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Is There Any Permanent Cure For Vertigo?
Question: Hi,
My Brother XXXXXXX XXXXXXX suffering from Vertigo, Right inner ear vestibular functional disorder, balance problem anxiety and tension. He was treated by Dr XXXXXXX Choudhury of INK Kolkata, but typically still problem exists. He has undergone several tests including otoneorologist and consultant_psychiatrist. Please advise permanent medication and cure.
My Brother XXXXXXX XXXXXXX suffering from Vertigo, Right inner ear vestibular functional disorder, balance problem anxiety and tension. He was treated by Dr XXXXXXX Choudhury of INK Kolkata, but typically still problem exists. He has undergone several tests including otoneorologist and consultant_psychiatrist. Please advise permanent medication and cure.
Hi,
Thank you for your query.
1. The cause of his vertigo has been narrowed down to a severe peripheral vestibular lesion. This means that the labyrinth consisting of the semicircular canals and other structures including the Eighth Cranial Nerve or it's immediate central connections are not functioning properly. This may occur due a variety of causes such as viral, bacterial infections; alcohol induced peripheral neuropathy and so on.
2. This vestibular loss appears to be a compensated during active movements of the head as there is no nystagmus (abnormal eye movements) during the tests.
3. Certain more tests such as the (Head Impulse Test, Head angulation, Skew Deviation, Gait testing , Use of Frenzel's glasses to remove visual fixation and so on) can only be performed by direct observation. Hence you should consult a Neurotologist again.
4. Migraine associated vertigo must be ruled out since he has a history of headaches. Episodic Ataxia Type 2 must be ruled out. This worsens with activity and alcohol. The medication here is acetazolamide or 4-amionpyridine.
5. Vestibular paroxysmia should also be ruled out as the symptoms would overlap. The treatment of choice here is carbamazepine.
6. If you can upload the results of the above mentioned tests, further treatment options may be discussed.
7. In the meanwhile since Vertigon (Cinnarizine 25 mg) does not seem to be helping, you may start him on high dose Vertin (Betahistine) OD (48 mg) three times a day. Vestibular rehabilitation exercises must be continued. Alcohol must be discontinued.
I hope I have answered your query. If you have any follow up queries, I will be available to answer them.
Regards,
Thank you for your query.
1. The cause of his vertigo has been narrowed down to a severe peripheral vestibular lesion. This means that the labyrinth consisting of the semicircular canals and other structures including the Eighth Cranial Nerve or it's immediate central connections are not functioning properly. This may occur due a variety of causes such as viral, bacterial infections; alcohol induced peripheral neuropathy and so on.
2. This vestibular loss appears to be a compensated during active movements of the head as there is no nystagmus (abnormal eye movements) during the tests.
3. Certain more tests such as the (Head Impulse Test, Head angulation, Skew Deviation, Gait testing , Use of Frenzel's glasses to remove visual fixation and so on) can only be performed by direct observation. Hence you should consult a Neurotologist again.
4. Migraine associated vertigo must be ruled out since he has a history of headaches. Episodic Ataxia Type 2 must be ruled out. This worsens with activity and alcohol. The medication here is acetazolamide or 4-amionpyridine.
5. Vestibular paroxysmia should also be ruled out as the symptoms would overlap. The treatment of choice here is carbamazepine.
6. If you can upload the results of the above mentioned tests, further treatment options may be discussed.
7. In the meanwhile since Vertigon (Cinnarizine 25 mg) does not seem to be helping, you may start him on high dose Vertin (Betahistine) OD (48 mg) three times a day. Vestibular rehabilitation exercises must be continued. Alcohol must be discontinued.
I hope I have answered your query. If you have any follow up queries, I will be available to answer them.
Regards,
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear Sir,
I have uploaded 4 more reports, report_otoneorologist, stepping test, nerve condition tests. By profession, he is a tea garden employee and invariably he is involved in outdoor jobs mainly to see garden activities. In the same manner he needs to move by motor-cycle. Sometimes the problem is so acute that he faces severe balance problem and tendency to fall. Last 2 weeks he is also suffering from ear pain. What are Dos and don'ts? Is it curable/non-curable? If curable then what is the time-frame he can get rid of the same. Should he continue to work in garden activities or he should quit job and take rest? Is it operable?
What is the side effects if Vertigon/Vertin OD is continued, since these are of high dosage medicines. How long he should continue this medicine. Should he continue Paxidep CR along with this?
Which are the best Hospitals/Institute where he can get good treatment (Apollo/NIMHANS)
Please suggest affirmatively.
