The Beneficial Effect of Methylprednisolone in Acute Vestibular Vertigo

Abstract

To assess the efficacy of corticosteroids in acute vestibular vertigo, we randomly selected 20 patients so that half took methylprednisolone and half took placebo. Extensive neurotologic examination confirmed the diagnosis. If no significant reduction of vertigo occurred within the first 24 hours of treatment, patients were instructed to switch medications. Patients were followed up prospectively for 1 month. Of the 10 patients receiving methylprednisolone, 9 had a marked reduction of vertiginous symptoms and 1 switched to the placebo medication. Of the 10 patients receiving placebo, 3 had relief of vertiginous symptoms, while the 7 with persistent symptoms switched to methylprednisolone and had subsequent effective reduction of vertigo within 24 hours. The electronystagmogram returned to normal within 1 month in all 16 patients taking methylprednisolone, but remained abnormal in 2 of the 4 patients treated with placebo. One patient receiving methylprednisolone had a relapse of symptoms when the dosage was tapered, but symptoms again remitted when the dosage was increased to 32 mg/d. From this double-blind, prospective, placebo-controlled, crossover study, we conclude that methylprednisolone is much more effective than placebo in reducing vertiginous symptoms in patients with acute vestibular vertigo.

Glucocorticoids improve acute dizziness symptoms following acute unilateral vestibulopathy

“…This study confirms prior reports showing peripheral vestibular function improvement in patients with AUV receiving glucocorticoids on admission [3,20,21]. Additionally, we have shown that the improvement in canal paresis with glucocorticoid treatment correlates with a reduction in the degree of nystagmus.…”

“…Previous studies hinted that glucocorticoids may not be clinically beneficial in AUV [10], despite apparent improvement in vestibular function [3,15,17,20]. Indeed, both a systematic review [13] and later a Cochrane review of four trials found no significant difference between corticosteroid and placebo in the symptomatic recovery of vestibular function [11], but only one study had assessed symptom recovery [20], and this was not a primary study outcome.…”

Vestibular neuritis: Vertigo and the high-acceleration vestibulo-ocular reflex

“…Such an analysis is particularly important in the light of recent suggestions that steroid treatment for acute VN improves peripheral-vestibular recovery (albeit measured with the caloric test and without symptom assessment) [1,16].…”

Disconnect Between Charted Vestibular Diagnoses and Emergency Department Management Decisions: A Cross‐sectional Analysis From a Nationally Representative Sample

“…As part of the NHAMCS protocol, trained hospital staff members gather data from ED visit records during a randomly assigned 4-week data period for each Canalith-repositioning maneuvers Proven benefit 25,26 and recommended 14,15,27 Not indicated Corticosteroids Not indicated Proven benefit [28][29][30] and recommended 31,32 Vestibular sedatives Ineffective 14,15,33,34 and potentially harmful from exacerbation of balance disturbance 5,13,15 or delay in repositioning maneuvers 5,15,35 Standard treatment 8,17,20,32,36 APV = acute peripheral vestibulopathy; BPPV = benign paroxysmal positional vertigo.…”