Benign paroxysmal positional vertigo in Parkinson's disease

Abstract

Background: Dizziness is a frequent complaint of patients with Parkinson's disease (PD), and orthostatic hypotension (OH) is often thought to be the cause. We studied whether benign paroxysmal positional vertigo (BPPV) could also be an explanation.

Aim: To assess the prevalence of benign paroxysmal positional vertigo in patients with Parkinson's disease, with and without dizziness.

Methods: 305 consecutive outpatients with PD completed the Movement Disorders Society-sponsored revision of the Unified Parkinsons' Disease Rating Scale-motor score, the Dizziness Handicap Inventory, the Dix-Hallpike maneuver and a test for orthostatic hypotension. When positive for benign paroxysmal positional vertigo, a repositioning maneuver was performed. Patients were followed for three months to determine the clinical response.

Results: 305 patients responded (186 men (61%), mean age 70.5 years (Standard Deviation 9.5 years)), of whom 151 (49%) complained of dizziness. 57 (38%) of the dizzy patients appeared to have orthostatic hypotension; 12 patients (8%) had a classical but previously unrecognized benign paroxysmal positional vertigo. A further four patients (3%) had a more atypical presentation of benign paroxysmal positional vertigo. Three months after treatment, 11 (92%) of patients with classical benign paroxysmal positional vertigo were almost or completely without complaints. We found no 'hidden' benign paroxysmal positional vertigo among patients without dizziness. The prevalence of benign paroxysmal positional vertigo among all patients with PD was 5.3%.

Conclusion: Among Parkinson patients with symptoms of dizziness, up to 11% may have benign paroxysmal positional vertigo, which can be treated easily and successfully.

Keywords: BPPV; Dix–Hallpike maneuver; Dizziness; Orthostatic hypotension; Parkinson's disease.