By Marcello Cherchi, MD PhD
For patients
Corticosteroids are not used very much in treating diseases that cause disequilibrium.
For clinicians
Overview
Corticosteroids have a limited role in otoneurology. Perhaps the most common use is as a migraine abortive for migraine associated vertigo. The use of corticosteroids in the management of vestibular neuritis is controversial, and current meta-analyses suggest that this is no more efficacious than placebo. Rarer uses of corticosteroids include in the management of central nervous system lymphoma, demyelinating disease, bacterial meningitis, paraneoplastic syndromes and central nervous system vasculitis.
Discussion
There are very few circumstances in which corticosteroids play any role in management of central vertigo. In these instances, the symptom of vertigo reflects involvement of vestibular-sensitive neuroanatomical structures that happen to be affected by a broader disease process whose management involves steroids. Possible examples include:
- To abort migraine, including perhaps migraine associated vertigo (MAV).
- Vestibular neuritis (VN). There is debate in the literature regarding the relevance of corticosteroids in the acute management of VN (Goudakos et al. 2014; Ismail et al. 2019; Kim et al. 2022; Strupp et al. 2004; Yoo et al. 2017). As of this writing, meta-analyses suggest that corticosteroids are not superior to placebo (Fishman et al. 2011; Leong et al. 2021; Yoo et al. 2017), though some clinicians still use corticosteroids for this purpose.
- Central nervous system lymphoma involving vestibular-sensitive structures such as the brainstem or cerebellum (Sasahara et al. 2000).
- Acute management of an exacerbation of demyelinating disease, such as multiple sclerosis, involving vestibular-sensitive structures (Surmeli et al. 2020).
- Acute management of bacterial meningitis.
- Acute management of immune-mediated conditions, such as paraneoplastic syndromes and autoimmune channelopathies (Vernino 2007).
- Acute management of central nervous system vasculitis. Patients with these diseases rarely experience vertigo in isolation, and thus do not usually present first to an otoneurology clinic.
References
Fishman JM, Burgess C, Waddell A (2011) Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis). Cochrane Database Syst Rev: CD008607. doi: 10.1002/14651858.CD008607.pub2
Goudakos JK, Markou KD, Psillas G, Vital V, Tsaligopoulos M (2014) Corticosteroids and vestibular exercises in vestibular neuritis. Single-blind randomized clinical trial. JAMA Otolaryngol Head Neck Surg 140: 434-40. doi: 10.1001/jamaoto.2014.48
Ismail EI, Morgan AE, Abdel Rahman AM (2019) Corticosteroids versus vestibular rehabilitation in long-term outcomes in vestibular neuritis. J Vestib Res. doi: 10.3233/VES-180645
Kim G, Seo JH, Lee SJ, Lee DH (2022) Therapeutic effect of steroids on vestibular neuritis: Systematic review and meta-analysis. Clin Otolaryngol 47: 34-43. doi: 10.1111/coa.13880
Leong KJ, Lau T, Stewart V, Canetti EFD (2021) Systematic Review and Meta-analysis: Effectiveness of Corticosteroids in Treating Adults With Acute Vestibular Neuritis. Otolaryngol Head Neck Surg: 194599820982910. doi: 10.1177/0194599820982910
Sasahara A, Kawamata T, Kubo O, Okami N, Kawamura H, Hori T (2000) [Primary central nervous system malignant lymphoma originating from the cerebellum and extending along the lower cranial nerves]. No Shinkei Geka 28: 879-83.
Strupp M, Zingler VC, Arbusow V, Niklas D, Maag KP, Dieterich M, Bense S, Theil D, Jahn K, Brandt T (2004) Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N Engl J Med 351: 354-61. doi: 10.1056/NEJMoa033280
Surmeli R, Surmeli M, Yalcin AD, Yilmaz AAS, Kucuk F (2020) Multiple sclerosis attack case presenting with pseudo-vestibular neuritis. Int J Neurosci: 1-5. doi: 10.1080/00207454.2020.1829617
Vernino S (2007) Autoimmune and paraneoplastic channelopathies. Neurotherapeutics 4: 305-14. doi: 10.1016/j.nurt.2007.01.007
Yoo MH, Yang CJ, Kim SA, Park MJ, Ahn JH, Chung JW, Park HJ (2017) Efficacy of steroid therapy based on symptomatic and functional improvement in patients with vestibular neuritis: a prospective randomized controlled trial. Eur Arch Otorhinolaryngol 274: 2443-2451. doi: 10.1007/s00405-017-4556-1
