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BPPV - Duration of Dizziness
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BPPV - Duration of Dizziness

Does anyone here with benign paroxysmal positional vertigo (BPPV) have their dizziness last more than a few minutes at a time as the literature says it will?  I'm on day 4 of feeling like I'm on an elevator (constantly moving and off balance) - not spinning vertigo, just really off balance.  As long as I'm sitting still it is not a problem.  

I see the vestibular rehab therapist again tomorrow and wonder if BPPV is causing all of my problems or is just one of multiple ones?


Any insight into MS and dizziness will also be appreciated as we try to work through this one!

my best,
Lulu
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847433_tn?1243013252
Lulu,
I have had benign vestibular type vertigo( i think thats what ur talking about) for about 26 years.  I had a car accident and smashed my head, concussion and ended up with vertigo.  My neuro at the time said "Well it can go away tomorrow or it can last the rest of your life".  Well its 26 years later and I still have it maybe a few times a year.  Yes vertigo feels very different than dizziness, i believe the definition is something like the sensation of inanimate objects moving in space.  when I get it it will last ususally only for like 30 seconds at a time but the "spells" if you will can last for weeks for me.  They used to be much worse and have gotten better over time.  I can be sleeping and turn over in bed and it will wake me up, its positional.  Sometimes it is accompanied with a real "dizzy" feeling as well.  I have fallen down many times getting up in the night to go the bathroom etc.  I have used Meclazine in the past with moderate results.

missy
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152264_tn?1280358257
Hi Lulu. The "paroxysmal" in the term is key -- BPPV, as I'm sure you know, is the world-spinning feeling that lasts from seconds to maybe a couple of minutes as a result of certain head-position changes.

Symptoms at other times are probably due to something else, though apparently BPPV CAN leave a person with some residual dizziness in between attacks. Your VR therapist should be able to give you better (i.e., more expert) information about whether the residual effects of BPPV could be responsible for your symptoms. My guess is not, but I'll be interested to see what she/he says about it.

Bummer, bummer, bummer about the constant dizziness.

How long have you had BPPV? How frequent have the attacks been? Have you had other (non-BPPV) dizziness in the past? Hearing loss or vestibular abnormalities?

I had a handful of BPPV attacks early on in my "worse" (1999 on) dizziness, but since a four-day period of BPPV in 2002 or 2003, I've avoided it. I don't think BPPV is responsible for the daily (mild) dizziness I've had since the 1980s.

Good luck tomorrow and good luck getting rid of the dizzies.

Nancy
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572651_tn?1333939396
Nancy,
I was sent for vestibular rehab evaluation by my ENT after we talked about my almost constant feeling of being off balance and dizzy.  He wanted to see if it was BPPV and not something else.  

When the therapist did the drop test with me, there was no reaction in my left eye, but my right eye was a different story .  I couldn't feel it but she said it definitely was bouncing all over (nymstagmus?) .  So she did the manipulation stuff to move the crystals back into place and gave me dirctions to follow for the next 48 hours.

We were hopeful that my dizziness would be this simple fix, but it appears that is not going to be the case.

I have had this feeling pretty much with me for almost 20 years. I've just learned to work around it, but it seems to have gotten more intense.  Taking a down escalator is quite a feat for me - often I avoid it entirely and look for elevators.  Standing on the edge of the Grand Canyon a while back was near impossible for me as well.  I'm not afraid of heights, I just can't tolerate them.  :-) It is apparent that this is beginning to interupt my life and not just merely an annoyance.

My mother has vertigo and I am well aware of its symptoms.  I can honestly say I have never had true vertigo if it requires the world spinning around me.

I guess I'll see tomorrow what's next.  

as always,
L

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Avatar_f_tn
I know next to nothing about BPPV. If they're sure you have it, that settles that. But that doesn't preclude your having some other vertigo as well, I wouldn't think. After all, vertigo is awfully common in MS.

