Anne Le Gall2 , Marie-Laure Machado2 , Jan Tuma3,4 ,

Stephane Besnard2

1
Centre de Recherche sur les Fonctionnements et Dysfonctionnements Psychologigues.

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CRFDP EA 7475. Rouen Normandie University, Bat Blondel, Place E. Blondel 76821, Mont

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Saint Aignan cedex, France
2
UMR UCBN/INSERM U 1075 COMETE, Pole des Formations et de Recherche en Sante,

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Normandie University, 2 Rue Rochambelles, 14032 Caen cedex 5, France
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3
Department of Pathophysiology, Faculty of Medicine in Pilsen, Charles University, alej

Svobody 1655/76, 323 00 Plzen, Czech Republic

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Laboratory of Neurodegenerative Disorders, Biomedical Center, Faculty of Medicine in

Pilsen, Charles University, alej Svobody 1655/76, 323 00 Plzen, Czech Republic
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* Corresponding author
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Pascal Hilber, Ph.D., HDR.

Centre de Recherche sur les Fonctionnements et Dysfonctionnements Psychologiques.

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CRFDP EA 7475. Rouen Normandie University, Bat Blondel, Place E. Blondel 76821, Mont
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Saint Aignan cedex, France

phone: +33 235 146 431

e-mail: pascal.hilber@univ-rouen.fr

Keywords:

anxiety disorders, cerebellum, depression, internal model, vestibular system

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Highlights:

1. Alteration of the vestibular system provokes self-perception disorganization.

2. Alteration of the cerebellar system could provoke internal model disorganization.

3. Self-perception and internal models could be involved in anticipation and anxiety.

4. Alteration of internal models might provoke unsuited behavior as well as anxiety disorders

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and depression.

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Abstract

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The discipline of affective neuroscience is concerned with the neural bases of emotion and
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mood. The past decades have witnessed an explosion of research in affective neuroscience,

increasing our knowledge of the brain areas involved in fear and anxiety. Besides the brain
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areas that are classically associated with emotional reactivity, accumulating evidence

indicates that both the vestibular and cerebellar systems are involved not only in motor
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coordination but also influence both cognition and emotional regulation in humans and animal

models. The cerebellar and the vestibular systems show the reciprocal connection with a
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myriad of anxiety and fear brain areas. Perception anticipation and action are also major

centers of interest in cognitive neurosciences. The cerebellum is crucial for the development
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of an internal model of action and the vestibular system is relevant for perception, gravity-
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related balance, navigation and motor decision-making. Furthermore, there are close

relationships between these two systems. With regard to the cooperation between the

vestibular and cerebellar systems for the elaboration and the coordination of emotional

cognitive and visceral responses, we propose that altering the function of one of the systems

could provoke internal model disturbances and, as a result, anxiety disorders followed

potentially with depressive states.

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Contents

1 Introduction and anatomical connections................................................................................ 3

2 The roles of the cerebellum: from motor coordination to the coordination of high-level
mental functions ......................................................................................................................... 6
2.1 Motor function of the cerebellum..................................................................................... 6
2.2 Influence of the cerebellum on cognition......................................................................... 8

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2.3 Cerebellar influence on anxiety and the depression ......................................................... 9
3 The roles of the vestibular system: from tradition to emotion .............................................. 14

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3.1 Sensory function of the vestibular system...................................................................... 14
3.2 Influence of the vestibular system on cognitive function .............................................. 16

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3.3 Influence of the vestibular system on anxiety and depression ....................................... 19
4 Vestibulocerebellar cooperation: from motor control to anxiety and depression ................. 23
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5 Conclusion............................................................................................................................. 28
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1 Introduction and anatomical connections

Patients with neurological diseases with motor and/or sensory disturbances are often
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handicapped in their daily life. These difficulties could deteriorate their self-feeling in social

interaction and provoke affective changes, such as anxiety and depression. Nevertheless, at
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least in the case of patients with vestibular or cerebellar lesions, many case reports and animal
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studies suggest that emotional alterations appear in addition to motor disturbances.

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This also suggests that these two structures are: (1) involved in emotional regulation
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and networks and (2) these lesions could provoke specific emotional alteration.

The vestibular and cerebellar systems are classically associated with postural

regulation, muscle tone control, movement coordination, and motor learning. Despite clinical

and experimental evidence, their implication in other non-motor events remains unclear and

somehow underestimated. Vestibular and cerebellar syndromes are usually associated with

cognitive and emotional symptoms expressed by patients. Though controversial, as discussed

later, animal models of vestibular and cerebellar deficiencies with a peripheral or central
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selective cerebral lesion (for instance, the cerebellar cortex or the gravity receptors) reinforced

the idea that both vestibular and cerebellar systems could be integrated in neural networks

involved in emotional processes. Thus, disturbances in each system (vestibular or cerebellar)

separately might provoke affective disorders. To our knowledge, there are no published

research studies that have investigated the cooperation between these two systems in the

context of emotional deregulation. In fact, besides the biological linkage, the extension of the

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role of these devoted sensorimotor structures to emotional processes raises a key question:

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“From a cognitive point of view, how is the collaboration between vestibular and cerebellar

systems involved in affective disorders?”, and the corollary, “How does the dysfunction of

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one of these structures influence the function of the other to provoke anxiety and
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depression?”. In the present review, we would like to propose a hypothesis based on the

following established concepts (Ito, 2008, 2005), which are later described in detail:
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- Vestibular and cerebellar systems are highly connected and involved in both sensory and

motor processing.
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- Vestibular signals are involved in self-perception through sensations that relate to the

positioning of the body and its movements.

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- The cerebellum is involved in internal model construction and in updates that pertain to the

computation of internal and external stimulations.

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- The cerebellum acts as a forward controller. It permits predictions to be made about the
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sensory consequences of an action, which can control mental activities.

Finally, we conclude that anxiety disorders and depression could be, at least in part, due to

alterations in internal models and self-perception involving functional cooperation between

the vestibular and cerebellar systems.

