Vestibular disease
Vestibular paroxysmia
This information is intended as a general introduction to this topic. As everyone is affected differently by balance and dizziness problems, you should speak to your doctor for individual advice.
For reasons of better readability, the generic masculine is used and the simultaneous use of the language forms male, female and diverse (m/f/d) is dispensed with. Unless otherwise indicated, the personal designations used in this patient information refer to all genders.
What is vestibular paroxysmia?
Vestibular paroxysmia causes short, recurring attacks of vertigo. Each attack can last from less than a second to a minute. Some people have many attacks in a row, up to thirty per day. Other people only have a few attacks a year. The attacks usually occur without warning.
Vestibular paroxysmia is rare and affects around 4% of people who suffer from spinning and non-spinning vertigo. It is most common in people in their 40s and 50s. However, vestibular paroxysmia can also occur in children.
Vestibular paroxysmia can also be referred to as microvascular compression syndrome.
Summary
- Caused by damage or pressure on the vestibulocochlear nerve, which carries signals from the inner ear to the brain.
- Most common in 40- and 50-year-olds, but can occur at any age.
- Brings with it short recurring bouts of dizziness.
- The seizures usually occur without warning and last less than a minute.
- Often treatable with antispasmodic medication.
- Unusual and usually chronic.
- In some cases, surgery is recommended.
What causes vestibular paroxysmia?
Vestibular paroxysmia is caused by damage or pressure on the vestibulocochlear nerve (8th cranial nerve), which carries signals to and from the inner ear.
This damage can be caused by
- Pressure from nearby arteries or veins
- Vestibular neuritis
- a tumor, e.g. an acoustic neuroma
- a cyst
- Injuries or trauma
- Surgery or radiotherapy
Where does the damage come from?
Researchers believe that damaged nerves that are close to each other sometimes cause a "short circuit" that leads to vestibular paroxysmia attacks.
The symptoms of vestibular paroxysmia can vary from person to person, but generally everyone shows the same pattern of symptoms during a seizure.
- Rotational vertigo
- the feeling that you are swaying or rocking even though you are sitting or standing still
- Oscillopsia (wobbling or jumping vision)
- Gait instability and problems walking during the attack
- Hearing loss in one ear
- Tinnitus during the attack
- Sensitivity to noise (hyperacusis) during the attack
For most people, vestibular paroxysmia attacks occur without warning. Some people find that turning their head to a certain position triggers the seizures. Other people have seizures when they breathe heavily (hyperventilate) or exercise.
Each seizure usually lasts less than 1 minute. However, some people have several seizures in a row, sometimes up to 30 per day. Vestibular paroxysmia is usually a chronic condition, i.e. it lasts longer than three months, with some people having several hundred seizures a year. In some people, the seizures become longer and more frequent as the disease progresses.
Diagnosis of vestibular paroxysmia
Vestibular paroxysmia is usually diagnosed by a specialist such as a neurologist, an ENT specialist or a neurootologist.
The symptoms of vestibular paroxysmia are similar to the symptoms of many other conditions, including- Benign paroxysmal positional vertigo (BPLS)
- Ménière's disease
- Perilymph fistula
- Archway dehiscence
- Vestibular migraine
- Vestibular neuritis
- Epilepsy with vestibular aura
- Episodic ataxia type 2
- Sudden, violent (paroxysmal) brainstem seizures (in multiple sclerosis or after a brainstem infarction)
- Transient ischemic attack (TIA)
- Panic attacks
Your doctor must therefore rule out these other possible causes before making a diagnosis of vestibular paroxysmia.
The diagnosis of vestibular paroxysmia is mainly based on your medical history. Your doctor will ask you about your symptoms. Try to describe your symptoms as accurately as possible, when they started and when they got better or worse.
Your doctor will also ask you about your medical history, such as any medications you are taking or have recently stopped taking, any recent illnesses you have had, and any illnesses you have been diagnosed with in the past. Your doctor will also give you a thorough physical and neurological examination.
You will probably have some of the following diagnostic tests:
- Vestibular functional examination
- Electroencephalogram (EEG)
- Imaging examinations such as an MRI
- Clear vestibular paroxysmia is defined as:
- at least 10 attacks of spinning or non-spinning vertigo
- that last less than 1 minute
- that occur without warning (spontaneous)
- the pattern of symptoms is very similar for every attack (stereotypical phenomenology)
- Response to treatment with carbamazepine or oxcarbazepine
- cannot be better explained by another diagnosis
- Probable vestibular paroxysmia is defined as:
- At least 5 attacks of spinning or non-spinning vertigo
- that last less than 5 minutes
- that occur without warning or are triggered by turning the head to a certain position
- the pattern of symptoms is very similar for every attack (stereotypical phenomenology)
- cannot be better explained by another diagnosis
Treatment of vestibular paroxysmia
Therapy option
Vestibular paroxysmia can often be treated with low-dose anticonvulsants such as carbamazepine or oxcarbazepine. In one study, patients treated with these drugs had 90% less frequent, 85% less intense and 89% shorter seizures. Other medications are also being investigated as treatment options.
Therapy option
If medication does not work and no obvious cause such as a tumor or cyst is visible, microsurgery may be considered to separate the vestibulocochlear nerve (8th cranial nerve) from the blood vessel that is pressing on it. However, it is often difficult for doctors to determine with certainty which side is affected. There is also a risk of a brain stem infarction (stroke) during microvascular decompression surgery.
Therapy option
If the condition is caused by a tumor or cyst, surgery may be recommended.
What happens next?
What you can expect in the future.
There is still a lot we don't know about vestibular paroxysmia. Researchers are still investigating what causes it, how many people are affected and how best to define, diagnose and treat it.
In children, vestibular paroxysmia can disappear on its own.
In order to keep this patient information as short as possible, we have not included a detailed list of references. However, this can be requested at any time at info@ivrt.de.
