Forthcoming treatment of vertigo/dizziness

Abstract

Although dizziness is very common symptom, there are few specific treatments for dizziness. In dizziness of peripheral origin, benign paroxysmal positional vertigo can be treated with otolith repositioning maneuver. Ménière's disease can also be treated specifically although effectiveness is not enough. On the other hand, there have been no specific treatments for the dizziness of central origin. Recently, we indicated that chronic post–lateral medullary infarction dizziness was caused by a cerebellar control disorder of the vestibulo–ocular reflex (VOR). Based on this, we enrolled patients with chronic post–lateral medullary infarction dizziness, applied cerebellar repetitive transcranial magnetic stimulation (rTMS) to improve cerebellar control of VOR, and followed these patients up for up to 25 months for clinical symptoms, signs, and neurophysiological examinations. This study indicated that cerebellar rTMS appeared to be effectual for treatment of chronic post–lateral medullary infarction dizziness. We also successfully treated ocular flutter/opsolconus, which were caused by cerebellar control disorder of the fastigial nucleus, with cerebellar rTMS. Improving cerebellar control of vestibular or deep cerebellar nuclei by cerebellar rTMS may become a forthcoming treatment of dizziness of central origin.