• Michael Strupp, Julia Dlugaiczyk, Birgit Bettina Ertl-Wagner, Dan Rujescu, Martin Westhofen, and Marianne Dieterich.
• Department of Neurology, Ludwig Maximilians University, Munich (LMU); German Center for Dizziness and Balance Disorders, Ludwig Maximilians University, Munich (LMU); Medical Imaging, University of Toronto, Canada; University Clinic and Outpatient Department for Psychiatry, Psychotherapy and Psychosomatics, University of Halle-Wittenberg; Department of Otorhinolaryngology and Plastic Head and Neck Surgery, University Medical Center, RWTH Aachen; Munich Cluster for Systems Neurology (SyNergy), Munich.
• Dtsch Arztebl Int. 2020 Apr 24; 117 (17): 300310300-310.

BackgroundRecent research findings have improved the understanding of the diagnosis, pathophysiology, genetics, etiology, and treatment of peripheral, central, and functional vestibular vertigo syndromes.MethodA literature search, with special attention to the current classification, treatment trials, Cochrane analyses, and other meta-analyses.ResultsThere are internationally accepted diagnostic criteria for benign positional paroxysmal vertigo, Menière's disease, bilateral vestibulopathy, vestibular paroxysmia, and functional dizziness. Whether an acute vestibular syndrome is central or peripheral can usually be determined rapidly on the basis of the history and the clinical examination. "Cere - bellar vertigo" is a clinically important entity. For bilateral vestibulopathy, balance training is an effective treatment. For Menière's disease, preventive treatment with betahistine (48 mg and 144 mg per day) is not superior to placebo. For vestibular paroxysmia, oxcarbazepine has been shown to be effective. Treatments that are probably effective for functional dizziness include vestibular rehabilitation, cognitive behavioral therapy, and serotonin reuptake inhibitors.ConclusionThe diagnostic assessment of vestibular syndromes is much easier for clinicians now that it has been internationally standardized. There is still a lack of randomized, controlled trials on the treatment of, for example, Menière's disease, vestibular migraine, and "cerebellar vertigo."

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