Neurology Letters (Jan 2023)
Benign Paroxysmal Positioning Vertigo in Multiple Sclerosis (PP-09)
Abstract
Introduction: In patients with multiple sclerosis (MS), demyelination occurs frequently in the brainstem and cerebellum. It is therefore not surprising that abnormal vestibular sensations are a frequent feature of the clinical course. True vertigo (the perception of self and/or environmental movement, typically rotational) is estimated to occur in about 20% of MS patients at some time during the illness. True vertigo is estimated to occur in about 20% of MS patients and can be the presenting manifestation of MS in up to 5%. Lesions within the vestibular nuclei and in the root entry zone of cranial nerve VIII represent the most common locations where demyelinating activity can provoke vertigo in patients with MS. However, other causes of vertigo should be explored in MS patients in order to avoid unnecessary treatment with corticosteroids and vestibular suppressants. The aim of this study is report on the most common causes of vertigo in patients with multiple sclerosis (MS) and emphasizes appropriate diagnostic techniques and treatment interventions. Method and materials: We performed a literature review with the following keywords: multiple sclerosis, benign paroxysmal positional vertigo, repositioning maneuvers. Four different databases (PubMed, Scopus, and Web of science and Google Scholar) were independently screened. Publications in English were considered and reviewed from 2021 to 2022. Results: We a total of 20 articles. Results showed that benign paroxysmal positioning vertigo (BPPV) to be the most common cause. In this vertigo, episodes of vertigo lasting only seconds, and provoked by movement of the head. All patients diagnosed with BPPV were treated successfully with particle repositioning maneuvers without any need to suppressors of the vestibular system. Conclusion: Empiric treatments with corticosteroids and/or vestibular suppressants should not be employed until all MS patients undergo a careful bedside examination which includes diagnostic positional and, if indicated, particle repositioning maneuvers.
