Long-term course and relapses of vestibular and balance disorders

Issue title: Vestibular, Ocular Motor, and Locomotor Plasticity and Rehabilitation

Article type: Research Article

Authors: Brandt, Thomas^; | Huppert, TDoreen^; | Hüfner, Katharina^; | Zingler, Vera C.^; | Dieterich, Marianne^; | Strupp, Michael^;

Affiliations: Institute of Clinical Neurosciences, Ludwig-Maximilian University, Munich, Germany | Department of Neurology, Ludwig-Maximilian University, Munich, Germany | Integrated Center for Research and Treatment of Vertigo, Balance and Ocular Motor Disorders, Ludwig-Maximilian University, Munich, Germany

Note: [] Corresponding author: Thomas Brandt, MD, FRCP, Institute of Clinical Neurosciences, University of Munich, Klinikum Großhad- ern, Marchioninistr. 15, D-81377 Munich, Germany. Tel.: +49 89 7095 2380; Fax: +49 89 7095 8855; E-mail: thomas.brandt@med.uni-muenchen.de

Abstract: The long-term course and the frequency of relapses for various peripheral vestibular disorders and somatoform phobic postural vertigo are discussed with respect to the clinically most important questions for thus afflicted patients. This review is mainly based on our own long-term follow-up studies and takes into consideration the most relevant literature. The following syndromes are discussed in detail. Vestibular neuritis: the recovery rate of peripheral vestibular function lies between 40–63% depending on early-onset treatment with corticosteroids; the recurrence rate within 10 years is 2%. Menière's disease} loss of auditory and vestibular function occurs mainly in the first 5 to 10 years; frequency of vertigo attacks may decline after 5 to 10 years; bilateral involvement increases with increasing duration of the condition in up to 30–50%; vestibular drop attacks may occur early or late within the course, mostly with spontaneous remission; high-dose and long-term treatment with betahistine significantly reduces attack frequency in Menière's disease, Benign paroxysmal positioning vertigo: the recurrence rate is 50% within 10 years (in females 58%, in males 39%), most recurrences (80%) being observed within the first year after initial relief; recurrence rate in the seventh decade is half of that in the sixth decade. Vestibular paroxysmia: medical treatment with carbamazepine or oxcarbazepine leads to a continuous significant reduction in attack frequency, intensity, and duration of 10–15% of baseline. Bilateral vestibulopathy: recovery of vestibular function is limited to single cases depending on their etiology. Phobic postural vertigo: within 5 to 16 years 27% of the patients are symptom-free, 48% improve, 22% remain unchanged, and 3% worsen; a detailed explanation of the mechanisms that cause and the factors that provoke attacks is imperative, as well as instructions for self-controlled desensitization within the context of behavioral therapy.

Keywords: Vestibular neuritis, Menière's disease, benign paroxysmal positioning vertigo, vestibular paroxysmia, bilateral vestibulopathy, phobic postural vertigo, long-term follow-up, relapse rate

DOI: 10.3233/RNN-2010-0504

Journal: Restorative Neurology and Neuroscience, vol. 28, no. 1, pp. 69-82, 2010