Health-related quality of life and functional impairment in acute vestibular disorders.
Eur J Neurol. 2020;10.1111/ene.14318. doi:10.1111/ene.14318 [published online ahead of print, 2020 May 13]
|Authors/Editors:||Möhwald K, Hadzhikolev H, Bardins S, Becker-Bense S, Brandt T, Grill E, Jahn K, Dieterich M, Zwergal A.|
Background: Acute vestibular symptoms have a profound impact on patients' well-being. In this study, health-related quality of life (HRQoL) and functional impairment were investigated prospectively in patients with different peripheral and central vestibular disorders during the acute symptomatic stage to decipher the most relevant underlying factors.
Methods: 175 patients with acute vestibular disorders were categorized in central vestibular (CV, n=40), peripheral vestibular (PV, n=68) and episodic vestibular disorders (EV, n=67). All patients completed scores to quantify generic HRQoL (EQ-5D-5L) and disease-specific HRQoL (Dizziness Handicap Inventory, DHI). Vestibular-ocular motor signs were assessed by video-oculography, vestibular-spinal control by posturography and verticality perception by measurement of subjective visual vertical (SVV).
Results: Patients with PV had a poorer HRQoL compared to patients with CV and EV (EQ-5D-5L/DHI: PV: 0.53±0.31/56.1±19.7; CV: 0.66±0.28/43.3±24.0; EV: 0.75±0.24/46.7±21.4). After adjusting for age, gender, cardiovascular risk factors and non-vestibular brainstem/cerebellar dysfunction patients with PV persisted to have poorer generic and disease-specific HRQoL (EQ-5D-5L: -0.17, DHI: +11.2) than patients with CV. Horizontal spontaneous nystagmus (SPN) was a highly relevant factor for subgroup differences in EQ-5D-5L and DHI, while vertical SPN, SVV and sway path were not. EQ-5D-5L decreased significantly with more intense horizontal SPN in CV (Rho=-0.57) and PV (Rho=-0.5), but not EV (Rho=-0.13).
Conclusions: Patients with PV have the highest functional impairment of all patients with acute vestibular disorders. Vestibular-ocular motor disturbance in the yaw plane has more impact than vestibular-spinal or -perceptive asymmetry in the roll and pitch plane, suggesting that horizontal visual stability is most critical for HRQoL.