Traditionally, the cerebellum is divided into three major phylogenetic parts. The oldest

one, the archicerebellum, comprises the flocculonodular lobe and the fastigial nuclei. It is also
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named the vestibulocerebellum due to the bilateral connections with the vestibular system and

its role in maintaining equilibrium (see below). The two other parts, the paleocerebellum

(spinocerebellum) and the neocerebellum (corticocerebellum), are classically associated with

muscle tone regulation, general movement coordination, and higher mental functions,

respectively. Five main cerebellar regions receive inputs from the vestibular nerve or

vestibular nuclei: the flocculus and ventral paraflocculus; the nodulus and ventral uvula; the

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oculomotor vermis of the posterior lobe; vermal lobules I and II of the anterior lobe; and the

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cerebellar nuclei. Because of the direct connections between the two systems, the

vestibulocerebellar relationship is quite different from the cerebellar relationship with all of

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the other afferent systems.
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There are three types of vestibulocerebellar projections (for a review, see Barmack,

Neal H. Yakhnitsa, 2013 and Barmack, 2003) (Fig. A). Primary direct fibers from the
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vestibulum pass the superior and lateral vestibular nuclei without being reconnected there,

and they enter the ipsilateral nodulus and uvula as mossy fibers. The semicircular canals are
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the only peripheral sense organ directly connected to the cerebellum. Secondary vestibular

inputs to the cerebellum are reconnected in the medial, inferior, and superior vestibular nuclei.
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They terminate as mossy fibers bilaterally in a wider area of the cerebellum, including the

uvula, nodulus, flocculus paraflocculus, and caudal vermis (Thunnissen, Epema, 1989).
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Tertiary projections from the vestibular nerve are reconnected first in the parasolitary nucleus,
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then in the inferior olive, and after crossing the midline, they terminate as climbing fibers in

the contralateral cerebellar cortex (Barmack, Yakhnitsa, 2013; Barmack, 2003; Barmack,

Fagerson, Fredette, Mugnaini, 1993). The vestibular nuclei receive direct inputs from the

Purkinje axons arising from the vestibulocerebellum. The fastigial nucleus receives inputs

from Purkinje axons in the vermis, and it sends its efferent stimuli to both the vestibular
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nuclei and the reticular formation. Thus, the connections between the cerebellum and

vestibular system are reciprocal.

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Figure A: Overview of the main vestibulocerebellar connections. Solid lines show primary
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(I.), secondary (II.), and tertiary (III.) vestibular projections to the cerebellum. Dashed lines
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show cerebellar projections to the vestibular nuclei.

2 The roles of the cerebellum: from motor coordination to the coordination of high-level

mental functions

2.1 Motor function of the cerebellum

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The cerebellum is recognized as a key structure in the motor system. It is involved in

motor coordination, equilibrium, and postural maintenance. Among the pioneers who

participated in the discovery of motor manifestations of cerebellar injuries are Flourens

(Flourens, 1824) and Holmes (Holmes, 1917). As a result of his experimental approach,

Flourens first showed that progressive destruction of the cerebellum induced loss of motor

coordination and posture disabilities in several groups of animals (Flourens, 1824). Holmes

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provided detailed descriptions of cerebellar ataxia after gunshot injuries of the cerebellum

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(Holmes, 1917). Babinski (1902; as cited by and discussed in Marks,1914) clearly described

the following clinical cerebellar signs: dysmetria, asynergia, cerebellar catalepsy, and

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adiadochokinesia. Babinski’s syndrome only concerns the motor sphere.
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During the second half of the 20th century, experimental studies refined our

understanding of the crucial role of the cerebellum in motor control and extended it to motor
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learning. The cerebellar hemisphere, specifically the left anterior cerebellar hemisphere

(lobules V and VI), is involved in successful learning of motor skills, particularly smooth
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movements, as demonstrated by brain activation results from functional magnetic resonance

imaging (fMRI) (Lefebvre et al., 2012).

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Schmahmann et al. in 2009 compared motor deficits in patients following focal

cerebellar strokes in different locations. Most patients (92%) with a lesion in lobules VII–X
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were normal with regard to motor function, and they demonstrated none of the classical signs
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of a cerebellar motor syndrome (Schmahmann et al., 2009).

The data presented in this section, other clinical data (Stoodley, 2016; Stoodley and

Limperopoulos, 2016), and functional imaging data (Stoodley and Schmahmann, 2009a,

2010; Stoodley, Valera, and Schmahmann, 2012) definitively demonstrate that the whole

cerebellum is not devoted solely to motor functions, and there is a topographic organization of

the human cerebellum with partial segregation of its function. The anterior part of the
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cerebellum is related to sensorimotor functions, whereas the posterior lobules contribute to

high-level processes (Stoodley et al., 2012; Stoodley and Schmahmann, 2010, 2009a).

2.2 Influence of the cerebellum on cognition

During the last decades of the 20th century, linkages between the cerebellum and

cognitive and affective processes have been suggested several times (see, for example, Iwata

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and Snider, 1959; Leiner et al., 1989, 1986; Snider and Maiti, 1976). At the end of the 1990s,

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an approach suggested by Schmahmann resulted in the description and definition of cerebellar

cognitive affective syndrome (CCAS), now named Schmahmann’s syndrome, which is a

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complex of neuropsychiatric symptoms in patients with cerebellar affections (Schmahmann
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and Sherman, 1998, 1997). CCAS is characterized by executive function impairments,

visuospatial and spatial memory deficits, visuospatial disintegration, working memory

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worsening, mental arithmetic deficits, alterations of language, affective changes associated

with flattening of affects, disinhibition and inappropriate behaviors, and difficulty modulating
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behavior (Schmahmann, 2004; Schmahmann and Caplan, 2006; Schmahmann and Sherman,

1998). The “dysmetria of thought”, postulated by Schmahmann in 1991, has been depicted in
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CCAS as a parallel between the cerebellar motor and non-motor deficits (Schmahmann,

1991). The author suggested that non-motor deficits could be explained as hypermetria and
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hypometria of sensibility; that is, as an excessive or insufficient response to internal and

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external stimuli (Schmahmann and Sherman, 1998; see also Schmahmann, 2010). The

cerebellum and its brain region interactions (i.e., neocortex and basal ganglia) have crucial

influence in sensory integration and sensory disorders (Koziol et al., 2011)

Neuropsychological evaluations further showed or confirmed a wide range of other

cognitive and affective symptoms in patients with acquired cerebellar lesions or inherited

degeneration of the cerebellum, such as depression, abnormal aggressiveness, and verbal and
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visual memory dysfunctions (Bürk et al., 2003, 2001; Cooper et al., 2010). In some cases,

cerebellar strokes induced cognitive decline that was characterized by visuospatial and

intentional disruptions, linguistic and verbal memory impairments, and emotional changes

