The treatment and natural course of peripheral and central vertigo

Dtsch Arztebl Int. 2013 Jul;110(29-30):505-15; quiz 515-6. doi: 10.3238/arztebl.2013.0505. Epub 2013 Jul 22.


Background: Recent studies have extended our understanding of the pathophysiology, natural course, and treatment of vestibular vertigo. The relative frequency of the different forms is as follows: benign paroxysmal positional vertigo (BPPV) 17.1%; phobic vestibular vertigo 15%; central vestibular syndromes 12.3%; vestibular migraine 11.4%; Menière's disease 10.1%; vestibular neuritis 8.3%; bilateral vestibulopathy 7.1%; vestibular paroxysmia 3.7%.

Methods: Selective literature survey with particular regard to Cochrane reviews and the guidelines of the German Neurological Society.

Results: In more than 95% of cases BPPV can be successfully treated by means of liberatory maneuvers (controlled studies); the long-term recurrence rate is 50%. Corticosteroids improve recovery from acute vestibular neuritis (one controlled, several noncontrolled studies); the risk of recurrence is 2-12%. A newly identified subtype of bilateral vestibulopathy, termed cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS), shows no essential improvement in the long term. Long-term high-dose treatment with betahistine is probably effective against Menière's disease (noncontrolled studies); the frequency of episodes decreases spontaneously in the course of time (> 5 years). The treatment of choice for vestibular paroxysmia is carbamazepine (noncontrolled study). Aminopyridine, chlorzoxazone, and acetyl-DL-leucine are new treatment options for various cerebellar diseases.

Conclusion: Most vestibular syndromes can be treated successfully. The efficacy of treatments for Menière's disease, vestibular paroxysmia, and vestibular migraine requires further research.

Publication types

  • Review

MeSH terms

  • Brain Diseases / diagnosis*
  • Brain Diseases / epidemiology
  • Brain Diseases / therapy*
  • Causality
  • Comorbidity
  • Disease Progression
  • Disease-Free Survival
  • Evidence-Based Medicine*
  • Humans
  • Prevalence
  • Risk Factors
  • Treatment Outcome
  • Vertigo / diagnosis*
  • Vertigo / epidemiology
  • Vertigo / therapy*
  • Vestibular Diseases / diagnosis*
  • Vestibular Diseases / epidemiology
  • Vestibular Diseases / therapy*