Clinical NeuroscienceResearch PaperWho is at risk for ongoing dizziness and psychological strain after a vestibular disorder?
Section snippets
Experimental procedures
A total of 68 patients with vestibular vertigo syndromes (benign paroxysmal positioning vertigo (BPPV, n=19); vestibular neuritis (VN, n=14); vestibular migraine (VM, n=27); Menière's disease (MD, n=8)) were recruited for this interdisciplinary longitudinal study (Table 1). Only two patients who fit all inclusion criteria refused to participate in the study because of the remoteness of our clinic. None of the 68 included patients dropped out.
The aim was to include patients as early as possible
Neuro-otological standard parameters
VN patients showed pathological results on initial (T0) electrophysiological examinations. These were significantly elevated in comparison to the other subgroups (group mean side difference in calorics: 61%, P=0.001; group mean SVV tilt: 4.8°, P<0.001; group mean ocular torsion: 13.2°, P<0.001). The values for caloric testing in relation to international standards remained at a pathological level (>25% side difference) but did not differ significantly from the normal values of the other
Discussion
The current study identified three risk factors for the development of psychological strain and ongoing dizziness after the onset of an organic vertigo syndrome. These factors could explain the extent of subjective severity, vertigo-induced anxiety, disease-specific handicap, and emotional distress:
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Only patients with a vestibular type of migraine (VM) exhibited significantly elevated rates of psychological strain (VSS-AA, VSS-VER and VHQ) in comparison to other patients with vestibular vertigo
Conclusion
The amount of vestibular deficit did not correlate with the psychological strain of patients with vestibular vertigo syndromes, not with vertigo-induced anxiety, subjective severity, disease-specific handicap, or emotional distress. Instead, the amount of fluctuations of vestibular excitability over the 1 year follow up correlated positively with the extent of subjectively perceived vertigo and dizziness symptoms. Patients with vestibular migraine had the significantly highest psychological
Acknowledgments
This work contains essential parts of the doctoral thesis of Regine Tschan. We wish to thank Anja Kühn for her help with the neuro-otological measurements. Special thanks are to Judy Benson, who critically copy-edited the manuscript. This work was supported by the Deutsche Forschungsgemeinschaft (DFG) (EC 220/2-1).
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