(Baillieux et al., 2010; Mariën et al., 2009). Such alterations of cognition and behavior are

observed in sensory integration disturbances (Koziol et al., 2011) and are one of the probable

substrates and symptoms of the autism spectrum disorders (Tseng et al., 2011). Furthermore,

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the neocerebellar vermal lobules VI and VII were found to be significantly smaller in autistic

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patients (Courchesne et al., 1988; Hampson and Blatt, 2015). fMRI studies revealed that in

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healthy volunteers, the cerebellum, more specifically the vermis and the abovementioned

lobule VI, are also activated not only during motor learning (Lefebvre et al., 2012) but also
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during motor imagery (Hétu et al., 2013; Habas and Manto, 2014). Such motor imagery is

defined as executing a motor task mentally without any motor output. These data suggested
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that mental imagery could be altered in patients with autism spectrum disorders. They also

reinforced the idea that the cerebellum is included in a neural network that supports mental
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representations and internal models (depicted later in this article) that are involved in

anticipation (Miall et al., 1993; Wolpert et al., 1998) and mental alteration (Hilber, 2016;
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Schutter, 2016).
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2.3 Cerebellar influence on anxiety and the depression

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In their article, after observing cerebellar activation during feeling and self-generated

emotion, Damasio et al. concluded: “although the cerebellum was not included in the

hypothesis, we believe that the evolutionarily older components of the cerebellum probably

are involved in the coordination of emotional responses and in the learned adjustment of

those responses in a social setting” (Damasio et al., 2000).

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There are several lines of evidence that support a role for the cerebellum in the

modulation of emotion-related behaviors in both humans and animal models of fear and

anxiety (Sacchetti et al., 2009a; Schutter and Van Honk, 2005; Strata, 2015). Particularly,

lobules VI and VII within the vermis are named the limbic cerebellum and participate to

influence affective processes (Stoodley and Schmahmann, 2010, 2009b). The cerebellum is

activated during emotional processing in healthy individuals. For instance, authors showed

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cerebellar activation when exposed to both pleasant and unpleasant stimuli (Bartels and Zeki,

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2000; Lane et al., 1997; Zeki and Romaya, 2010). This structure is also solicited when

remembering personal unpleasant events (Turner et al, 2007). More recently, Ferarri et al.

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showed that transcranial magnetic stimulation of the left cerebellar hemisphere in healthy
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individuals during the confrontation of pictures showing angry and happy faces impaired

facial emotional recognition (Ferrari et al., 2018). Nevertheless, the role of the cerebellum is
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still not well understood and seems to be influenced by gender, since Seo and collaborators

found an opposite pattern of cerebellar activation in stress-induced anxiety (Seo et al., 2017).
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Lesions of the cerebellum could be manifested by affective disorders, including

anxiety or depression, that are components of CCAS that have been defined as a
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neuropsychiatric manifestation of cerebellar diseases (Schmahmann and Sherman, 1997,

1998). Mutism, irritability, emotional lability, apathetic behaviors, and affective disturbances
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have been observed after resection of cerebellar tumors in children (Kossorotoff et al., 2010;
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Riva, 2000). Depression also often accompanies some (Lo et al., 2016) but not all hereditary

cerebellar ataxias (Costabile et al., 2018; Fancellu et al., 2013; Mariotti et al., 2007).

Furthermore, abnormalities of the cerebellum have been found in patients with various

psychiatric diseases, such as developmental dyslexia and autism (Allen, 2006; Allen et al.,

2004; Ingram et al., 2000; Kern, 2002, 2003; Rogers et al., 2013), and in pathologies with

well recognized emotional disturbances, such as major depressive and bipolar disorders
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(Hoppenbrouwers et al., 2008; Mohapatra et al., 2003), attention-deficit hyperactivity disorder

(Townsend et al., 1999), obsessive–compulsive disorders (Pujol et al., 2004; Subirà et al.,

2013), and post-traumatic stress disorder (Sussman et al., 2016). Functional neuroimaging

studies showed cerebellar hyperactivity during either baseline conditions or during anxiety

attacks in patients suffering from the post-traumatic stress disorder (Ke et al., 2016; Wang et

al., 2016), panic disorder (Sakai et al., 2005), and specific phobias (Ipser et al., 2013). In post-

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traumatic stress disorder patients, a follow-up study showed normalization of clinical

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symptoms and decrease of activation of the cerebellum after 2 years (Ke et al., 2016). Strong

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activation of several brain structures, including the cerebellum, was also observed during

experimental cholecystokinin tetrapeptide-induced panic attacks in healthy volunteers (Eser et

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al., 2009). This suggests that the cerebellum may not only be involved in chronic anxiety

disorders but also may play an active or passive role in single anxiety episodes. The potential
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role of the cerebellum in neuroses is also supported by the findings of lower cerebellar

activity (Moon and Jeong, 2017) and decreased functional connectivity between the
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cerebellum and the cerebral circuitries in patients with obsessive-compulsive disorder (Xu et

al., 2018), as shown by magnetic resonance imaging.

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Greater cerebellar gray matter has been found in social anxiety disorder (SAD)

patients (Talati et al., 2013). SAD patients showed lower activation in several brain regions,
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including the left cerebellum, as evaluated by fMRI when performing a social situation task
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(Nakao et al., 2011; Tillfors et al., 2002) and observed changes of blood flow in the

cerebellum of SAD patients anticipating to speak in public. Since the cerebellum provides

anticipation of future states (state estimate) (Wolpert et al., 1998), the relationship between

the anticipation role of the cerebellum and mental alteration was proposed (Hilber, 2016).

Moreno-Rius (Moreno-Rius, 2018) suggested that cerebellar diseases might lead to

overestimation of environment-associated harms and thereby to a higher level of anxiety.

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Recently, Schutter proposed that the alteration of the predictive role of the cerebellum,

involving internal models, could provoke homeostatic dysregulation associated with

depressive disorder (Schutter, 2016). SAD often precedes major depression and an early onset

of the former constitutes a good predictor of the latter in adulthood (Stein et al., 2001).

Comorbidity of generalized anxiety disorder and major depression was evaluated at about

60% (Carter et al., 2001). Thus, we can propose that the cerebellum, more particularly its

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predictive coding role (Schutter, 2016), might be one of the potential common denominators

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for anxiety and subsequent depression, as we will discuss later.

