Exploring the preventive effect of sodium valproate on benign recurrent vertigo: A case series and literature review

BackgroundBenign recurrent vertigo (BRV) accounts for a high proportion of episodic vestibular syndrome (EVS) patients. To date, randomized controlled trials and guidelines are lacking, and preventive treatment has not been established.ObjectiveIn clinical practice, we have found that sodium valproate has excellent effect on reducing vertigo attacks in BRV patients. Herein, these cases were collected and analyzed to share our clinical experience.MethodsIn this retrospective case series, we evaluated 84 patients with BRV or vestibular migraine (VM) who received prophylactic treatment with sodium valproate (400-500 mg/day) between April 2022 and July 2024. The primary clinical outcomes were the proportion of patients achieving a ≥50% reduction in monthly vertigo days (50% reduction rate) and the complete remission rate. Patients who achieved complete symptom resolution and subsequently discontinued medication were monitored to assess post-withdrawal recurrence rates.ResultsA total of 84 patients were enrolled, including 43 in the BRV group and 41 in the VM group. After 3 months of prophylactic treatment with sodium valproate, 91.1% of patients had a 50% reduction rate in monthly vertigo days and 71.4% had complete remission. There was no significant difference in preventive efficacy between the VM group and BRV group (p = 0.348). There was no significant difference in the cumulative recurrence rates between different preventive treatment courses (<6 and ≥6 months) (p = 0.907). The cumulative recurrence rate after discontinuing medication was 38.2% at 3 months, and this rate after 6 months was 70.0%. Among the 25 patients who experienced recurrence, 44.0% needed to undergo prophylactic treatment again.ConclusionLow-dose sodium valproate showed a good preventive effect in patients with BRV, comparable to that in patients with VM.