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Methylprednisolone, valacyclovir, or the combination for vestibular neuritis.

TitleMethylprednisolone, valacyclovir, or the combination for vestibular neuritis.
Publication TypeJournal Article
Year of Publication2004
AuthorsStrupp M, Zingler VCarina, Arbusow V, Niklas D, Maag KPeter, Dieterich M, Bense S, Theil D, Jahn K, Brandt T
JournalN Engl J Med
Volume351
Issue4
Pagination354-61
Date Published2004 Jul 22
ISSN1533-4406
KeywordsAcyclovir, Adolescent, Adult, Aged, Analysis of Variance, Antiviral Agents, Caloric Tests, Double-Blind Method, Drug Therapy, Combination, Factor Analysis, Statistical, Female, Glucocorticoids, Humans, Male, Methylprednisolone, Middle Aged, Prospective Studies, Treatment Outcome, Valine, Vestibular Neuronitis
Abstract

<p><b>BACKGROUND: </b>Vestibular neuritis is the second most common cause of peripheral vestibular vertigo. Its assumed cause is a reactivation of herpes simplex virus type 1 infection. Therefore, corticosteroids, antiviral agents, or a combination of the two might improve the outcome in patients with vestibular neuritis.</p><p><b>METHODS: </b>We performed a prospective, randomized, double-blind, two-by-two factorial trial in which patients with acute vestibular neuritis were randomly assigned to treatment with placebo, methylprednisolone, valacyclovir, or methylprednisolone plus valacyclovir. Vestibular function was determined by caloric irrigation, with the use of the vestibular paresis formula (to measure the extent of unilateral caloric paresis) within 3 days after the onset of symptoms and 12 months afterward.</p><p><b>RESULTS: </b>Of a total of 141 patients who underwent randomization, 38 received placebo, 35 methylprednisolone, 33 valacyclovir, and 35 methylprednisolone plus valacyclovir. At the onset of symptoms there was no difference among the groups in the severity of vestibular paresis. The mean (+/-SD) improvement in peripheral vestibular function at the 12-month follow-up was 39.6+/-28.1 percentage points in the placebo group, 62.4+/-16.9 percentage points in the methylprednisolone group, 36.0+/-26.7 percentage points in the valacyclovir group, and 59.2+/-24.1 percentage points in the methylprednisolone-plus-valacyclovir group. Analysis of variance showed a significant effect of methylprednisolone (P<0.001) but not of valacyclovir (P=0.43). The combination of methylprednisolone and valacyclovir was not superior to corticosteroid monotherapy.</p><p><b>CONCLUSIONS: </b>Methylprednisolone significantly improves the recovery of peripheral vestibular function in patients with vestibular neuritis, whereas valacyclovir does not.</p>

DOI10.1056/NEJMoa033280
Alternate JournalN. Engl. J. Med.
Citation KeyCK65
PubMed ID15269315