The cerebellum, more precisely the vermis, is also involved in aversive conditioned

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autonomic responses (Sacchetti et al., 2009, 2004; Zhu et al., 2006). For instance, bradycardia
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conditioning has been found to be impaired after vermal lesions in rabbits (Supple and Kapp,

1993) and rats (Supple and Leaton, 1990). Comparable results were obtained in goldfish
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(Rodríguez et al., 2005). As demonstrated with cerebellar mutants, the cerebellar cortex seems

to be critical for the consolidation of fear memory (Sacchetti et al., 2004). The synaptic
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plasticity of Purkinje cells underlies both the establishment and the temporal accuracy of the

memory trace in fear conditioning (Sacchetti et al., 2004; Zhu et al., 2006).
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Besides its involvement in fear conditioning, data obtained using cerebellar mutants

showed that the cerebellar cortex also contributes to the modulation of anxiety-related
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behaviors in rodents. Thus, as first described by Monnier and Lalonde (1995), we observed
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that Lurcher mice with a deficient cerebellar cortex exhibited poor avoidance of aversive

areas in an elevated plus-maze apparatus (Hilber et al., 2004; Lorivel and Hilber, 2006), a test

classically used to assess the level of anxiety in mice and rats (Pellow et al., 1985). Such

behavior would indicate a lower level of anxiety. Nevertheless, it was accompanied by very

high corticosterone surge in Lurcher mice. This suggested that contrary to classical point of

view the poor avoidance was not due to being less stressed (and potentially not being less
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anxious), but rather because they were stressed and that it is an abnormal behavior induced by

exposure to anxiogenic conditions and stress as proposed previously (Lorivel et al., 2010).

Furthermore, compared to controls, hyperresponsiveness in the hypothalamic-

pituitary-adrenal (HPA) axis in these mutants was also observed during other experimental

conditions (Frederic et al., 1997; Tuma et al., 2017). We proposed that these mutants, with

degeneration of the main components of the cerebellar cortex and olivocerebellar pathway,

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were less inhibited than controls when exposed to the experimental anxiogenic environment

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(Hilber et al., 2004; Lorivel et al., 2010; Tuma et al., 2015). For instance, the “uncontrolled”

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behavior of Lurcher mice was observed during pre-pulse inhibition and classical conditioning

(Porras-García et al., 2005) and in an open field (Tuma et al., 2015). Lurcher mice also
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showed no immobility responses in the forced swimming test (Lalonde, 1998; Tuma et al.,

2015). In this test, classically used to measure depressive-like behavior in rodents, immobility
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was first proposed as learned helplessness (Porsolt et al., 1978). This supposed resignation

sign could also be interpreted alternatively as a tendency to adopt passive behavior (Marti and
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Armario, 1996) and thus a suitable behavior to spare energy when escape from water is not

possible. Thus, lack of immobility response in lurchers can be considered not as lack of
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depressive-like behavior but rather as unsuitable behavior caused by their behavioral

disinhibition provoked by anxiogenic stimuli.

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Neglecting the vestibular connections, in 2004, we first proposed that the disinhibited
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profile of this mutant may be due to a functional defect of the neuronal network (Hilber et al.,

2004). This later included the cerebellum and its connected structures that are classically

involved in anxiety, such as the septo-hippocampal system and the hypothalamus (Schutter

and van Honk, 2006; Schutter and Van Honk, 2005; J. N. Zhu et al., 2006). The cerebellum

exerts tonic inhibition on the amygdala, hippocampus, and septum relative to the Papez circuit

(Snider and Maiti, 1976) that is involved in emotional reactivity. We proposed that the
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emotional action of the cerebellum is obviously dependent on its connections with the

components of the defensive system (McNaughton and Corr, 2004), the prefrontal cortex and

the cingulate gyrus (Cotterill, 2001), the septo-hippocampal system (Heath et al., 1980), the

amygdala, the hypothalamus (Zhu et al., 2006), and the periaqueductal gray matter (Moers-

Hornikx et al., 2011). There are direct projections from cerebellar nuclei to the lateral,

posterior, and dorsal hypothalamic areas; the dorsomedial hypothalamic nucleus; and the

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paraventricular nucleus, which is the key structure of the HPA stress axis (Dietrichs et al.,

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1994; Dietrichs and Haines, 1989; Zhu et al., 2006) that supports this hypothesis.

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Hypothalamic neurons project to the cerebellar cortex and nuclei (Zhu et al., 2006), and some

hypothalamic neurons also project to both the cerebellum and the amygdala (Dietrichs et al.,
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1994).

Because of its multiple brain connections, the authors of a “comment article”

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published in Nature Neuroscience reviews reported that the cerebellum could be a key

structure, even the main structure, in the cerebral fear network, and it orchestrates adaptive
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defensive behavior (Apps and Strata, 2015). Nevertheless, neither that article nor a recent

consensus paper published in 2017 concerning the cerebellum and emotion (Adamaszek et al.,
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2017) mentioned the vestibular system as a participant in this harmony.

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3 The roles of the vestibular system: from tradition to emotion

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3.1 Sensory function of the vestibular system

Earth’s gravity is a fundamental mechanical constraint for living organisms against

which we have adapted our strategies of posture and locomotion, as well as all metabolic and

cardiovascular regulations for energy expenditure and to maintain brain perfusion,

respectively. The vestibular organ was the first sensory system to emerge in protochordates

about 500 million years ago, as early as the visual system, with the function of encoding
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gravity strength into the brain (Graf and Klam, 2006). The vestibular system has since been

devoted to sensorimotor functions, and it is commonly known as the organ of balance in

mammals. This sensory organ informs the brain about: (i) head movement in three dimensions

in space (three orthogonal semicircular canals, dynamic sensor), (ii) head position relative to

gravity (static function of the utricular otolithic sensor) and linear and three-dimensional

displacements of the body (horizontal and vertical dynamic functions of the otolithic saccular

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and utricular sensors), and (iii) the level of gravity itself (static sensor from utricle and

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saccule). The vestibular system is classically known to be involved in several mechanisms of

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motor processes, including balance, postural control, and oculomotor processes for

stabilization gaze as well as vertical and self-motion perceptions (Cullen, 2012).

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The generated vestibular information is relayed in the brainstem to the vestibular

nucleus by the vestibulocochlear nerve (cranial nerve VIII). The vestibulo-ocular reflex
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(VOR) for gaze fixation during head movement and ocular pursuit (Lehnen et al., 2008) is

assumed by vestibular projections to ocular motor nuclei, while reflexes involved in balance
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and postural control (in static or dynamic conditions, in cooperation with the archicerebellum)

(Barmack, Neal H. Yakhnitsa, 2013; Barmack, 2003) are assumed by vestibular projections to
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motor neurons of the spinal cord by the vestibulo-spinal route. Direct and indirect

communication between the vestibular system and cerebellar structures were also identified,
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demonstrating the important cooperation between both these systems, particularly in the case
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of vestibular pathology supporting the compensation process of the lesioned side.

