THURSDAY, May 16, 2019 — Teaching patients to wear goggles when symptomatic to videorecord nystagmus can assist with the diagnosis of episodic vestibular disorders, according to a proof-of-concept study published online May 15 in Neurology.
Allison S. Young, M.Aud., from the University of Sydney, and colleagues prospectively recruited adults reporting recurrent vertigo. Patients were taught to use video-oculography goggles to self-report spontaneous and positional nystagmus at home while symptomatic. Ictal eye videos of 117 patients with Ménière disease (MD), vestibular migraine (VM), or benign paroxysmal positional vertigo (BPPV) were included.
The researchers found that 40 of 43 patients with MD showed high-velocity spontaneous horizontal nystagmus. Spontaneous horizontal, upbeating, or downbeating nystagmus was observed in 44 of 67 patients with VM; 16 showed positional nystagmus only and seven had no nystagmus. For MD, spontaneous horizontal nystagmus with SPV >12.05 degrees/second had a sensitivity of 95.3 percent and specificity of 82.1 percent. Change in nystagmus direction within 12 hours was highly specific for MD (95.7 percent). For VM, spontaneous vertical nystagmus was highly specific (93.0 percent). Spontaneous nystagmus was absent or <3 degrees/second for the seven patients with BPPV. Patients with VM and MD demonstrated persistent positional nystagmus. A medium time for the peak SPV to halve of <47.3 seconds had sensitivity and specificity of 100 and 77.8 percent, respectively, for BPPV.
“This study represents the first instance of patient-initiated vestibular event monitoring towards identification of the etiology of recurrent vertigo,” the authors write.
Two authors disclosed financial ties to Otometrics.
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Posted: May 2019