Summary of December 2023 Topic: Outcome predictors in dizziness

The first article aimed to investigate illness perceptions, cognitive, and behavioral responses with vertigo and dizziness (VD)-related handicap over 12 months. This longitudinal study examined 161 patients at baseline, 6-month follow-up, and 12-month follow-up after undergoing neurological, and psychiatric evaluations, and comprehensive psychological assessment with self-reported questionnaires. Results showed that perceived illness, depression, and anxiety are associated with the long-term course of VD-related handicap and imply that mental comorbidity seems to have a persistent impact on VD. (1)

The next article prospectively investigated 754 patients with chronic vertigo and dizziness to determine risk factors for favorable and unfavorable outcomes after being subjected to a 5-day multimodal and interdisciplinary day care treatment. Several questionnaires, including the Vertigo Severity Scale (VSS) and Hospital Anxiety and Depression Scale (HADS), were taken at baseline and after six months. Results revealed that attitudes towards dizziness, understanding the somatic causes, and the perceived ability to influence dizziness were the most improved. Unfavorable outcomes included the presence of depressive symptoms, a longer disease duration, higher VSS, and distinct diagnoses, including central vertigo and multisensory deficits. Therefore, the authors concluded that patients with unfavorable outcomes likely can benefit from adapted and customized interventions to improve long-term outcomes. (2)

The purpose of the third article was to investigate the risk factors for residual dizziness (RD) in patients successfully treated for benign paroxysmal positional vertigo (BPPV). The risk factors found were age, female gender, secondary BPPV, a longer duration of BPPV before treatment, abnormal ocular vestibular evoked myogenic potential, abnormal cervical vestibular evoked myogenic potential, higher Dizziness Handicap Index score before treatment, anxiety, osteopenia, onset in winter, and with a history of BPPV. The authors conclude that early recognition of these risk factors can help prevent and treat RD. (3)

The last article aimed to examine the factors of long-term functioning and health-related quality of life (HRQoL) in patients with vestibular stroke. This was a prospective study of thirty-six patients over an average of 30.2 months. Quality of life, symptom severity, and general function and disability were taken via several questionnaires less than 24 hours after symptom onset and at least one year after stroke. Stroke volume and localization were also analyzed. Results showed the overall prognosis of vestibular stroke was favorable. The most important prognostic markers for individual outcomes include personal anxiety trait, initial symptom intensity, and lesion volume. Therefore, the authors concluded that interventions should be tailored to the patient’s risk factors and psychological therapy elements should be considered in case of high anxiety traits. (4)

Wolf J, Limburg K, Sattel H, Lahmann C. Perceived illness consequences predict the long-term course of handicap in patients with vertigo and dizziness beyond vestibular abnormality. J Psychosom Res. 2023;172:111401. doi:10.1016/j.jpsychores.2023.111401
Prell T, Finn S, Zipprich HM, Axer H. What Predicts Improvement of Dizziness after Multimodal and Interdisciplinary Day Care Treatment?. J Clin Med. 2022;11(7):2005. Published 2022 Apr 3. doi:10.3390/jcm11072005
Ke Y, Ma X, Jing Y, Diao T, Yu L. Risk factors for residual dizziness in patients with benign paroxysmal positional vertigo after successful repositioning: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2022;279(7):3237-3256. doi:10.1007/s00405-022-07288-9
Schuhbeck F, Strobl R, Conrad J, et al. Determinants of functioning and health-related quality of life after vestibular stroke. Front Neurol. 2022;13:957283. Published 2022 Sep 8. doi:10.3389/fneur.2022.957283