The role of the vestibular system is not limited to its somatic function. It has been

more recently admitted to contribute to a variety of vegetative and chronobiological functions,

such as fast blood pressure postural regulation (Normand et al., 1997), bone remodeling

(Vignaux et al., 2013), and circadian-rhythm regulation (Fuller et al., 2002; Martin et al.,
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2015), supported by vestibulo-hypothalamic and vegetative center connections (for review,

see Lopez and Blanke, 2011a; Yates et al., 2014).

3.2 Influence of the vestibular system on cognitive function

One of the specificities of the vestibular system is the multimodal convergence of

sensory signals (Angelaki and Cullen, 2008; Cullen, 2012; Cullen and Taube, 2017) from the

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first synapse of the brainstem and central vestibular pathways (Angelaki and Cullen, 2008) to

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projections in different cortical areas (Lopez and Blanke, 2011). Therefore, the vestibular

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signals do not cause isolated conscious sensations as other sensory systems do, but they

participate in various high-level cognitive functions that, at least partly, require an internal
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environmental representation.

Vestibular signals are involved in self-perception through sensations that relate to

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the positioning of the body and its movements according to the gravitational vector on Earth

(Lopez et al., 2015, 2011; Mast et al., 2006). Furthermore, proprioceptive, somatosensory,
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and visual afferents also provide information when the individual interacts with its

environment that overlap the gravitational referential frame originating from the vestibular
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information and consolidate self-perception and the navigation/orientation in its environment

(Ferrè et al., 2015; Ferrè and Haggard, 2015) (see Fig. B).
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Figure B: External and internal environments provide sensory inputs that are detected by

many complementary captors in the sensory systems (that is, the vestibular system). These
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sensations are treated by computational centers that give conscious perception, which is an

estimation of the sensorimotor state. This sensory state participates in dynamic internal model
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construction and updating processes permitting anticipation. Such anticipation provides an

internal feedback and permits us to act in harmony in our environment with adapted
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behavioral and visceral outputs (Action A). These outputs are external feedbacks that update

our external and internal environments.

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The existence of the vestibular cortex was proposed as a result of a series of cortical

neuron recordings in the parietal insular cortex that responded to vestibular stimulation in

non-human primates (Grüsser et al., 1990). However, no consensus exists in the literature

concerning the identification and localization of such a vestibular cortex, sometimes identified

in the temporal cortex (Ventre-Dominey and Vallee, 2007) and sometimes in the parietal

cortex (Grüsser et al., 1990). Indeed, the parietal region may be involved in subjective vertical
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orientation and perception (Grüsser et al., 1990), while the temporal region may play a role in

a myriad of functions, including the internal representation of gravity (Green and Angelaki,

2010), self-motion perception, spatial navigation, and self-internal representation (Borel et al.,

2008; Lopez, 2013; Lopez et al., 2015, 2011; Péruch et al., 2011).

The most commonly documented cognitive function of the vestibular system is related

to spatial orientation and memory (Besnard et al., 2012; Hüfner et al., 2007; Ossenkopp and

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Hargreaves, 1993; Russell et al., 2003; Stackman et al., 2002). Spatial orientation is based on

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two major components: idiothetic cues (self-displacement and self-motion) and external cues

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that cooperate to generate a spatial representation. It has been suggested that vestibular

information is an essential part of idiothetic indices (Stackman and Herbert, 2002), which is
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established in addition to the geocentric reference.

The vestibular-thalamic-hippocampal neuronal pathway may play a crucial role in

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spatial and memory processes (Hüfner et al., 2011). Studies in rats have shown that lesions of

the peripheral vestibular system induce dysfunction in the hippocampal “place cells” and
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disrupt spatial learning (Stackman et al., 2002). Stimulation or inactivation of the vestibular

system can alter the electrophysiological signal of hippocampal place cells in the CA1 layer
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(Horii et al., 2004), which is highly involved in spatial learning. The vestibular information

seems to be strongly involved in the integration of spatial information within the

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hippocampus (Liu et al., 2003). Thus, the role of the vestibular system in spatial orientation is
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entangled with that of the hippocampus, which encodes the location and types of elements in

our environment in space (Zheng et al., 2013). In addition, from a biochemical point of view,

we found NMDA-receptor density modulation in the hippocampus after bilateral vestibular

lesioning in rodents (Besnard et al., 2012). These results are of interest considering the crucial

role of the hippocampal glutamatergic system in spatial learning. The vestibular-hippocampal

pathway has still not been completely described, but it has been hypothesized that the
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information moves through the dorsal anterior thalamus and involves at least four different

neuronal routes (Cullen and Taube, 2017; Hitier et al., 2014). Moreover, the vestibular signals

are crucial sensory inputs for the cerebellar computation involved in spatial representation and

navigation (Rondi-Reig et al., 2014).

3.3 Influence of the vestibular system on anxiety and depression

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Areflexic vestibular patients suffer from vertigo, nystagmus, abnormal gait, and

vegetative signs. Although emotional disturbances are not recognized as a principal symptom

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in these patients, some of the patients declared feelings of anxiety, particularly when facing a
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novel environment. The functional link between vestibular and emotional disturbances is still

poorly understood, but it seems to be bidirectional. At the present time, a cause and effect
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relationship between anxiety disorders and vestibular lesions remains difficult to demonstrate

(Balaban et al., 2011; Godemann et al., 2009, 2004; Staab, 2006). Because gravito-inertial
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disorientation could be accompanied by fear and panic attacks, patients with bilateral

vestibular alterations report not only vestibular troubles but also social and anxiety disorders,
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including panic episodes and phobias.