I've never had the spinning thing either, and I too feel normal  when I'm sitting down. When I walk it's a different story. The ground is moving this way and that, and sometimes I lurch like a rummy. It's the old boat-rocking thing. Standing in a rowboat in the middle of the ocean.

Have you had a VNG? Sorry, I can't remember. Mine came out abnormal in one aspect, so at least I won't be told I'm anxious or something. The trouble is, they don't know if it's peripheral or central.

This is my 3rd bout of this symptom. Last one lasted 5 months, non-stop. This one started after a virus late this winter. So who knows?

ess
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572651_tn?1333939396
Thanks Ess,
Just doing some fact gathering before tomorrow's appt.  No, I have not had a VNG but it was mentioned as a possibility if this BPPV thingie doesn't pan out. Do you like all my technical language here?  :-)

I'm off, in more ways than one!
Lu
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873261_tn?1241693621
I don't know what it is that I have (not given a label) but I've had *dizzy* spells for over a couple of years now that my cardiologist tried to figure out.  He sent me for a tilt table test to rule out (oh, some long word that reminds me of syncope) and that came back negative.  I can no longer walk near railings on floors higher than level one, I cannot do escalators, or ladders.  Being on these can cause my world to spin.  It can also go crazy if I'm just sitting at my desk - it's a feeling of the world is spinning and I need to grab on to something so I don't slip away...  My neuro wants me to go to an ENT and I will, I'm just trying not to lose my job with missing all the work I need to do for all the tests, PT and other doctor appts I've had to go to since January.  Oh, I was given medication for the "vertigo" but my PCP thought the medication was making me too lethargic (or maybe I was feeling fatigued for other reasons.. who knows.  The dizziness doesn't take away too much from my quality of life, I just hope it doesn't happen while I'm driving...

There's my two cents.
All the best,
Chezbug
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147426_tn?1317269232
I had bilateral BPPV and I had 10 to 20 seconds of roiling vertigo that simmered down pretty quickly.  However, in between I was still not a happy camper.  My ENT (Yes, Epley, himself) felt that I also had an irritative labyrinthitis accounting for the ongoing symptoms.  I also had a left peri-lymph fistula which had to be surgically repaired.  So, I agree that you might have other stuff happening if you are so symptomatic at other times.

BPPV - another place where I object to the work "Benign."  Benign to whom exactly??

Quix
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572651_tn?1333939396
Chezbug,
I can relate - I can't walk along the railing on the second floor of the mall without feeling very uncomfortable - like I'm going to go over the edge.  I can fly in a plane and have even gone up in a hot air balloon without a problem and loved it so its not a fear of heights.  But don't ask me  to stand at a railing or the dreaded escalator.  I'm working through this with the ENT so I'll try to remember to keep you posted on what I find out.  Turning in my chair at work does make me feel off - perhaps I need to reconsider/look into what vertigo can be - I definitely don't feel a spinning though.  

Q- we should start a list of medical dx's that include the word benign just for the fun of it sometime.  

Thanks all for your help in noodling through this,
Lu
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152264_tn?1280358257
Hi Lulu--sounds familiar--I have long disliked standing near the edge of anything such as you describe--especially if there's no handrail (docks are the worst!!). I can't imagine standing by the Grand Canyon!! I also have no fear of heights and don't like turning around without something to put my hand on (for proprioceptive input).

If you didn't have a spinning feeling during the "drop test" (was that the Dix-Hallpike maneuver, where they lay you back quickly with your head hanging off the edge of the table? which is the diagnostic test for BPPV), it would seem surprising if that was considered BPPV... although if you had nystagmus (but why only in one eye!?), I guess it would be BPPN (benign paroxysmal positional nystagmus, which is the name that a well-known Portland neurotologist uses for it, i.e, describing the objective finding rather than the subjective symptom of vertigo).

Good luck tomorrow at your appointment. Even if you don't have BPPV, the vestibular therapist might be able to help you via exercises or have other recommendations. I hope your dizzy period passes soon.