I have uploaded 4 more reports, report_otoneorologist, stepping test, nerve condition tests. By profession, he is a tea garden employee and invariably he is involved in outdoor jobs mainly to see garden activities. In the same manner he needs to move by motor-cycle. Sometimes the problem is so acute that he faces severe balance problem and tendency to fall. Last 2 weeks he is also suffering from ear pain. What are Dos and don'ts? Is it curable/non-curable? If curable then what is the time-frame he can get rid of the same. Should he continue to work in garden activities or he should quit job and take rest? Is it operable?
What is the side effects if Vertigon/Vertin OD is continued, since these are of high dosage medicines. How long he should continue this medicine. Should he continue Paxidep CR along with this?
Which are the best Hospitals/Institute where he can get good treatment (Apollo/NIMHANS)
Please suggest affirmatively.
Hi,
Thank you for writing back.
1. His CCG and NCS tests are within normal limits. this means that his brain has reset itself well.
2. The balance system of the ear is responsible for fast movements against gravity. Even patients with damage to both ear balance systems can manage to move about if they make no sudden movements.
3. He should definitely avoid driving and exchange the field job for a desk job.
4. Surgical options are limited trans tympanic gentamicin injection and labyrinthectomy are last resorts. There is no operation that can cure this. Vestibular implants are in the development stage at present.
5. Dr XXXXXXX Biswas is one of the leading experts on Vertigo and Balance Disorders in India. Hence there is very little possibility for any further investigation or treatment at any other institute in India.
6. Dr XXXXXXX Strupp from Frankfurt, Germany was in Kolkatta two weeks ago and this was a good opportunity as he heads one of the largest research facilities on vertigo in the world. Possibly when he or one of his contemporaries is in India next time (a few months from now) it may be possible to arrange for a consultation. You may email him at YYYY@YYYY
7. There is no harm in continuing his medication.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Thank you for writing back.
1. His CCG and NCS tests are within normal limits. this means that his brain has reset itself well.
2. The balance system of the ear is responsible for fast movements against gravity. Even patients with damage to both ear balance systems can manage to move about if they make no sudden movements.
3. He should definitely avoid driving and exchange the field job for a desk job.
4. Surgical options are limited trans tympanic gentamicin injection and labyrinthectomy are last resorts. There is no operation that can cure this. Vestibular implants are in the development stage at present.
5. Dr XXXXXXX Biswas is one of the leading experts on Vertigo and Balance Disorders in India. Hence there is very little possibility for any further investigation or treatment at any other institute in India.
6. Dr XXXXXXX Strupp from Frankfurt, Germany was in Kolkatta two weeks ago and this was a good opportunity as he heads one of the largest research facilities on vertigo in the world. Possibly when he or one of his contemporaries is in India next time (a few months from now) it may be possible to arrange for a consultation. You may email him at YYYY@YYYY
7. There is no harm in continuing his medication.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Sir,
I have asked Dr Strupp, XXXXXXX and he has replied on this. Kindly suggest further. The e-mail conversation is attached below herewith.
-----Original Message-----
From: Strupp, XXXXXXX Prof.Dr. [mailto: YYYY@YYYY ]
Sent: 05 March 2013 11:29
To: XXXXXXX XXXXXXX
Subject: AW: Right Vestibular Functional Disorder// XXXXXXX Ghosh--Kindly Help
Thank you for your kind.
Indeed, a complicated case with different diagnoses.
One possible diagnosis is vestibular migraine.
Would treat him for three months with either a Betablocker, for instance, metoprolol, 100 mg per day or topiramate, 25 mg in the morning, increase dosage to 50 mg after one week.
In the next months I will not be in India, maybe next year ...
Best, XXXXXXX
________________________________________
Von: XXXXXXX XXXXXXX [ YYYY@YYYY ]
Gesendet: Dienstag, 5. März 2013 06:18
An: Strupp, XXXXXXX Prof.Dr.
Cc: YYYY@YYYY
Betreff: Right Vestibular Functional Disorder// XXXXXXX Ghosh--Kindly Help
Dear Sir,
I got your reference from Dr XXXXXXX Bhatti, ENT Specialist, Pune, Maharastra today and feeling an urge to contact you in e-mail for my Brother’s case.
My Brother XXXXXXX XXXXXXX is suffering from acute Vertigo. He has been treated by Dr XXXXXXX Choudhury (Institute of Neuroscience, Kolkata) and investigated further by Otoneorologist Dr XXXXXXX Biswas, Kolkata.
I am uploading all the reports and prescriptions till date investigated and suggestions sought.
Problems:-
a) He is suffering from Balance almost throughout the day.
b) Tremendous Vomiting Tendency throughout and tend to fall at times
c) Giddiness & Dizziness throughout the day.
d) Weakness after dizziness.
Present dosage is “Vertigon 25 half Tab at night, Paxidep CR one Tab at night”.
We desperately request your suggestion on medications or change/suggestion in current Medications. Request on DOS and DONTS on the same as he is engaged in field job in Tea Garden in upper part of Assam.
