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Old 02-26-2008, 11:08 PM   #1
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New Study on Vestibular Neuritis - Feb 2008

Hi All,

An interesting study popped up today which will help us all to understand the length of time necessary to recover from VN. The study was conducted on 68 patients with VN in Siena, Italy. The researchers observed how effective a number of bedside tests were for predicting recovery from a VN attack. Some interesting comments are made about time to recovery. This study lasted 12 months.

Effectiveness of Careful Bedside Examination in Assessment, Diagnosis, and Prognosis of Vestibular Neuritis
M Mandalà, MD; D Nuti, MD; AT Broman, MA; DS Zee, MD
Arch Otolaryngol Head Neck Surg, 134(2), Feb 2008

Summary and Highlights

OBJECTIVE: To determine whether the use of 4 bedside tests (head-impulse, head-heave, head-shake, and vibration tests) can be as effective as the caloric test, a widely accepted standard, in the diagnosis and prediction of the time to recovery from vestibular neuritis.
  • Symptoms usually resolve in weeks, but there may be a more protracted course with persistent disequilibrium.
  • Some recently developed bedside tests can also provide important information for the diagnosis and prognosis of vestibular neuritis.
  • Patients were asked to return for follow-up evaluation after 1, 3, 6, and 12 months. Patients were considered to have recovered when results of both caloric testing and bedside examination were normal, after which they were not considered further for this study.
** The chance of not recovering by the end of 12 months was 49.3%.
  • More than half of all patients had positive signs at baseline with the head-impulse, head-heave, head-shake, and vibration tests.
  • If the results were negative for the head-impulse and vibration tests, recovery was more likely.
  • Four patients developed benign paroxysmal positional vertigo during follow-up. In all 4 patients, this disorder was of the posterior semicircular canal type on the same side as the vestibular neuritis.
  • Previous data suggest that abnormal head-heave and head-impulse responses are often associated with a severe caloric deficit.
  • A negative result for the vibration test in the acute phase of disease is a strong predictor of a high chance for recovery.
  • Accepting treatment seemed to have an almost 3-fold effect on chance for recovery.
Treatment

After the initial evaluation, all patients were offered treatment with corticosteroids (oral methylprednisolone sodium succinate, 60 mg/d, tapered during 2.5 weeks) and acyclovir (800 mg 4 times daily for 7 days).

Sure makes me wish my doc had given me some of the above drugs 4 years ago to limit the damage and speed my recovery.

Best ... Scott

 
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Old 02-27-2008, 03:10 AM   #2
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Re: New Study on Vestibular Neuritis - Feb 2008

wow

only 50 percent are well after one year. is this study considering VRT?

 
Old 03-04-2008, 07:58 AM   #3
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Re: New Study on Vestibular Neuritis - Feb 2008

Scotsman

Did it say anything about how long some took to recover after a year or if they didnt recover in a year they just werent surveyed anymore?? What exactly are the drugs discussed??

 
Old 03-04-2008, 02:45 PM   #4
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Smile Re: New Study on Vestibular Neuritis - Feb 2008

"Patients were considered to have recovered when results of both caloric testing and bedside examination were normal, after which they were not considered further for this study. "

Does the bedside examination include the patient's subjective symptoms? I wonder if all the subjects who were considered fully recovered actually felt fully recovered. I hope this doesn't sound negative...I am just curious about what the researchers mean.

I think I am also prone to questioning because so few health care providers seem to be aware of the potential lengthy nature of these illnesses (VN/lab). Why so many health info. sources say the duration is likely to be a few days or a week or so is beyond me. Very misleading.

On a personal note, I actually do feel better now that I am in my 13th week. Not normal at all, but like I am making some progress and hopefully out of the very worst of this extremely difficult illness. I don't know whether it's due to increased VRT, the migraine diet, or all the supplements I've been taking, but I'm attacking this thing from all directions! Many thanks again to everyone for your help and advice during this crazy journey!

 
Old 03-05-2008, 03:57 PM   #5
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Re: New Study on Vestibular Neuritis - Feb 2008

D&S,

The study only mentions patients who remained in the study up to one year only. After that they all went on their way so no idea. But I would still maintain that if recovery isn't on some sort of clear positive trajectory after the one year mark that there is something else going on - eye problems, the need for directed VRT, or migraine. They also say " .. as is usually the case, at about one month after treatment, most patients showed no spontaneous nystagmus, implying either peripheral recovery or central compensation."

As I mentioned above, the treatment was the following:

After the initial evaluation, all patients were offered treatment with corticosteroids (oral methylprednisolone sodium succinate, 60 mg/d, tapered during 2.5 weeks) and acyclovir (800 mg 4 times daily for 7 days).

Hey Violet -

There was no mention of subjective feelings of dizziness - only diagnostic stuff. But a good point - I bet some of the ones who stopped showing diagnostic problems still felt dizzy.

>>> I think I am also prone to questioning because ...

Keep questioning because we'd have no idea what was going on otherwise. Sounds like you are a natural with critical thinking - keep it up!

>>> I don't know whether it's due to increased VRT, the migraine diet, or all the supplements I've been taking, but I'm attacking this thing from all directions!

