What is Vestibular Paroxysmia and How to Treat?

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Vestibular Paroxysmia is a disorder of the vestibular system that is usually episodic, and it usually occurs in patients with a high frequency of attacks. Designed first in 1975 as “disabling positional vertigo”, Vestibular Paroxysmia is also known as microvascular compression syndrome.

The cause of Vestibular Paroxysmia is usually attributed to the compression of the eighth cranial nerve, which is also known as the vestibulocochlear nerve. The nerve is responsible for supplying the inner ear and the cochlea. 

However, the exact cause of the disorder is still debated with some experts suggesting that there are many other causes of the irritability of the nerve other than vascular compression. 

Vestibular Paroxysmia can be particularly hard for the patient as the frequency of attacks can make it hard to manage the disorder. The frequency of attacks can range from a few times a month to 30 attacks every single day.

Vestibular Paroxysmia symptoms 

With persistent attacks, it can be hard for the patient to ignore Vestibular Paroxysmia symptoms. If a patient experiences these symptoms regularly, they should get their condition evaluated by a medical professional as quickly as possible for effective diagnosis and treatment.

Some of the significant Vestibular Paroxysmia symptoms include the following:

  • Very frequent attacks of non-spinning vertigo that can last from a fraction of a second to a minute or longer.
  • The frequency of attacks is usually very high, with some patients suffering from the attacks multiple times a day.
  • While some attacks might be provoked by head movements or hyperventilation, most of the attacks occur without any cause and spontaneously.
  • The patient might feel unsteadiness if they suffer an attack while they are standing or walking.
  • Along with vertigo, the patient might experience other symptoms such as sensitivity to sound or tinnitus (ringing of the ear) in one ear.  

Vestibular Paroxysmia diagnosis 

A doctor can make a Vestibular Paroxysmia diagnosis only after ruling out other diagnoses for vertigo that include disorders like Meniere’s disease, benign paroxysmal positional vertigo (BPPV), multiple sclerosis, stroke, super canal dehiscence syndrome, perilymph fistula and panic attacks.

During the diagnosis, MRI is generally used to visualize and identify if there is any compression present on the 8th cranial nerve. However, MRIs might not be the most effective way to make a Vestibular Paroxysmia diagnosis as some patients who suffer from the disorder don’t experience any compression on their 8th cranial nerve. 

Vestibular Paroxysmia diagnosis can have two results if the patient is found to suffer from the disorder – definite Vestibular Paroxysmia and probable Vestibular Paroxysmia. The difference between the two diagnoses is usually made clear by the symptoms that the patient is experiencing. 

Here are the major differences between definite and probable Vestibular Paroxysmia:

 

Definite  Probable
The patient experiences attacks of spinning or non-spinning vertigo at least 10 times.  The patient experiences attack of spinning or non-spinning vertigo at least 5 times.
The duration of attacks is less than 1 minute. The duration of attacks is less than 5 minutes.
The attacks occur spontaneously.  The attacks either occur spontaneously or are provoked by certain head movements.

 

As mentioned above in the article, making a Vestibular Paroxysmia diagnosis can be tough for the doctor as in order to make it, all other kinds of vestibular disorders have to be ruled out in the patient and even then, MRI scanning might not provide a clear cut solution.

If you’re experiencing any of the symptoms listed above, you should get medical help as soon as possible in order to avail the best Vestibular Paroxysmia treatment.

Vestibular Paroxysmia treatment 

Vestibular Paroxysmia treatment usually involves mostly medications and surgery is rarely used as an option when it comes to treating the disorder.

In most cases, neuralgia medications are used to counter the microvascular compression syndrome with some of the common medications for the disorder being carbamazepine, Oxcarbamazine, eslicarbazepine (Aptiom), levetiracetam (Keppra) among others. These medications help the patient fight the disorder if the compression is not caused due to blood vessels. These medications work to reduce the intensity, frequency, and duration of attacks in patients. 

If the patient is suffering from compression or irritation in the vestibular nerve due to the blood vessels, Vestibular Paroxysmia treatment can involve surgery. However, surgery is usually considered to be the last option for doctors when the patient doesn’t respond to other forms of treatment. This is due to the fact that surgery for Vestibular Paroxysmia treatment carries certain risks for the patient that most doctors would like to avoid. 

Conclusion 

Vestibular Paroxysmia is a serious disorder of the vestibular system which is known for frequently occurring attacks in patients. The disorder is primarily caused due to the compressive of the 8th cranial nerve by an attery that causes problems when it comes to our vestibular system.  

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