PubMed · 10028975
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R Moss-Morris, K J Petrie. 1999-02-13. Link between psychiatric dysfunction and dizziness.. https://doi.org/10.1016/s0140-6736(98)00348-1
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Handicap of the patient with vestibular disease can be measured by means of scales and questionnaires. The utility of a questionnaire developed and validated in Spanish language is commented (CEMPV). The CEMPV consists of 46 questions distributed in three scales (emotional, functional and organic) whose obtained scores are related to diverse degrees of handicap (global, emotional, functional and organic). The CEMPV is self-employed and evaluates the evolution of the patient and allows to accredit the results obtained between different investigators.
A method has been developed for objective assessment of balance using ultrasound time-of-flight (ToF) posturography measurements to accurately locate the centre of gravity (CoG) of a subject. Two orthogonal 40 kHz ultrasound transmitters are mounted on the subject's waist at the height of the CoG. Anterior/posterior and lateral motions are detected independently by measuring variations in the ToF from the transmitters to appropriately positioned wall-mounted receivers. The motion of the CoG is accurately traced during the course of 20 second assessment periods as the subject stands on a solid surface with eyes open and eyes closed. The tests are repeated with the subject standing on a standardized soft surface. Trials of day-to-day repeatability and repeated tests on patients prior to therapy indicate there is no significant improvement to balance measures with experience of the system. Balance measures are significantly worse in patients suffering vertigo symptoms following traumatic brain injury than for equivalent normal volunteers. Repeated measures post-therapy indicate significant improvement in balance measures following vestibular therapy in patients with vertigo. CoG location using ultrasound ToF is a suitable method of tracking sway and thus assessing balance in normals and balance-compromised patients.
The symptom of vertigo is usually managed in primary care without further referral. This review examines the evidence on which general practitioners can base clinical diagnosis and management of this relatively common complaint. Research in this area has in the main been from secondary and tertiary centres and has been of variable quality. Indications are that the conditions that present in general practice are most likely to be benign positional vertigo, acute vestibular neuronitis, and Ménière's disease; however, vascular incidents and neurological causes, such as multiple sclerosis, must be kept in mind. An important practice point is that vestibular sedatives are not recommended on a prolonged basis for any type of vertigo. There is a need for basic epidemiological and clinical management research of vertigo in general practice.