Nancy
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572651_tn?1333939396
Thanks Nancy for helping me to see its not only me that's confused here.  

She did the Dix-Hallpike maneuveur and it did not bother me at all.  She said I should have felt my eye moving - nystagmus - but I didn't.  And yes, it was only one eye, so she said that means only one ear was involved with the wayward crystals.  

I'll chat with her tomorrow about all of this ........
Lu
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147426_tn?1317269232
I don't understand the only one eye having nystagmus either.  In BPPV(N) no matter whether one or both eyes have displaced crystals BOTH eyes have nystagmus.  Period.  I've seen tons of videos of the nystagmus elicited during testing.  It is the Direction of the nystagmus, combined with the position in which it is found, that helps determine the location of the problem.  I'm sorry, what she said makes no sense.

But, I guess it doesn't matter.

Q
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152264_tn?1280358257
What Quix said is what I've always thought, too. Both eyes should have nystagmus even if the problem lies in only one ear.
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147426_tn?1317269232
ooops, I meant whether one or both inner "ears" have displaced crystals....
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572651_tn?1333939396
final update to this post -
I reviewed this with the therapist and she said I had nystagmus in both of my eyes, but the problem was only in one of my ears.  As of this morning, the jumping in my eyes is gone.  However, the balance problem is still an issue - she feels it is related to my vision and gave me eye exercises to perform 3 times daily to strengthen the eye-ear-brain connection.  She thinks it is not MS related - but we will talk in a week or so and review my progress.

Thanks everyone for helping me to be prepared today with the right questions.

Lu
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293157_tn?1285877039
Hi there... I was wondering if you could let me know the eye exercises that you will do for your vision...I myself think my Vertigo has to do with my horrible vision issue that the Dr can't figure out?  Or my Vertigo..they say it isn't my ears...

hope it helps you and I will try anything to stop this vertigo... I haven't had it for a few weeks..but it seems to come back after a few weeks or months..

thanks
wobbly
undx
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Avatar_f_tn
This gets curiouser and curiouser.

I'm glad your eyes are moving together, since that's the way it's s'posed to be. In my VNG they found a problem with one ear too, with 'normal' nystagmus (because it's induced, as part of the test). Mine is all tied up with balance issues as well.

I'll be very interested in hearing how the exercises go. Haven't heard of that before. Please keep us updated! Lots of us here have issues like this.

ess
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280418_tn?1306329510
I didn't get to read all comments but....

Get a VNG.  I am not aware of your history at all, but if you have a diagnosis of MS, it is very possible the VNG could reveal central (brain) versus peripheral (ear).  Peripheral symptoms are usually vertiginous in nature (spinning).  Dizziness, wobbly, woozy etc. can be either of the above.  The purpose of the VNG is to narrow it down to central vs. peripheral.  Of course, you can have both, which complicates things.  Also, I'm surprised you have vestibular rehab without having a VNG?  You have to establish that the lesion (wherever it is) is stable before you are even a candidate for vestibular rehab.  However, I have noticed some physical therapy practices getting money hungry and just saying they can "test you themselves".  This is not the rule, but it is happening.  A VNG should be first and foremost, otherwise, you could be wasting your time with the vestibular rehab.  It would be great if you had BPPV, because it is the most "curable" form of vertigo, but it doesn't sound like you do, especially if you didn't even feel anything from the Dix-Hallpike.  Feel free to correct me as I don't know your history.  I hope you can get some relief.  
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Avatar_f_tn
I had a VNG a couple of weeks ago, and based on the results, they agree there's a problem, but say it could be either central or peripheral. WTF? Isn't that where I came in?

ess
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280418_tn?1306329510
That does sound vague for the patient and that stinks.  As far as MS and VNGs are concerned, there is a high probability (in my humble opinion) that it would be abnormal.  The first reason being that if you have a VNG, it's  because you are already dizzy/vertiginous in the first place.  The squeaky wheel gets the oil, sort of speak.  This isn't a test that is ordered for any other reason.  The next reason being, if a central subtest of the VNG comes out abnormal, then it is quite possible that a peripheral issue will pop up in a peripheral subtest of the VNG.  If you have any central signs on VNG, then something is wrong and definitely could affect the cranial nerve leading to your ear/s (could be one or both), hence, peripheral is abnormal as well.  

