Vestibular paroxysmia: Long-term clinical outcome after treatment

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...

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Published inFrontiers in neurology Vol. 13; p. 1036214
Main Authors Chen, Chih-Chung, Lee, Ting-Yi, Lee, Hsun-Hua, Kuo, Yu-Hung, Bery, Anand K., Chang, Tzu-Pu
Format Journal Article
LanguageEnglish
Published Frontiers Media S.A 14.10.2022
Subjects
dizziness
Neurology
neurovascular compression
trigeminal neuralgia
typewriter tinnitus
vertigo
vestibular paroxysmia
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Summary: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.
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This article was submitted to Neuro-Otology, a section of the journal Frontiers in Neurology
Edited by: Sulin Zhang, Huazhong University of Science and Technology, China
Reviewed by: Hubertus Axer, Jena University Hospital, Germany; Alexandre Bisdorff, Hospital Center Emile Mayrisch, Luxembourg; Tino Prell, University Hospital in Halle, Germany
ISSN:1664-2295
1664-2295
DOI:10.3389/fneur.2022.1036214