Animal models of vestibular deficiencies offer a hope to elucidate the generation of

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emotional reactivity disturbances and, more particularly, anxiety. Nevertheless, results on

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anxiety-related behavior remain controversial due to the numerous models of vestibular

lesions and to the types of behavioral tests not really adequate when rodent combined clinical

signs of unbalance. While some authors reported a decrease of anxiety following bilateral

vestibular lesions using an elevated plus-maze test in rats (Zheng et al., 2008), recent results

indicate that rats were more anxious than non-lesioned rats in a black and white box test after

a two-step bilateral lesion of the vestibular organ (Machado et al., 2012). The discrimination
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between the emotional and cognitive effects in rodent models of vestibular deficiency remains

challenging (Zheng et al., 2012). In head-tilt mutant mice devoid of otoliths (that is, devoid of

gravisensors) (Bergstrom et al., 1998), recent data indicate that emotional reactivity was

clearly altered in the elevated plus-maze test. Compared to controls, the mutant mice

exhibited poor avoidance tendencies and a high level of activity when placed in anxiogenic

situations. The behaviors that classically reflect poor anxiety could also be interpreted as poor

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inhibition, as described previously in the cerebellar lurcher mutant (see above) (Hilber et al.,

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2004).

The concept of a relationship between the vestibular system and psychiatric diseases

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has been suggested for more than 70 years. As early as the 1930s, Shilder and his colleagues
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insisted on the importance of the vestibular system in the physiopathology of neurosis and

psychosis (Shilder, 1933). In the 1960s, vestibular abnormalities were reported in patients
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with depression, schizophrenia, and childhood autism (Levy et al., 1983). At the end of the

1980s (Levinson, 1989) and later, some studies clearly established balance disturbances and
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anxiety as comorbidities (Bigelow et al., 2016; Guidetti et al., 2008; Monzani et al., 2001);

such a comorbidity suggests that the vestibular system is connected to cortical and subcortical
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anxiety-related structures. Similarly, increased incidence of depression has been reported in

patients with vestibular diseases (Wackym et al., 2016; Bigelow et al., 2016; Guidetti et al.,
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2008), while higher depression scores were reported in patients with peripheral vestibular
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dysfunction caused by otic capsule dehiscence, which was reduced after surgical treatment. A

recent review entangles the depersonalization syndrome observed in schizophrenia and the

disturbance of the vestibular cortex and goes beyond bringing psychiatric disorders and the

vestibular cognitive functions together (Gurvich et al., 2013a). Additionally, the use of

vestibular stimulation as a therapy in psychiatric disorders is a renewal concept, firstly tested

in the 19th century by Cox (Cox, 1806), then in the 60s and 70s in children suffering from
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autism and more recently in mania and conversion disorder and mood control (Noll-Hussong

et al., 2014; Preuss et al., 2014).

Based on anatomical and anatomopathological data, some authors proposed theoretical

integrative models to explain emotional reactivity (Dalgleish, 2004). In these models, each

part of the neural network cooperates to allow an adaptive emotional response in both the

physiological (autonomous) and behavioral parts. Today, one of the most highly developed

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and complete models that includes the influence of the vestibular system in emotional

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reactivity alterations seems to be that proposed by Balaban; the model was first proposed in

2001, and it was completed after 10 years of research (Balaban et al., 2011; Balaban, 2002;

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Balaban and Jacob, 2001; Balaban and Thayer, 2001). In his model, Balaban proposed the
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parabrachial nucleus (PBN) as a pivot structure that coordinates emotional reactivity. This

hypothesis is based on the fact that it is located in a strategic position in the sensorimotor
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information tract (that is, between afferent sensory and efferent motor processing) (Stackman

and Herbert, 2002). It could be reasonably proposed as a good candidate for the node between
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anxiety disorders and vestibular failures (Balaban and Thayer, 2001). In fact, many sensory

afferents converge in the PBN, such as proprioceptive, vestibular, and interoceptive visceral
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sensations. Moreover, as demonstrated in rabbits, the Purkinje cells in the folium-p, located in

the cerebellar flocculus, directly project to the PBN (Nisimaru and Ito, 2011) and could
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modulate its activity via orexinergic neurons (Ito and Nisimaru, 2014; Nisimaru et al., 2013;
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Nisimaru and Ito, 2011). This nucleus is therefore a node where cerebellar and vestibular

influences converge.

The PBN is classically associated with autonomic mechanisms, such as respiratory-,

cardiovascular-, and digestive-control pathways. It also plays a major regulatory role in

emotional processes via its reciprocal connections with several structures, such as the

hypothalamus, infralimbic cortex, orbitofrontal cortex, amygdala (more precisely, the central
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amygdala nucleus), nucleus tractus solitarii, and cerebellar cortex. All of these structures are

well known to be involved in anxiety, panic disorders, and fear conditioning. Balaban also

proposed the cooperation between the limbic system and the vestibular system via the PBN to

explain the observation of both motor- and anxiety-related behaviors. In such cooperation, the

vestibular information would influence the ascending pathways involved in anxiety (Balaban

and Thayer, 2001). By projecting reciprocally to vestibular nuclei, the PBN allows two-way

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communication between these structures that convey contextual information to potential

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danger in a response of gravito-inertial elements (Gurvich et al., 2013b). Actually, the PBN

seems to relay vestibular information about body motion and gravito-inertial perception to

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neurologic structures that support autonomic functions and anxiety (Balaban, 2004, 2002). In
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this way, it has been proposed to have an integrative role in the evaluation of potential

positive or negative emotional valence of stimuli. In this model, the PBN is also considered as
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the substrate for panic, fear, and anxiety disorders (Deutch and Charney, 1996).

The serotonergic system is well known to be involved in emotional regulation and

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anxiety disorders. Because the vestibular nuclei receive many serotonergic and non-

serotonergic projections from raphe nuclei, more particularly from the dorsal raphe nucleus
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(DRN), Balaban proposed a crucial implication of the central serotonergic system in

vestibular function. In this idea, the serotoninergic modulation of central and peripheral
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balance circuitry would represent a neuroanatomical link between balance disturbances and
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anxiety. Clinical data reinforced this hypothesis, and the activation of these DRN neurons

appear to facilitate motor activity and to reduce responsiveness to sensory information in

subjects. The DRN also projects to the amygdala, the insula, and many cortical regions

involved in both cognitive and emotional processes (Balaban and Thayer, 2001).

Among the well-understood neurotransmitter systems and nuclei involved in

emotional reactivity, the locus coeruleus (LC) is also considered to be an initiator of anxiety
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responses and panic attacks (Gorman et al., 2004, 2000). It can modulate vestibular functions

via postsynaptic alpha- (1 and 2) and beta-adrenergic receptor mechanisms (Yates et al.,

2014). The noradrenergic projections from the LC to both vestibular nuclei and PBN network

seem to be substrates of vestibular-related motor processes in response to environment

changes. However, the LC also projects to the neocortex, the hypothalamus, the vestibular

nuclei, the spinal cord, the hippocampus, and the cerebellum, which suggests a possible role

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of the LC as a co-modulator of these structures via noradrenergic mechanisms.

