Vestibular Paroxysmia is a type of episodic vestibular disorder that is characterized by a series of high-frequency attacks. Janetta first described this disorder in 1975 as “disabling positional vertigo.”
Vestibular Paroxysmia is also sometimes called Microvascular Compression Syndrome (MVC).
Vestibular Paroxysmia is a syndrome of vestibular or positional auditory symptoms that are often treatable with medications for neuralgia, excluding other probable causes like Meniere’s disease, migraine, labyrinthitis, Perilymph Fistula Treatment, etc.
Vestibular Paroxysmia is usually chronic (i.e., lasting three or more months), with some patients experiencing up to 100 attacks annually.
Doctors believe that the compression of the eighth cranial nerve, also known as the vestibulocochlear nerve, by an artery to be the primary of Vestibular Paroxysmia causes.
The Vestibulocochlear nerve is responsible for supplying the inner ear (which helps with maintaining balance) & the organ of hearing, cochlea. There is, however, some controversy regarding the exact nature of Vestibular Paroxysmia causes. The bone of contention is the exact cause of this compression of the Vestibulocochlear nerve. With some medical experts suggesting that although some Vestibular Paroxysmia symptoms seem to be due to nerve irritation, there can be a host of other Vestibular Paroxysmia causes other than nerve compression.
Some of these Vestibular paroxysms cause aside from Vestibulocochlear nerve compression are:
- Nerve damage arising from Vestibular Neuritis,
- Nerve damage due to a tumor, such as an acoustic neuroma,
- Nerve damage from radiation, such as post gamma knife, atomic radiations, etc.
- Nerve damage from surgery of the eighth nerve
- Paroxysmal brainstem attacks,
- Superior oblique myokymia,
- Vestibular migraine,
- Benign paroxysmal positional vertigo (BPPV),
- Somatoform phobic postural vertigo (functional dizziness),
- Rotational vertebral artery occlusion syndrome,
- Superior canal dehiscence syndrome,
- Central positional/positioning nystagmus,
- Panic attacks,
- Orthostatic dysregulation,
- Epileptic vestibular aura
Its analogy deduced the existence of Vestibular Paroxysmia to the hemifacial spasm syndrome, in which it was unanimously accepted that the cause was a compressed, aberrant blood vessel. The credit for the discovery & diagnosis of Vestibular Paroxysmia causes, Vestibular Paroxysmia symptoms, and Vestibular Paroxysmia treatment goes to Dr. Peter Janetta, a neurosurgeon Pittsburgh Pennsylvania, along with Dr. Aage Moller & Dr. Margarita Moller.
However, the exact cause of the compression of the Vestibulocochlear nerve is unknown, & it has long been a controversial disorder, especially considering the treatment methods. If the argument that Vestibular Paroxysmia occurs due to compression in blood vessels & nerves, then a surgical approach towards treatment makes sense. However, if one believes that Vestibular Paroxysmia symptoms happen due to other causes & are part of a more extensive vestibular process, then a strategic, step-by-step treatment aimed at recognizing the origin of the disorder & condition management is the right choice.
Although the debate goes on till this date, doctors do agree on a few general Vestibular Paroxysmia symptoms as being common in all patients. These are:
- Spinning or non-spinning Vertigo attacks, lasting anything from a fraction of a second to a minute or more
- Widespread attacks; from a few times per month to almost 30 per day
- Most of these attacks are spontaneous, & happen out-of-the-blue(i.e., without any prior warning or symptoms), however for some people attacks can be brought on by specific head movements or positions,
- Unsteadiness in walking or standing during an attack,
- Tinnitus(ringing) in one ear during the attack,
- Some people also experience sensitivity to sound during attacks
- Chronic attacks that take place for longer than three months
It’s important to note, however, that effective diagnosis of Vestibular depends largely on the patient’s symptoms. And for your doctor to correctly diagnose your condition as Vestibular Paroxysmia, they’ll have to rule out other probable conditions. Like Meniere’s disease, vestibular migraine, benign paroxysmal positional vertigo (BPPV), epileptic visual aura, multiple sclerosis (MS), stroke/ mini-strokes, superior canal dehiscence syndrome, perilymph fistula, and panic attacks. MRI has often been used to visualize the compression of the 8th cranial nerve. However, the role of magnetic imaging in visualizing & identifying the affected region is not yet clear, as there have been instances of a high rate of vascular compression even in healthy subjects. There are multiple ways of knowing if a patient has definitive signs of Vestibular Paroxysmia, or is just vulnerable to it.
Doctors make the above discretion based on the symptoms shown by the patients, some of which are given below:
Definitie Vestibular Paroxysmia
- The patient has to have at least 10 attacks of spinning or non-spinning vertigo,
- The duration of these attacks has to be less than a minute,
- These attacks occur spontaneously,
- The attacks usually follow a particular pattern in every patient,
- The patients respond to treatment with carbamazepine/oxcarbazepine
- The patient’s condition doesn’t fit with any other diagnosis
If a patient’s condition doesn’t fit with the symptoms mentioned above, the diagnosis is that of Probable Vestibular Paroxysmia, symptoms of which are given below:
- The patients have to have at least five attacks of spinning or non-spinning Vertigo,
- The duration of these attacks have to be less than 5 minutes,
- The attacks either occur spontaneously or are provoked by certain head movements,
- The attacks follow a precise pattern. However, it isn’t as clearly marked as that of Definite vestibular,
- The patient’s condition doesn’t fit with any other diagnosis, including Definite Vestibular
Vestibular Paroxysmia treatment
Due to the lack of clarity on the exact origin of the disorder, Vestibular Paroxysmia treatment largely depends on the patient’s specific condition, medical history & the results of simultaneous tests.
Doctors, however, have found that treatment with anti-seizure medications like carbamazepine & oxcarbazepine helps reduce the intensity, duration & frequency of attacks. If a patient continues to respond positively to these medications & their condition shows signs of improvement, surgical treatment is not recommended.
Read Also: Seizure: Symptoms, Causes, Treatment
However, in certain medically intractable cases, microvascular decompression or surgery should be considered, especially if Vestibular Paroxysmia occurs with other conditions like arachnoid cysts. Surgery is usually recommended only in instances where the patient doesn’t respond well to medications.
Other treatment options & desirable clinical developmental therapies include:
- improved imaging techniques that reveal neurovascular cross-compression of the eighth nerve, especially to distinguish between symptomatic and asymptomatic contacts,
- clinical tests to reliably determine the affected side,
- randomized placebo-controlled trials,
- new medications in case the patient isn’t responding well to original medications
Below is a list of some well-known drugs that have been used to treat Vestibular Paroxysmia successfully.
|Carbamazepine (tegretol)||100||Relatively high rate of side effects|
|Oxcarbazepine (trileptal, oxtellar XR)||150||Few side effects, generic is expensive|
|eslicarbazepine (Aptiom)||400||Fewer side effects recorded, expensive as branded, its working is still unknown but is probably identical to oxcarbazepine.|
|levetiracetam (Keppra)||250||Unknown efficacy in this condition|
If you’re suffering from Vertigo & spells of dizziness & nausea, you should consult a doctor right away. NeuroEquilibrium is one of the best Vertigo diagnosis & treatment clinics in India. Fight Vertigo with our experienced doctors at NeuroEquilibrium.
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