We would be delighted if we can contact you in Kolkata or any other part of India in your next visit in a month or so and we can plan accordingly. Request you to kindly let us know your India Visit schedule.
Sir, kindly reply at earliest available opportunity.
Thanking You
With Warm Regards XXXXXXX XXXXXXX
I have asked Dr Strupp, XXXXXXX and he has replied on this. Kindly suggest further. The e-mail conversation is attached below herewith.
-----Original Message-----
From: Strupp, XXXXXXX Prof.Dr. [mailto: YYYY@YYYY ]
Sent: 05 March 2013 11:29
To: XXXXXXX XXXXXXX
Subject: AW: Right Vestibular Functional Disorder// XXXXXXX Ghosh--Kindly Help
Thank you for your kind.
Indeed, a complicated case with different diagnoses.
One possible diagnosis is vestibular migraine.
Would treat him for three months with either a Betablocker, for instance, metoprolol, 100 mg per day or topiramate, 25 mg in the morning, increase dosage to 50 mg after one week.
In the next months I will not be in India, maybe next year ...
Best, XXXXXXX
________________________________________
Von: XXXXXXX XXXXXXX [ YYYY@YYYY ]
Gesendet: Dienstag, 5. März 2013 06:18
An: Strupp, XXXXXXX Prof.Dr.
Cc: YYYY@YYYY
Betreff: Right Vestibular Functional Disorder// XXXXXXX Ghosh--Kindly Help
Dear Sir,
I got your reference from Dr XXXXXXX Bhatti, ENT Specialist, Pune, Maharastra today and feeling an urge to contact you in e-mail for my Brother’s case.
My Brother XXXXXXX XXXXXXX is suffering from acute Vertigo. He has been treated by Dr XXXXXXX Choudhury (Institute of Neuroscience, Kolkata) and investigated further by Otoneorologist Dr XXXXXXX Biswas, Kolkata.
I am uploading all the reports and prescriptions till date investigated and suggestions sought.
Problems:-
a) He is suffering from Balance almost throughout the day.
b) Tremendous Vomiting Tendency throughout and tend to fall at times
c) Giddiness & Dizziness throughout the day.
d) Weakness after dizziness.
Present dosage is “Vertigon 25 half Tab at night, Paxidep CR one Tab at night”.
We desperately request your suggestion on medications or change/suggestion in current Medications. Request on DOS and DONTS on the same as he is engaged in field job in Tea Garden in upper part of Assam.
We would be delighted if we can contact you in Kolkata or any other part of India in your next visit in a month or so and we can plan accordingly. Request you to kindly let us know your India Visit schedule.
Sir, kindly reply at earliest available opportunity.
Thanking You
With Warm Regards XXXXXXX XXXXXXX
Hi,
Thank you for writing back.
1. I think the best option is to discuss this with your doctor.
2. You may start the treatment suggested by Dr. Strupp over the next three months.
3. Kindly follow up here on a monthly basis with the progress. There is a direct query page at bit.ly/dr-sumit-bhatti.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Thank you for writing back.
1. I think the best option is to discuss this with your doctor.
2. You may start the treatment suggested by Dr. Strupp over the next three months.
3. Kindly follow up here on a monthly basis with the progress. There is a direct query page at bit.ly/dr-sumit-bhatti.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Sir,
Basis suggestions sought from you and Prof XXXXXXX I have again consulted Neorologist Mr. XXXXXXX Choudhury yesterday and have suggested new medicines basis My brother's present problem and condition. I have uploaded latest report INK_Tridib_Choudhry_latest_Prescription_0000. He clearly told me that this is not the case of Vestibular Migraine and has suggested for attached medicine with immediate effect.
Kindly suggest further.
With Warm Regards XXXXXXX
Basis suggestions sought from you and Prof XXXXXXX I have again consulted Neorologist Mr. XXXXXXX Choudhury yesterday and have suggested new medicines basis My brother's present problem and condition. I have uploaded latest report INK_Tridib_Choudhry_latest_Prescription_0000. He clearly told me that this is not the case of Vestibular Migraine and has suggested for attached medicine with immediate effect.
Kindly suggest further.
With Warm Regards XXXXXXX
Hi,
Thank you for writing back.
1. It s interesting to note that in spite of not agreeing he has started Betahistine (Zevert) as per my suggestion and Topitamate (Topirol) as per Dr. Strupp's suggestion.
2. It will now be prudent to observe his process over the next few months.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Thank you for writing back.
1. It s interesting to note that in spite of not agreeing he has started Betahistine (Zevert) as per my suggestion and Topitamate (Topirol) as per Dr. Strupp's suggestion.
2. It will now be prudent to observe his process over the next few months.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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