From the Guidelines
Treatment for vestibular disequilibrium should prioritize canalith repositioning procedures, such as the Epley maneuver, for patients with posterior canal BPPV, as recommended by the strongest and most recent evidence 1.
Key Considerations
- The diagnosis of BPPV should be made based on the Dix-Hallpike maneuver and the presence of torsional, upbeating nystagmus 1.
- Vestibular rehabilitation therapy, including gaze stabilization, balance training, and habituation exercises, may be offered as an option for the treatment of BPPV 1.
- Lifestyle modifications, such as staying hydrated, avoiding sudden head movements, and reducing consumption of alcohol, caffeine, and salt, are also important for managing vestibular disequilibrium.
- Patient education regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up is crucial 1.
Treatment Options
- Canalith repositioning procedures, such as the Epley maneuver, are highly effective for treating posterior canal BPPV 1.
- Vestibular rehabilitation therapy may be beneficial for improving long-term outcomes and reducing recurrence rates of BPPV 1.
- Medications, such as meclizine, diazepam, and promethazine, may be used to manage acute vertigo, but are not recommended for routine treatment of BPPV 1.
Important Recommendations
- Clinicians should not recommend postprocedural postural restrictions after canalith repositioning procedure for posterior canal BPPV 1.
- Clinicians should reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms 1.
- Clinicians should evaluate patients with persistent symptoms for unresolved BPPV and/or underlying peripheral vestibular or central nervous system disorders 1.
From the FDA Drug Label
Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults. Recommended dosage: 25 mg to 100 mg daily, in divided doses. The treatment for vestibular disequilibrium is meclizine with a recommended dosage of 25 mg to 100 mg daily, in divided doses 2.
- Key points:
- Indication: treatment of vertigo associated with diseases affecting the vestibular system in adults
- Dosage: 25 mg to 100 mg daily, in divided doses
- Administration: tablets should be swallowed whole 2.
From the Research
Vestibular Disequilibrium Treatment
- Vestibular rehabilitation therapy (VRT) is an exercise-based treatment program designed to promote vestibular adaptation and substitution, with goals including enhancing gaze stability, postural stability, improving vertigo, and improving activities of daily living 3.
- VRT facilitates vestibular recovery mechanisms, including vestibular adaptation, substitution by other eye-movement systems, substitution by vision, somatosensory cues, and habituation 3.
- Key exercises for VRT include head-eye movements with various body postures and activities, maintaining balance with a reduced support base, and repeating movements that provoke vertigo 3.
- Vestibular rehabilitation is also effective in improving symptoms of imbalance, falls, fear of falling, oscillopsia, dizziness, vertigo, motion sensitivity, and secondary symptoms such as nausea and anxiety 4.
Effectiveness of Vestibular Rehabilitation
- Exercise-based vestibular rehabilitation has been shown to be effective in adult patients with chronic dizziness, with improvements in vertigo symptom scale, fall risk, balance, and emotional status 5.
- A systematic review of randomized controlled trials found that vestibular rehabilitation was associated with significant improvements in symptoms and functional outcomes in patients with vestibular disorders 5.
- The Academy of Neurologic Physical Therapy of the American Physical Therapy Association recommends vestibular rehabilitation for adults with unilateral and bilateral vestibular hypofunction, with strong evidence supporting its effectiveness in reducing symptoms and improving function 6.
Considerations for Treatment
- Vestibular suppressants, such as meclizine and benzodiazepines, are not recommended for routine use in patients with dizziness due to the potential risk of falls 7.
- A retrospective study found that patients who filled a vestibular suppressant prescription were more likely to experience a fall resulting in a medical encounter within 60 days of filling the prescription 7.
- Clinicians should consider factors such as time from onset of symptoms, comorbidities, cognitive function, and use of medication when evaluating rehabilitation outcomes 6.