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Periphere, zentrale und funktionelle Schwindelsyndrome

Peripheral, central and functional vertigo syndromes

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Zusammenfassung

In Abhängigkeit vom zeitlichen Verlauf lassen sich drei Formen von Schwindelsyndromen unterscheiden: 1) Schwindelattacken (z. B. benigner peripherer paroxysmaler Lageschwindel [BPPV], Morbus Menière, vestibuläre Migräne), 2) akut einsetzender über Tage anhaltender Schwindel (z. B. akute einseitige Vestibulopathie, Hirnstamm- oder Kleinhirninfarkt), 3) über Monate bis Jahre dauernde Symptome (z. B. bilaterale Vestibulopathie, funktioneller Schwindel). Die spezifische Therapie der verschiedenen Syndrome beruht im Wesentlichen auf drei Prinzipen: 1) physikalische Behandlung mit Befreiungsmanövern bei BPPV und Balancetraining bei vestibulärem Defizit; 2) Pharmakotherapie z. B. bei akuter einseitiger Vestibulopathie (Kortikosteroide) oder Morbus Menière (transtympanale Gentamycin- oder Steroidapplikation, Hochdosistherapie mit Betahistin); placebokontrollierte Pharmakotherapiestudien werden derzeit für akute einseitige Vestibulopathie, Vestibularisparoxysmie, Prophylaxe des BPPV, vestibuläre Migräne, episodische Ataxie Typ 2 und zerebelläre Ataxien durchgeführt; 3) Psychotherapie bei funktionellem Schwindel.

Summary

Depending on the temporal course, three forms of vertigo syndrome can be differentiated: 1) vertigo attacks, e.g. benign paroxysmal positional vertigo (BPPV), Menière’s disease and vestibular migraine, 2) acute spontaneous vertigo lasting for days, e.g. acute unilateral vestibulopathy, brainstem or cerebellar infarction and 3) symptoms lasting for months or years, e.g. bilateral vestibulopathy and functional vertigo. The specific therapy of the various syndromes is based on three principles: 1) physical treatment with liberatory maneuvers for BPPV and balance training for vestibular deficits, 2) pharmacotherapy, e.g. for acute unilateral vestibulopathy (corticosteroids) and Menière’s disease (transtympanic administration of gentamicin or steroids and high-dose betahistine therapy); placebo-controlled pharmacotherapy studies are currently being carried out for acute unilateral vestibulopathy, vestibular paroxysmia, prophylaxis of BPPV, vestibular migraine, episodic ataxia type 2 and cerebellar ataxia; 3) psychotherapy for functional dizziness.

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Danksagung

Arbeiten zu dieser Publikation wurden vom BMBF unterstützt (Förderkennzeichen 01 EO 0901).

Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Strupp ist Joint Chief Editor von Journal of Neurology, Editor in Chief von Frontiers of Neuro-otology und Section Editor von F1000. Er hat Vortragshonorare erhalten von Abbott, Actelion, UCB, GSK, TEVA, Biogen, Pierre-Fabre, Eisai, MSD und Hennig Pharma. Er war als Berater tätig für Abbott und Actelion. M. Dieterich, A. Zwergal und T. Brandt geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Neurologische Klinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    M. Strupp FANA, FEAN, M. Dieterich & A. Zwergal

  2. Deutsches Schwindel- und Gleichgewichtszentrum, Klinikum der Universität München, Campus Großhadern, München, Deutschland

    M. Strupp FANA, FEAN, M. Dieterich, A. Zwergal & T. Brandt

  3. Institut für Klinische Neurowissenschaften, Klinikum der Universität München, Campus Großhadern, München, Deutschland

    T. Brandt

  4. SyNergy, Munich Cluster for Systems Neurology, München, Deutschland

    M. Dieterich

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  1. M. Strupp FANA, FEAN
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  2. M. Dieterich
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  3. A. Zwergal
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  4. T. Brandt
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Correspondence to M. Strupp FANA, FEAN.

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Strupp, M., Dieterich, M., Zwergal, A. et al. Periphere, zentrale und funktionelle Schwindelsyndrome. Nervenarzt 86, 1573–1587 (2015). https://doi.org/10.1007/s00115-015-4425-3

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