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4 Vestibulocerebellar cooperation: from motor control to anxiety and depression

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The role of the vestibular system and the cerebellum in posture and eye movement
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control has been extensively described. The cerebellum and the vestibular system are thereby

two cooperating systems involved in body stance and ocular reflexes. For instance, data
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obtained from monkeys showed that the cerebellum is an integration center of otolith signals

in the VOR (Walker et al., 2008).

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If we consider the close linkage between the two systems and the anxiety and/or

depression-related data obtained from cerebellar and vestibular patients and from animal
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models of vestibular or cerebellar disturbances, one can easily envisage that the cerebellum

and the vestibular apparatus play complementary roles in emotional reactivity. In 1989,
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Levinson investigated the cerebellar-vestibular basis of fears and phobias (Levinson, 1989).
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He measured neurological parameters and fears and found that 64.5% of patients with

vestibular deficiencies demonstrated one or more fears or phobia, with the most representative

fear being agoraphobia. He concluded that cerebellar-vestibular dysfunction might be a

predisposing factor to fear; nevertheless, to date, no neurological explanation has really been

proposed to explain how cerebellar-vestibular dysfunction could contribute to anxiety

processes. Balaban and Thayer (2001) separated the vestibular system and the cerebellum,
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and they proposed an integrative theoretical model to explain the role of the vestibular system

in anxiety disorders (Balaban and Thayer, 2001). Considering that the cerebellum could play a

role in the integrative sensory processes that sustain emotion, we propose to use this model as

a basis to include the cerebellum in the network of anxiety and depression.

As mentioned above, due to similar cognitive and emotional symptoms observed in

both humans and animals with vestibular or cerebellar alteration, the cooperation of the two

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systems in both motor and emotional events must be considered. Balaban's concept is a robust

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heuristic model to investigate the influence of the vestibular system in anxiety-related

behaviors. However, the concept neglected the importance of the cerebellum in the regulation

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of anxiety phenomena, or at least it did not ascribe a specific function to this structure. As
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described above, it is now well-recognized that the cerebellum is involved in both conditioned

and unconditioned fear, and some authors have proposed that this part of the encephala could
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oversee the functioning of the whole “emotional system” (Apps and Strata, 2015). It is also

now well-recognized that the cerebellum supports the internal models (Wolpert et al., 1998).
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These models are used for sensorimotor processing (Bastian, 2006) and are of great interest,

particularly to explain cerebellar function (Ito, 2008, 2006, 2005; Wolpert et al., 1998).
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Briefly, the internal models described above correspond to neural representations of

the external world that are used to predict and adjust not only movement but also behavioral
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reactivity to real external world events (Miall et al., 1993; Miall and King, 2008). These
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models give a specific function to the cerebellum: to predict the future sensory signals

associated with an action in a specific sensorimotor context (Bastian, 2006; Ito, 2005; Ivry,

2000; Nixon and Passingham, 2001). They allow internal feedback to occur (see Fig. A),

which short-circuits the external feedback (Ito, 2008). In this way, the internal representation

allows a quick adjustment to be made to our behavior and visceral functioning in response to

external disturbances via sensorimotor anticipation (action A). This adapted action A
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corresponds to the environmental solicitation, and it provides new external sensory inputs in

accordance with the anticipated external sensory feedback. In fact, some authors have

proposed that rather than being involved in motor control, the cerebellum is involved in

sensory acquisition and discrimination (Gao et al., 1996). In this scheme, its functional role

would be devoted to sensory anticipation (Ohyama et al., 2003). The cerebellum receives and

integrates a large variety of exteroceptive and proprioceptive information to elaborate and to

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update the internal model. Thus, the internal model necessitates the organization of complex

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coherent multisensory information. Within that context, the vestibular information would play

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a crucial role, because the vestibular signals are involved in extra-personal space

representation (Borel et al., 2008; Viaud-Delmon et al., 2011). Ito proposed that the
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cerebellum could also control mental activities by internal models (Ito, 2008). In this way,

using feedforward control, the cerebellum would combine a large variety of sensory inputs
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and previous contexts to predict the appropriate output. In cooperation with the limbic system,

such a role of the cerebellum could permit an adapted and rapid behavioral and visceral
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response to sensory events. Our decision making and ability to produce adapted behavior in a

considered situation is closely tied to our perception of the situation and our ability to
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anticipate the consequences (value) of our future actions in such an environment (Paulus,

2007; Paulus and Yu, 2012; Sanfey, 2007). It is a basic condition to successfully interact with
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the social world (Brown and Brüne, 2012). For that, we must select and compute relevant
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stimuli in our environment. These latter are the basement of the internal representations of our

body, our action, our environment, and at least the consequence of our action in the

environment. Due to this interaction, this internal representation or internal model is

constantly updated. With learning, this permits us to anticipate the future consequences of our

actions and to adopt the most accurate, optimal, and adaptive behavior in a social context

(Brown and Brüne, 2012; Hilber, 2016; Marti and Armario, 1996). Anxiety is a complex
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emotion based on, at least in part, two major factors: rumination (Crowell et al., 2017;

Kircanski et al., 2015) and anticipation (T. J. Sussman et al., 2016). The involvement of the

predictive function of the cerebellum internal models in psychiatric disorders was recently

discussed (Hilber, 2016; Moreno-Rius, 2018). Moreno-Rius proposed that the functioning of a

forward model involved in prediction and expectation of drug could, at least in part, explain

the role of the cerebellum in craving (Moreno-Rius and Miquel, 2017) as well as in

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feedforward control of locomotion (Pisotta and Molinari, 2014). Such internal predictions

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generated by the cerebellum could also influence social cognition for social behavior and

anxiety-related disorders (Van Overwalle and Mariën, 2016) and influence homeostatic

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regulation (Schutter, 2016). The cerebellum is a real active interface between the environment
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and the representations. Thus, cerebellar diseases could generate potential internal model

deficiencies. As a consequence, anticipatory disabilities could therefore generate a false

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predictive representation of the future associated with unsuited behavior (Hilber, 2016). Every

disturbance, or lack thereof, at the sensory level via external input or integration could
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provoke a false internal representation and an altered internal model. In that case, internal

feedback, as well as the resulting behavior and visceral response, could be modified. The
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action B that would be produced (see Fig. C) could therefore not be adapted to the

environmental solicitation. If action A permits the recovery of homeostasis, then action B

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would not adapt to the solicitation of the environment. There is a “discrepancy” between the
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actual state and the desired state. Such a discrepancy impaired anticipation of future events,

including consequences of an individual’s own actions (interfering with adequate action

planning), may lead to uncertainty and to anxiety and/or depression. Furthermore, anxiety and

depression could influence the belief system and self-assessment, impairing computational

processes during decision making (Paulus, 2007; Paulus and Yu, 2012; White et al., 2017).

