Vestibular paroxysmia: Long-term clinical outcome after treatment

Chih-Chung Chen; Ting-Yi Lee; Hsun-Hua Lee; Yu-Hung Kuo; Anand K Bery; Tzu-Pu Chang

doi:10.3389/fneur.2022.1036214

Vestibular paroxysmia: Long-term clinical outcome after treatment

Front Neurol. 2022 Oct 14:13:1036214. doi: 10.3389/fneur.2022.1036214. eCollection 2022.

Authors

Chih-Chung Chen^{1

2

3}, Ting-Yi Lee^{1

2

3}, Hsun-Hua Lee^{1

2

3}, Yu-Hung Kuo⁴, Anand K Bery⁵, Tzu-Pu Chang^{6

7}

Affiliations

¹ Dizziness and Balance Disorder Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
² Taipei Neuroscience Institute, Taipei Medical University, New Taipei City, Taiwan.
³ Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁴ Department of Research, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.
⁵ Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁶ Department of Neurology, Neuro-Medical Scientific Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.
⁷ Department of Neurology, School of Medicine, Tzu Chi University, Hualien, Taiwan.

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.