Either way you put it, it is an abnormal VNG study and will be of importance in the diagnosis of a central issue, like MS (one would hope, b/c docs don't always put all the puzzle pieces together for MS'ers).  I does not help you so much, however, when you are just simply trying to not feel dizzy.  That does annoy you, I'm know.  

How do I know all of this?  I've already been down that path with my undiagnosed symptoms.  My best friend is an audiologist and I had him put me through the entire battery of tests possible that could show MS, including VNG, ABR (or BAER), etc. etc.  I was dizzy like a drunk.  No abnormalities.  I have to say, his equipment was old and he wasn't a specialist in vestibular testing, so I sometimes wonder about the validity?  If dizziness/vertigo is causing you grief, don't hesitate to go to a large balance center.  You wouldn't believe the differences in equipment and tester knowledge.

So, it could be a help in confirming the diagnosis of MS.  If mine were abnormal centrally, I would be much more concerned of that diagnosis.  I don't know if they have an ENT or audiology forum on here??
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152264_tn?1280358257
Hi Hope. There is an ENT community forum but not many people answer questions there, and the expert forum on hearing and ear disorders has completely shut down--docs haven't answered any questions since early this year, and apparently no new questions are being allowed (what would be the point anyway, since they're not being answered?).

I've been dizzy-woozy since the 1980s, worse since 1999 (though still mild enough that I can work, etc.). (Cause unknown; no diagnosis; normal ENGs, highly abnormal BAER bilaterally.) So I've been reading a dizziness forum for almost ten years where a balance-testing expert posts, and he always says about vestibular testing, "If you don't find your keys on the table, that doesn't mean they are aren't in the house." In other words, if vestibular tests are normal, that doesn't mean there isn't a vestibular problem. There aren't such good and sensitive tests for vestibular problems as there are for hearing.

Lulu--so are you going back to the ENT, since the therapist has pretty much ruled out BPPV? I wonder if the ENT is going to assume that your dizziness is due to MS or is going to do a VNG, as he/she has apparently suggested?

Good luck with the exercises; I hope they help.

Nancy
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572651_tn?1333939396
As most of you know, I have MS.  It was a slam-dunk dx that skipped a whole bunch of other fun tests.  The MRI and LP were enough.  The ENT left it that a VNG could be in my future is the rehab  person didn't come up with a simple problem/fix (BPPV was the hoped for choice!).

This ENT is also the one who ordered the sleep study.  I will see him again after the results of both of those tests are in.  

The exercises are for the Visual Vestibular connection - we'll see how they work.  Wobbly - I will PM you with the instructions in the next day or so - if I don't rmember, please remind me.  Its late now and I got to get some zzzzzz's.

thanks all,
Lulu
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280418_tn?1306329510
That stinks that the forums weren't well taken care of.  Yes, if the VNG is negative, that doesn't mean nothing is wrong.  BUT, my point was that if it IS abnormal, then you really have something to go on since false negatives are more common than false positives.  It is a red flag and if it is abnormal centrally, then it could be another little tool in someone's toolbox to find a diagnosis - if that diagnosis involves central lesions, like MS.

Lulu, I hope they can help you out.  I would hope for BPPV too.  MS is definitely your central abnormality and is more difficult to treat as far as vestibular therapy.  The exercises may work, I've seen them work, but the person had peripheral lesions, not central.  My vote is to try anything that may work your brain out.  I've heard of so much research lately that proves that the brain is a use it or lose it (like a muscle) organ.  Good luck with the therapy and take care!
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