Anxiety also enhances intolerance of uncertainty (Dugas et al., 1998). Thereby, depression
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and anxiety may also potentiate disturbances in action planning and enhance unsuited

behavior resulting from alteration of internal models. This could be one of the amplifiers of

the vicious circle (Fig. C).

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Figure C: Altered sensory systems (that is, the vestibular system) and computational systems
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involved in anticipation (that is, the cerebellum) modify sensations and perception.
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Consequently, the internal representation and dynamic internal model are altered. Internal

disturbances are accompanied by false anticipation of motor command and external sensory
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feedback (according to internal models). The false anticipation results in action B (different

from previous action A), which could not be adapted to environmental constraints. In turn,

these chronically unsuited, and potentially inefficient, behavioral and visceral responses to

environmental solicitations lead to stressful situations. This inability to adapt to the context of

the situation generates chronic anxiety, which could precede or be accompanied by depressive

states. This system of causes and consequences represents a vicious circle having the only exit
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into anxiety and depression that, however, could reinforce the disturbances in the

computational centers and thereby return back into the circle as its amplifiers.

Impairments of vision, hearing, taste or olfaction provoke lack of information. On the

contrary, vestibular lesions in a general manner could provoke not only lack of information

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but also false sensory information about the body and movement, such as (Anderson et al.,

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1995) vertigo. We can now easily envisage that a precocious vestibular lesion induces an

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alteration or lack of sensory information (that is, the essential gravity perception), which

consequently produces an alteration of cerebellar sensory integration. In a complementary

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manner, lesions of the cerebellar circuitry could also have the same consequences and could

lead to failed operation in the internal model. In the two cases, the resulting anxiety disorder
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could be a manifestation of distorted multisensory integration, as evoked by Viaud-Delmon et

al. (2011). In fine, cerebellar and/or vestibular patients exhibit anxiety-related behavior and
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finally subsequent depression towards environmental stimuli or contexts, which normally are

not threatening.
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5 Conclusion
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The cerebellum and vestibular systems have long been ingrained and retained in the
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concept of motor control. Now, several independent observations in animals and humans

indicate that each of these structures is involved in cognitive and emotional processes. These

“emerged” functions are easily understandable considering the multiple interconnections of

these structures with brain areas well known to be integrated with emotional and cognitive

networks and that play crucial roles in emotional regulation and expression. For instance,

emotional- and cardiovascular-related responses could be explained, at least in part, by their

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action on the PBN and their respective connections to the LC, raphe nucleus, and

hypothalamus, which strengthen their integration in the emotional neuronal network. Here, we

proposed that the cerebellum and the vestibular system cooperate in the construction of an

internal world via internal models. Such models permit action on the external world in an

adapted manner. Thus, we postulated that alteration in the sensory system (for instance, due to

a vestibular lesion) or the integrative system involved in updating the internal models (the

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cerebellum) could provoke disorganization in internal representation. As a result, patients

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become chronically unable to anticipate events in the environment. The “vicious internal

circle” is described in Figure B: cerebellar or vestibular dysfunctions are associated with less

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ability to integrate external sensory inputs that leads to false internal models, wrong
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anticipation, and consequently unsuitable action. In turn, the latter produces new sensory

information. In fine, because of the false internal feedback, with discrepancy conferring to the
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abovementioned feedback sensory information, such internal model disturbances prevent any

“allostatic solution” (Ganzel et al., 2010; Sterling, 2014, 2012; Sterling and Eyer, 1988). In
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this viewpoint, the false internal feedback provokes the decision-making dysfunction that alter

homeostatic processing (Paulus, 2007). Consequently, the patients become unable to find or
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reach a body balance not only from a motor but also in a physiological and behavioral point

of view. Finally, we propose that such disorganization associated with the mismatch between
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the “real” (external) and the “virtual” (internal) world generates unsuited behavior and
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inability to cope with environmental solicitation, in the meaning of Lazarus and Folkman

(Lazarus and Folkman, 1984). This impossibility of effective transaction between the

individual and his environment leads to a chronic physiological stress and anxiety state

resembling some anxiety disorders, such as generalized anxiety disorder, potentially turning

to depression because of a learned helplessness response, which was observed in the patients

with cerebellar and/or vestibular alterations.

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It is obvious that other sensory systems participate to representation and internal

model elaboration and update. Consequently, one can easily envisage that alteration in the

functioning of these systems if not precociously treated or compensated by another system

could provoke anxiety and depression in the same or analogous way.

Acknowledgment

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This work was supported by the Hubert Curien Partnership Barrande Project, Campus

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France “Longitudinal analysis of behavioral abnormalities in an animal model of autism

spectrum disorders” (grant Nr. 40664PK); MOBILITY (7AMB18FR047); the National

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Sustainability Program I (NPU I Nr. LO1503), provided by the Ministry of Education, Youth
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and Sports of the Czech Republic; and by the Charles University Research Fund (project

number Q39).
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ALTERED 54 ALT
External Sensation Perc
environment and
context
(external world) Sensory
inputs DISTURBED
DISTURBED
COMPUTATIONAL
SENSORY SYSTEMS CENTERS
Internal
environment
(body functioning)

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UNSUITED FALSE ANTICIPATION
ACTION B - of estimated motor command

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Altered sensory systems (i.e. the vestibular system) and computational systems invo
cerebellum) modify sensations and perception. Consequently, the internal representation a
altered resulting in false anticipation of motor command and sensory feedback. As a conseq
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inability to adapt to the context of the internal and external environment generates chroni
depressive states.
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Highlights:

1. Alteration of the vestibular system provokes self-perception disorganization.

2. Alteration of the cerebellar system could provoke internal model disorganization.

3. Self-perception and internal models could be involved in anticipation and anxiety.

4. Alteration of internal models might provoke unsuited behavior as well as anxiety disorders

and depression.

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T ED
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