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Nervenheilkunde 2023; 42(01/02): 8-20
DOI: 10.1055/a-1928-4776
Schwerpunkt

Die sechs häufigsten peripherenvestibulären Syndrome

The six most frequent peripheral vestibular syndromes
Michael Strupp
1   Neurologische Klinik und Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ), Klinikum der Ludwig Maximilians Universität, München
,
Andreas Zwergal
1   Neurologische Klinik und Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ), Klinikum der Ludwig Maximilians Universität, München
,
Nicolina Goldschagg
1   Neurologische Klinik und Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ), Klinikum der Ludwig Maximilians Universität, München
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ZUSAMMENFASSUNG

Periphere vestibuläre Syndrome beruhen auf einer Funktionsstörung des Labyrinths und/oder des Nervus vestibulocochlearis. Phänomenologisch und pathophysiologisch lassen sich 3 Formen klinisch unterscheiden: 1. Rezidivierende Schwindelepisoden mit je nach Ursache unterschiedlicher Dauer, unterschiedlichen Begleitsymptomen und Auslösern. Die zugrunde liegenden Erkrankungen sind der Benigne periphere paroxysmale Lagerungsschwindel, Morbus Menière, Vestibularisparoxysmie und das Syndrom der dritten mobilen Fenster. 2. Das akute vestibuläre Syndrom, bedingt durch eine akute vestibuläre Tonusdifferenz mit dem Leitsymptom heftiger langdauernder Drehschwindel: die akute unilaterale Vestibulopathie/Neuritis vestibularis. 3. Persistierender Schwankschwindel und Gangunsicherheit bedingt durch ein bilaterales vestibuläres Defizit: die bilaterale Vestibulopathie. Für alle diese Erkrankungen liegen Diagnosekriterien der Bárány-Society vor, die gleichermaßen wichtig sind für die klinische Praxis und für wissenschaftliche Studien. Für die Behandlung peripherer vestibulärer Syndrome werden in Abhängigkeit von der Ursache 5 Therapieprinzipien eingesetzt: 1. Sorgfältige Aufklärung des Patienten über Art und Ursache der Beschwerden und die Therapieeffekte; dies ist auch wichtig für die Compliance des Patienten. 2. Physikalisch-medizinische Behandlung: A) Bogengangspezifische Befreiungsmanöver: für den posterioren Kanal das SémontPlus-Manöver, das dem Sémont- und Epley- Manöver überlegen ist; für den horizontalen Kanal das modifizierte Roll-Manöver und für den anterioren Bogengang das modifizierte Yacovino-Manöver. B) Balancetraining bei sensorischen Defiziten (hohe Evidenz). 3. Symptomatische oder kausale medikamentöse Behandlung. Hier mangelt es weiterhin an placebokontrollierten Pharmakotherapiestudien, sodass die Evidenzlage niedrig ist und ein hoher klinischer Forschungsbedarf besteht. 4. Operative Maßnahmen, z. B. bei dem Syndrom der dritten mobilen Fenster. 5. Bei funktionellem Schwindel psychotherapeutische Verfahren.

ABSTRACT

Three forms of peripheral vestibular disorders, each with its typical symptoms and clinical signs, can be differentiated functionally, anatomically and pathophysiologically: 1. inadequate unilateral paroxysmal stimulation or rarely inhibition of the peripheral vestibular system, e. g., BPPV, Menière’s disease, vestibular paroxysmia or syndrome of the third mobile windows; 2. acute unilateral vestibulopathy leading to an acute vestibular tone imbalance manifesting as an acute peripheral vestibular syndrome; and 3. loss or impairment of function of the vestibular nerve and/or labyrinth: bilateral vestibulopathy. For all of these diseases, current diagnostic criteria by the Bárány-Society are available with a high clinical and scientific impact, also for clinical trials. The treatment depends on the underlying disease. It basically consists of 5 principles: 1. Explaining the symptoms and signs, pathophysiology, aetiology and treatment options to the patient; this is important for compliance, adherence and persistence. 2. Physical therapy: A) For BPPV specific liberatory maneuvers, depending on canal involved. Posterior canal: The new SémontPLUS maneuver is superior to the regular Sémont and Epley maneuvers; horizontal canal: the modified roll-maneuver; anterior canal the modified Yacovino-maneuver; 3. Symptomatic or causative drug therapy. There is still a deficit of placebo-controlled clinical trials so that the level of evidence for pharmacotherapy is most often low. 4. Surgery, mainly for the syndrome of the third mobile windows. 5. Psychotherapeutic measures for secondary functional dizziness.

Schlüsselwörter

Benigner peripherer paroxysmaler Lagerungsschwindel - akute unilaterale Vestibulopathie - Morbus Menière - bilaterale Vestibulopathie - Vestibularisparoxysmie - Syndrom der dritten mobilen Fenster

Key words

Benign paroxysmal positional vertigo - acute unilateral vestibulopathy - Meniere’s disease - bilateral vestibulopathy - vestibular paroxysmia - syndrome of the third mobile windows


Publication History

Article published online:
13 February 2023

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