Vestibular Paroxysmia is described as an episodic vestibular disorder, in which the patients experience a high frequency of Vertigo attacks. The condition was first described as “disabling positional vertigo” by Janetta in 1975. It is also sometimes referred to as Microvascular Compression Syndrome (MVC). MVC is a condition of the vestibular or the positional auditory system.
These can respond to treatment involving medications for neuralgia, & other treatment options when common conditions like Meniere’s Disease, Migraine, Labyrinthitis, & Perilymph Fistula diagnosis have been eliminated. Vestibular paroxysmia symptoms are usually chronic in nature, i.e., they last longer than three months. Some patients with a Vestibular paroxysmia diagnosis suffer hundreds of attacks almost every year.
Causes of Vestibular Paroxysmia:
Causes of Vestibular Paroxysmia include compression of the eighth cranial nerve, which is also otherwise known as the vestibulocochlear nerve, by an artery. This nerve leads to the inner ear, which helps maintain the body’s balance, & the cochlea, which is the organ of hearing. Although there happens to be some controversy regarding the exact cause of this nerve compression. This is primarily because one of the main Vestibular Paroxysmia symptoms seems to be due to nerve irritation, & some Vestibular paroxysmia specialists argue that there are multiple possible causes for that besides vascular compression.
Notedly, Timothy Hain, MD, summarized that the key features of the syndrome suggested some sort of electrical problem, rather than a vascular one. Basically, he noted that since the exact cause of this nerve compression is unknown, the exact causes of Vestibular Paroxysmia can’t be determined so easily.
Vestibular Paroxysmia Symptoms:
Vestibular Paroxysmia symptoms include:
- Attacks that involve spinning or non-spinning vertigo, lasting almost a fraction of a second or over a minute,
- Attacks that are very frequent in nature, ranging anywhere from a few per month to over 30 in a day,
- Attacks that seemingly occur “out of the blue”, or are provoked by certain head movements or hyperventilation,
- A feeling of unsteadiness when the attacks occur while standing or walking,
- Tinnitus (ringing in the ears) during the attacks,
- Sensitivity to sound during attacks,
- Attacks are chronic in nature, lasting more than 3 months.
Vestibular Paroxysmia Diagnosis:
Vestibular Paroxysmia Diagnosis is often based on the patient’s particular symptoms. It is also important to rule out other conditions such as:
- Meniere’s Disease,
- Vestibular Migraine,
- Benign Paroxysmal Positional Vertigo(BPPV),
- epileptic Visual Aura,
- Multiple Sclerosis(MS),
- mini Stroke,
- Superior Canal Dehiscence syndrome,
- Perilymph Fistula,
- Panic attacks
MRI tests are often used to visualize the compression of the 8th cranial nerve. However, the role of imaging to accurately diagnose & identify the affected side is not very clear yet. This is due to the fact that there is sometimes a high rate of vascular compression of the 8th nerve even in healthy subjects. Below you’ll find the diagnostic criteria for definitive & probable Vestibular Paroxysmia.
Definitive Vestibular Paroxysmia diagnosis:
A patient can be said to have a definite Vestibular Paroxysmia diagnosis when they meet all of these conditions:
- At least 10 attacks of spinning or non-spinning Vertigo,
- Each attack must be of a duration of at least 1 minute,
- The attacks must occur spontaneously,
- There must be stereotyped phenomenology in a specific patient,
- The patient should respond to treatment with carbamazepine/oxcarbazepine
- The patient’s condition should not be consistent with any other disorder or diagnosis
Probable Vestibular Paroxysmia diagnosis:
A patient can be said to have a probable Vestibular Paroxysmia diagnosis if they meet all of these conditions:
- At least 5 attacks of spinning or non-spinning Vertigo,
- Each attack must be less than 5 minutes long,
- Each attack must either occur spontaneously or be provoked by certain head movements,
- Presence of stereotyped phenomenology in the patient,
- The patient’s condition doesn’t match any other diagnosis
Vestibular Paroxysmia treatment:
Vestibular Paroxysmia is considered to be quite similar to trigeminal neuralgia. The first line of vestibular paroxysmia treatment involves sodium channel blockers like Carbamazepine and Oxcarbazepine. These drugs are used as a therapeutic trial to establish the presence of microvascular compression. If the patient shows symptomatic relief from this course of treatment, then it means the microvascular compression is present, & the vestibular paroxysmia diagnosis is confirmed.
The recommended dosage of Carbamazepine is 200-600mg/day and Oxcarbazepine is 300-900mg/day. Vestibular Paroxysmia Treatment usually begins with Carbamazepine 100 mg BD and is increased to provide maximum relief to the patient. Vestibular sedatives are usually not very effective in these patients. Vestibular Paroxysmia specialists & doctors have found that treatment with carbamazepine &/or oxcarbazepine reduces the intensity, frequency, & duration of the attacks.
If the patient does not respond to this line of treatment, & presents with intractable symptoms, then microvascular decompression surgery may be done. This surgery is performed endoscopically. It involves the identification of the VII-VIII nerve complex and the cauterization of the vascular loop. Sometimes, a sponge is also placed between the blood vessel and nerve to prevent nerve compression. This surgery should only be done when all the other Vestibular Paroxysmia treatment options fail, & should only be performed by Vestibular Paroxysmia specialists.