The beneficial effect of methylprednisolone in acute vestibular vertigo. Prednisone treatment for vestibular neuritis. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis.
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. To evaluate the value of corticosteroids in the treatment of vestibular neuritis (VN).
                Prospective controlled randomized.
                Thirty VN patients, 15 in the study and 15 in the control group, were the subjects of the study. The study group was treated by 1 mg/kg prednisone for 5 days, followed by gradually reduced doses of prednisone for an additional 15 days, and vestibular sedatives for symptomatic relief during the first 5 days after presentation. The control group received a placebo and similar vestibular sedatives. The patients had a baseline evaluation and follow-up examinations after 1, 3, 6, and 12 months. The groups were compared for the presence of symptoms and signs, caloric lateralization on the electronystagmography (ENG), the presence of other pathologic findings in the ENG, and Dizziness Handicap Inventory scores.
                No differences were found between the groups in the occurrence of symptoms and signs, degree of caloric lateralization, presence of other ENG pathologic findings, and Dizziness Handicap Inventory scores at the end of the study. Complete resolution was observed in 64% of the study and in 80% of the control group. The study group showed earlier recovery of ENG lateralization at the 1- and 3-month follow-up evaluations and higher rates of complete resolution at the 3- and 6-month follow-up points.
                Prednisone therapy might enhance earlier recovery but does not improve the long-term prognosis of VN. The clinical and laboratory parameters in VN are not correlated, and both are required for complete patient evaluation. Vestibular neuritis is the second most common cause of peripheral vestibular vertigo. Its assumed cause is a reactivation of herpes simplex virus type 1 infection. Therefore, corticosteroids, antiviral agents, or a combination of the two might improve the outcome in patients with vestibular neuritis.
                We performed a prospective, randomized, double-blind, two-by-two factorial trial in which patients with acute vestibular neuritis were randomly assigned to treatment with placebo, methylprednisolone, valacyclovir, or methylprednisolone plus valacyclovir. Vestibular function was determined by caloric irrigation, with the use of the vestibular paresis formula (to measure the extent of unilateral caloric paresis) within 3 days after the onset of symptoms and 12 months afterward.
                Of a total of 141 patients who underwent randomization, 38 received placebo, 35 methylprednisolone, 33 valacyclovir, and 35 methylprednisolone plus valacyclovir. At the onset of symptoms there was no difference among the groups in the severity of vestibular paresis. The mean (+/-SD) improvement in peripheral vestibular function at the 12-month follow-up was 39.6+/-28.1 percentage points in the placebo group, 62.4+/-16.9 percentage points in the methylprednisolone group, 36.0+/-26.7 percentage points in the valacyclovir group, and 59.2+/-24.1 percentage points in the methylprednisolone-plus-valacyclovir group. Analysis of variance showed a significant effect of methylprednisolone (P<0.001) but not of valacyclovir (P=0.43). The combination of methylprednisolone and valacyclovir was not superior to corticosteroid monotherapy.
                Methylprednisolone significantly improves the recovery of peripheral vestibular function in patients with vestibular neuritis, whereas valacyclovir does not.
                Copyright 2004 Massachusetts Medical Society