Vestibular paroxysmia: a systematic review

Area of Science:

• Neurology
• Otolaryngology
• Neuroscience

Background:

• Vestibular paroxysmia (VP) presents as frequent, brief episodes of vertigo and dizziness.
• Symptoms can include unilateral auditory issues like tinnitus and are often triggered by head movements or hyperventilation.
• VP is diagnosed in 3% of tertiary vertigo center patients, typically in adults aged 47-51.

Purpose of the Study:

• To review the diagnosis and management of vestibular paroxysmia (VP).
• To differentiate between classical, secondary, and idiopathic VP forms.
• To highlight the efficacy of sodium channel blockers and surgical decompression.

Main Methods:

• High-resolution MRI sequences (3D-CISS/FIESTA) of the cerebello-pontine angle support diagnosis.
• Response to sodium channel blockers is a key clinical indicator for classical, secondary, and idiopathic VP.
• Differential diagnosis is considered in exceptional cases due to VP's distinct symptomatology.

Main Results:

• Sodium channel blockers (carbamazepine, oxcarbazepine, lacosamide) are the preferred medical therapy.
• Microsurgical decompression is effective for secondary VP and an option for refractory classical or idiopathic VP.
• Imaging is crucial for differentiating VP subtypes.

Conclusions:

• Vestibular paroxysmia requires careful diagnosis, with response to sodium channel blockers being a reliable sign.
• Medical management with sodium channel blockers is the first-line treatment.
• Surgical intervention is reserved for specific cases unresponsive to or intolerant of medication.