Just keep hammering away at it and you'll gain the upper hand. Once you feel much better try introducing some migraine trigger foods and see if it has any negative effect.

Best ... .Scott

 
Old 03-06-2008, 06:01 AM   #6
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Re: New Study on Vestibular Neuritis - Feb 2008

Quote:
Sure makes me wish my doc had given me some of the above drugs 4 years ago to limit the damage and speed my recovery.
Hi Scott,

Not so sure about the anti-inflammatory drugs as I was on a course of prednisone (steriods). They made me feel worse. I suppose that it wouldn't have helped me anyway assuming it was not my vestibular system but rather my current neurologist's therory that it is central damage.

Hope you are well and had a great birthday.

Gloria

 
Old 03-07-2008, 05:41 PM   #7
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Re: New Study on Vestibular Neuritis - Feb 2008

Hi, Scott--

I just wanted to say thank you for your encouragement! Just when I think I feel better, I don't anymore! Trying to get to the bottom of this problem is not easy, is it? With my newfound knowledge of migraine, I don't think I can deny that my very bad headache today is hormonally related, but does that mean my dizziness is also migraine related? I still feel strongly that this all was set off by VN. These are the things I'm thinking about pretty much constantly. I'll be seeing a chiropractor on Monday, although I'm a bit afraid, actually...I've never been to one before. I figured he might know something about various supplements that might be helpful.

I hope you are doing well!

--Violet

 
Old 03-07-2008, 06:16 PM   #8
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Re: New Study on Vestibular Neuritis - Feb 2008

Hi Violet,

We may both very well be in the same boat. I feel that mine also started from VN and for whatever reason, migraine was a complicating cofactor that was made more and more prominent in this long and relentless "trip". I also have the added complication of having herpes. I get a lot of outbreaks on my backside - triggered from sitting too long. Sometimes a herpes attack will kick off short-lived depression and some dizziness and other times it does nothing. Whether or not I have some sort of recurrent viral thing going on (herpes type thing) as well in or near my vestibuar system (as suggested in the paper posted by Robsydney earlier today) is definitely debatable.

I see a chiro every 2 weeks or so and it does help a lot. You may feel a little more off at first after the first few adjustments but now they only help me out a fair bit. I have to warn you that sometimes chiros get a little too mystical for my liking so take some of the "advice" with a grain of salt if you think he/she is talking rubbish.

I'm feeling pretty weird these last few days. I'm trying to drop the SSRI dose down to half or 10 mg - to reduce side effects and for the simplicity of not having to chop them up with a razor. So it's to be expected. I'm hoping these new supplements I'm using will make this transition doable this time.

Do you ever get short and brief dizzy spells followed by a headache? I got this last night for the first time in a while. I was disorientated and feeling really out of it for about 30 min. It stopped and then my head started to hurt immediately afterwards for about 4 hours.

Hope you're feelig better ... Scott

 
Old 03-08-2008, 06:06 AM   #9
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Re: New Study on Vestibular Neuritis - Feb 2008

Hi, Scott--

It sounds like you have been dealing very well with a mixture of difficult issues. It's very hard when it's not just one thing, and one has to be something like a detective. I really thought the uber-experts I recently saw would be more helpful, but honestly they quickly gave me a diagnosis without much inquiry or discussion. It turns out they publish lots of papers on the diagnosis they gave me (MAV).

Still, the migraine thing is clearly affecting me. I see it more with headaches than with dizziness. I get bad headaches (but not the typical aura/vomiting/visual symptoms kind) if I don't eat frequently, and I'm working on tracking down other triggers. My dizziness is still 24/7 (since its onset in Dec.), so it's difficult for me to gauge changes in it. Overall, it has improved since the initial 2-3-week attack, but very slowly. I still feel quite impaired from the illness, but thanks to you and other veterans, I know it will continue to get better, so that keeps me going.

It sounds like your dizzy/headache experience was very much a migraine situation, with the dizziness being the aura. Have you been taking all the usuals, such as magnesium, feverfew, B vitamins, etc? Also lots of vitamin C to combat everything, inc. the herpes? I'm sure you have considered all these things before. I still need to buy some tryptophan and/or 5HT, although I have no idea how much to take. Are you dizzy all the time, or do you usually have spells and feel fine in between?

What I find interesting is the serotonin link with both depression and migraine, as well as female hormonal issues (PMS, etc.). It also seems as though insulin/blood sugar plays a role in headaches for many, and I think I have that as well.

I am sure the herpes virus is the culprit with much of this VN stuff. I say that based not on scientific evidence, but more on a gut feeling and my own experience. I think viruses are responsible for many more problems than we know. I've often thought depression might have a viral component, as well.

I wish you luck as you cut back on some of your meds. I have found things like massage and water therapy (spas/baths/etc) to be helpful for weird feelings. Years ago when I had panic attacks, doing yoga-type stretching helped me feel centered and "in my body."

(I'm also beginning to be a fan of negative ions--still learning about this one & you may know about it, but they reduce depression and increase creativity and they are greatly reduced in heated/air-conditioned environments. I think plants might increase them.)

I guess a plus side of this yucky illness is learning to live healthier...

--Violet

 
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