Management of dizziness and vertigo
Dizziness (and related vertigo, unsteadiness and light headedness) is one of the five most common symptoms reported in general practice. It is also one of the three main presenting symptoms in neurological and ENT clinics. Dizziness can arise from problems in the balance receptors in the inner ear (the vestibular receptors) or in the vestibular pathways in the brain.
One of the problems that we investigate is why some patients with apparently simple and self-limiting inner ear disorders (eg a viral vestibular neuritis) develop complex and long standing symptoms of dizziness or disorientation. Causes perpetuating such symptoms are multiple and difficult to establish and treat in the individual patient. In this respect, we have recently described a new successful treatment for chronic dizzy patients using a battery of visual and whole body movement rehabilitation techniques.
We have also provided a rational framework for the understanding of a number of visual symptoms, namely oscillopsia and visual vertigo, that develop in patients with vestibular disease. Future developments will include the assessment of motion sickness susceptibility, autonomic nervous system function and personality factors in perpetuating symptoms of disorientation in patients with inner ear disorders.
Link to BBC online article:
Current Clinical Trials
1. Acute vestibular neuritis/labyrinthitis.
2. Theraputic trial in refractory Ménière's disease (unilateral)
3. Effect of deep brain stimulation on postural control in Parkisons disease
Movies showing clinical examination and signs in assessing the dizzy patient.
Six movies to illustrate these positional techniques:
The positional Hallpike manoeuvre for right sided BPPV (Benign paroxysmal positional vertigo).
Sideways lying positional manoeuvre for right sided BPPV.
Semont manoeuvre for treatment of a patient with right sided BPPV.
Semont manoeuvre for treatment of a patient with left sided BPPV.
Epley manoeuvre for treatment of a patient with right sided BPPV.
Epley manoeuvre for treatment of a patient with left sided BPPV.
Two movies demonstrating nystagmus with the Hallpike manoeuvre:
Typical right BPPV nystagmus ('peripheral' nystagmus).
Nystagmus due to central vestibular dysfunction ('central' nystagmus).
Three movies to showing the head thrust test:
Normal head thrust.
Bilaterally abnormal head thrust test.
Unilateral right-sided impairment.
References
Bronstein AM (2004) Vision and vertigo Some visual aspects of vestibular disorders. J Neurol. 251: 381-7.
Pavlou M, Wijnberg N, Faldon ME, Bronstein AM (2003) Effect of semicircular canal stimulation on the perception of the visual vertical. J Neurophysiol. 90:622-30.
Marousa Pavlou, Ari Lingeswaran, Rosalyn A. Davies, Michael A. Gresty, Adolfo M. Bronstein (2004) Simulator based rehabilitation in refractory dizziness. J Neurol 251:983-95
Bronstein AM (2003) Vestibular reflexes and positional manoeuvres. J Neurol Neurosurg Psychiatry. 74(3):289-93.
Seemungal BM and Bronstein AM (2008). A practical approach to Acute Vertigo. Practical Neurology 2008 Aug;8(4):211-21.
Bronstein AM and Lempert T (2007). Dizziness: A practical approach to diagnosis and management. Cambridge University Press. The movies above are all taken from this book.
