Elsevier

Neuroscience

Volume 164, Issue 4, 29 December 2009, Pages 1579-1587
Neuroscience

Clinical Neuroscience
Research Paper
Who is at risk for ongoing dizziness and psychological strain after a vestibular disorder?

https://doi.org/10.1016/j.neuroscience.2009.09.034Get rights and content

Abstract

Patients with vestibular vertigo syndromes often suffer from anxiety and depression, whereas patients with psychiatric disorders often experience subjective unsteadiness, dizziness, or vertigo. Thus, it has been hypothesized that the vestibular system may be interlinked with the emotion processing systems. The aim of the current study was to evaluate this hypothesis by correlating vestibular and psychiatric symptoms with the course of the disease over 1 year. This interdisciplinary, prospective, longitudinal study included a total of 68 patients with acute vestibular vertigo syndromes. Four subgroups of patients with benign paroxysmal positioning vertigo (BPPV, n=19), acute vestibular neuritis (VN, n=14), vestibular migraine (VM, n=27), or Menière's disease (MD, n=8) were compared. All patients underwent neurological and neuro-otological examinations and filled out standardized self-report inventories including the Vertigo Symptom Scale (VSS), the Vertigo Handicap Questionnaire (VHQ) and the Symptom Checklist 90R (GSI, SCL-90R) at five different times (T0–T4) in the course of 1 year. VM patients experienced significantly more “vertigo and related symptoms” (VSS-VER), “somatic anxiety and autonomic arousal” (VSS-AA), and “vertigo induced handicap” (VHQ) than all other patients (P<0.001−P=0.006). Patients with a positive history of psychiatric disorders had significantly more emotional distress (GSI, SCL-90R), regardless of the specific phenomenology of the four diagnostic subgroups. Finally, fluctuations of vestibular excitability correlated positively with the extent of subjectively perceived vertigo. VM patients are significantly more handicapped by vertigo and related symptoms. They show significantly elevated fluctuations of vestibular excitability, which correlate with the (subjective) severity of vertigo symptoms.

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:

  • 1

    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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