title: Vestibular paroxysmia: Diagnostic criteria.
abstract: This paper describes the diagnostic criteria for vestibular paroxysmia (VP) as defined by the Classification Committee of the Bárány Society. The diagnosis of VP is mainly based on the patient history and requires: A) at least ten attacks of spontaneous spinning or non-spinning vertigo; B) duration less than 1 minute; C) stereotyped phenomenology in a particular patient; D) response to a treatment with carbamazepine/oxcarbazepine; and F) not better accounted for by another diagnosis. Probable VP is defined as follows: A) at least five attacks of spinning or non-spinning vertigo; B) duration less than 5 minutes; C) spontaneous occurrence or provoked by certain head-movements; D) stereotyped phenomenology in a particular patient; E) not better accounted for by another diagnosis.Ephaptic discharges in the proximal part of the 8th cranial nerve, which is covered by oligodendrocytes, are the assumed mechanism. Important differential diagnoses are Menière's disease, vestibular migraine, benign paroxysmal positional vertigo, epileptic vestibular aura, paroxysmal brainstem attacks (in multiple sclerosis or after brainstem stroke), superior canal dehiscence syndrome, perilymph fistula, transient ischemic attacks and panic attacks. Current areas of uncertainty in the diagnosis of VP are: a) MRI findings of vascular compression which are not diagnostic of the disease or predictive for the affected side because they are also observed in about 30% of healthy asymptomatic subjects; and b) response to treatment with carbamazepine/oxcarbazepine supports the diagnosis but there are so far no randomized controlled trials for treatment of VP.
authors.affiliation: Department of Neurology and German Center for Vertigo and Balance Disorders, University Hospital Munich, University of Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Strupp
authors.affiliation: Otology and Neurotology Group CTS495, Department of Genomic Medicine - Centre for Genomics and Oncology Research - Pfizer/Universidad de Granada/Junta de Andalucía (GENyO), PTS, Granada and Department of Otolaryngology, University Hospital Granada, Spain.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Lopez-Escamez
authors.affiliation: Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea.
authors.forename: Ji-Soo
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland.
authors.forename: Dominik
authors.initials: D
authors.lastname: Straumann
authors.affiliation: Department of Neurology & Neurobiology, University of California, Los Angeles, CA, USA.
authors.forename: Joanna C
authors.initials: JC
authors.lastname: Jen
authors.affiliation: Department of Otorhinolaryngology, Johns Hopkins University School of Medicine, Baltimore, USA.
authors.forename: John
authors.initials: J
authors.lastname: Carey
authors.affiliation: Department of Neurology, Centre Hospitalier Emile Mayrisch, Esch, Luxemburg.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Bisdorff
authors.affiliation: Department of Neurology and German Center for Vertigo and Balance Disorders, University Hospital Munich, University of Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Brandt
mesh_terms: D065635:Benign Paroxysmal Positional Vertigo / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D002220:Carbamazepine / Q000031:analogs & derivatives / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D019416:Head Movements; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013506:Otologic Surgical Procedures; D000078330:Oxcarbazepine; D015995:Prevalence; D014717:Vertigo / Q000175:diagnosis / Q000209:etiology; D015837:Vestibular Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D014724:Vestibular Function Tests; D000159:Vestibulocochlear Nerve / Q000503:physiopathology
chemical_list: D002220:Carbamazepine; D000078330:Oxcarbazepine
keywords: ICVD; Vertigo; attacks; dizziness; neurovascular compression