Special goggles that allow patients to self-record ictal nystagmus may provide early and accurate diagnosis of vertigo, an Australian proof-of-concept study has found.
Sydney University researchers investigated the ability of video-oculography goggles in 117 people who had been previously diagnosed with Meniere’s disease (43 patients), vestibular migraine (67 patients) or benign paroxysmal positional vertigo (seven patients).
Led by research student Allison Young of the Institute of Clinical Neurosciences, the research team taught patients with recurrent vertigo recruited from a neurology outpatient clinic to self-record spontaneous and positional nystagmus at home while symptomatic, using the goggles.
They found that spontaneous horizontal nystagmus with SPV >12.05°/s had a sensitivity and specificity of 95.3% and 82.1% for Meniere’s disease.
Nystagmus direction change within 12 hours was also highly specific (95.7%) for Meniere’s disease. By comparison, audio tests for Meniere’s disease have both a sensitivity and specificity of 91%, the researchers noted.
Spontaneous vertical nystagmus was highly specific (93%) for vestibular migraine, but had a but a low sensitivity of 24%. For those with benign paroxysmal positional vertigo, the sensitivity was 100 percent and the specificity was 78%.
“Patient-initiated vestibular event monitoring is feasible and could facilitate rapid and accurate diagnosis of episodic vestibular disorders,” the study authors concluded.
They acknowledged limitations such as some patients not feeling well enough to wear the goggles when experiencing vertigo, and others not wearing them when they thought their vertigo was too mild. Also, some medications taken for vertigo may have influenced eye movement.
“While further studies are needed in larger groups, providing people with a pair of goggles that they can easily use at home to record eye movement has the potential to help with vertigo diagnosis not only by a neurologist in a clinic, but also by physicians in an emergency room and physicians diagnosing patients remotely as well,” commented study co-investigator Dr Miriam Welgampola, Associate Professor of Neurology at the Central Clinical School, University of Sydney.
“Event monitoring could also be useful in the emergency department, where it could serve as the link between frontline physicians who can observe ictal nystagmus but may not always possess the expertise to arrive upon a diagnosis, and specialists who possess the expertise but lack the opportunity to witness the ictus,” she wrote.
The findings are published in Neurology.