Vestibular paroxysmia: Diagnostic criteria

Michael Strupp, Jose A. Lopez-Escamez, Ji Soo Kim, Dominik Straumann, Joanna C. Jen, John Carey, Alexandre Bisdorff, Thomas Brandt

Research output: Contribution to journalArticlepeer-review

Abstract

This paper describes the diagnostic criteria for vestibular paroxysmia (VP) as defined by the Classification Committee of the Bárány Society. The diagnosis of VP is mainly based on the patient history and requires: A) at least ten attacks of spontaneous spinning or non-spinning vertigo; B) duration less than 1 minute; C) stereotyped phenomenology in a particular patient; D) response to a treatment with carbamazepine/oxcarbazepine; and F) not better accounted for by another diagnosis. Probable VP is defined as follows: A) at least five attacks of spinning or non-spinning vertigo; B) duration less than 5 minutes; C) spontaneous occurrence or provoked by certain head-movements; D) stereotyped phenomenology in a particular patient; E) not better accounted for by another diagnosis. Ephaptic discharges in the proximal part of the 8th cranial nerve, which is covered by oligodendrocytes, are the assumed mechanism. Important differential diagnoses are Menière's disease, vestibular migraine, benign paroxysmal positional vertigo, epileptic vestibular aura, paroxysmal brainstem attacks (in multiple sclerosis or after brainstem stroke), superior canal dehiscence syndrome, perilymph fistula, transient ischemic attacks and panic attacks. Current areas of uncertainty in the diagnosis of VP are: a) MRI findings of vascular compression which are not diagnostic of the disease or predictive for the affected side because they are also observed in about 30 of healthy asymptomatic subjects; and b) response to treatment with carbamazepine/oxcarbazepine supports the diagnosis but there are so far no randomized controlled trials for treatment of VP.

Original languageEnglish (US)
Pages (from-to)409-415
Number of pages7
JournalJournal of Vestibular Research: Equilibrium and Orientation
Volume26
Issue number5-6
DOIs
StatePublished - 2017

Keywords

  • ICVD
  • Vertigo
  • attacks
  • dizziness
  • neurovascular compression

ASJC Scopus subject areas

  • Neuroscience(all)
  • Otorhinolaryngology
  • Sensory Systems
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Vestibular paroxysmia: Diagnostic criteria'. Together they form a unique fingerprint.

Cite this