Vestibular paroxysmia: Long-term clinical outcome after treatment

Abstract

Objective: To study the long-term treatment outcome of vestibular paroxysmia (VP).

Study design: Retrospective study.

Setting: Tertiary referral hospital.

Methods: We analyzed records of 29 consecutive patients who were diagnosed with VP and who were treated with VP-specific anticonvulsants for at least 3 months. Patients were followed for a minimum of 6 months. We recorded and assessed starting and target dosage of medications, time to achieve adequate therapeutic response, adverse effects, and the rates of short-term and long-term remission without medication.

Results: All 29 patients were started on oxcarbazepine as first-line treatment, and 93.1% and 100% of patients reported good-to-excellent therapeutic response within 2 and 4 weeks, respectively. Three patients switched to other anticonvulsants at 3 months. At long-term follow-up (8-56 months), most (84.6%) oxcarbazepine-treated patients maintained good therapeutic response at doses between 300 and 600 mg/day. Eleven (37.9%) patients experienced complete remission without medication for more than 1 month, of which six (20.7%) had long-term remission off medication for more than 12 months. Nineteen (65.5%) patients had neurovascular compression (NVC) of vestibulocochlear nerve on MRI, but its presence or absence did not predict treatment response or remission.

Conclusion: Low-dose oxcarbazepine monotherapy for VP is effective over the long term and is generally well-tolerated. About 20% of patients with VP in our study had long-term remission off medication.

Keywords: dizziness; neurovascular compression; trigeminal neuralgia; typewriter tinnitus; vertigo; vestibular paroxysmia.

Figure 1

Flowchart demonstrating cohort derivation. ^†Patient records that had not been updated in the last 3 months before study enrollment.

Figure 2

Short-term and long-term remission off medication.

Figure 3

Cumulative remission rate since medication treatment for VP.