Journal of Vestibular Research 19 (2009) 1–13 IOS …

1 Journal of Vestibular Research 19 ( 2009 ) 1 131 DOI PressClassification of Vestibular symptoms:Towards an international classification ofvestibular disordersFirst consensus document of the Committee for the Classification of Vestibular Disorders of the B ar anySocietyAlexandre Bisdorffa, , Michael Von Brevernb, Thomas Lempertcand David E. Newman-TokerdaDepartment of Neurology, Centre Hospitalier Emile Mayrisch, L-4005 Esch-sur-Alzette, LuxembourgbVestibular Research Group Berlin, Department of Neurology, Park-Klinik Weissensee, Berlin, GermanycVestibular Research Group Berlin, Department of Neurology, Schlosspark-Klinik, Berlin, GermanydDepartment of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USAOn behalf of the Committee for the Classification of Vestibular Disorders of the B ar any Society: Pierre Bertholon,Alexandre Bisdorff, Adolfo Bronstein, Herman Kingma, Thomas Lempert, Jose Antonio Lopez Escamez, M nsMagnusson, Lloyd B.

2 Minor, David E. Newman-Toker, Nicol as P erez, Philippe Perrin, Mamoru Suzuki, Michaelvon Brevern, John Waterston and Toshiaki YagiReceived 4 February 2009 Accepted 1 September 20091. IntroductionThe Committee for Classification of Vestibular Dis-orders of the B ar any Society was inaugurated at themeeting of the B ar any Society in Uppsala 2006. Itscharge is to promote development of an implementableclassification of Vestibular and disease definitions are a fundamen-tal prerequisite for professional communication both inclinical and Research settings. However, the perceivedneed for a formalized classification system, uniformdefinitions, or explicit diagnostic criteria varies some-what by discipline.

3 Having structured criteria for di-agnosis is obviously mandatory for disciplines whichrely heavily on symptom-driven syndromic diagnosis, Corresponding author: Alexandre Bisdorff, Department of Neu-rology, Centre Hospitalier Emile Mayrisch, L-4005 Esch-sur-Alzette,Luxembourg. E-mail: as psychiatry and headache, where often there isno histopathologic, radiographic, physiologic, or otherindependent diagnostic standard available. However,diagnostic standards and classification are also crucialin areas of medicine such as epilepsy and rheumatolo-gy, where, although confirmatory tests do exist, thereis substantial overlap in clinical features or biomarkersacross , not only scientific and therapeuticprogress but also public awareness of psychiatric andheadache disorders has vastly increased after the in-troduction of the Diagnostic and Statistical Manualof Mental Disorders (DSM) by the American Acade-my of Psychiatry and the international Classificationof Headache Disorders (ICHD) by the InternationalHeadache Society (IHS).

4 In contrast, Vestibular nomen-clature remains in its infancy. Other than the definitionof Meni`ere disease by the American Academy of Oto-laryngology Head and Neck Surgery (AAOHNS) [3]ISSN 0957-4271/09/$ 2009 IOS Press and the authors. All rights reserved2A. Bisdorff et al. / Classification of Vestibular symptoms: Towards an international classification of Vestibular disordersand the Classification of Peripheral Vestibular Dis-orders by the Spanish Society of Otorhinolaryngolo-gy [4], we are unaware of other systematic efforts tocreate widely accepted classification numerous advances in Vestibular researchhave been made over the past several decades, thereis now mounting evidence that the field may be ham-pered moving forward by the lack of explicit anduniform criteria for various clinical , witness the ongoing controversy surround-ing the distinction between Vestibular migraine and Vestibular Meni`ere disease [2]

5 Or the varied use of theterms Vestibular neuritis, cochleovestibular neuri-tis, labyrinthitis, cochleolabyrinthitis, and acuteperipheral vestibulopathy in the medical yet, problems of terminology have now beendemonstrated at the level of describing core vestibularsymptoms such as dizziness and vertigo. Even whenstudied in a single, English-speaking country, the term vertigo has been shown to have diverse meanings forpatients [5], generalist physicians [6] and even otolo-gists [6].We believe the time is right to pursue development ofthe first international Classification of Vestibular Disor-ders (ICVD-I). Initially, we expect its predominant usewould be to guide investigators conducting clinically-oriented Vestibular Research .

6 It is our belief that, overtime, well-honed Research criteria will gradually spreadto use in the clinical domain. We envision a stagedand iterative development process that involves interna-tional experts from both neurology and otolaryngologybackgrounds. It is our hope that the B ar any Society willpartner with the AAOHNS and other neuro-otologicalassociations who are willing to promote this project,including funding agencies whose priorities are to sup-port Vestibular Research . To initiate this process, theCommittee sought first to define key Vestibular symp-toms as a basis for a subsequent classification of spe-cific Vestibular disorders and then to build consensusaround these formalized MethodsThe B ar any Society is an international society com-prised of Vestibular experts with a wide range of back-grounds from basic science, bioengineering, and spaceflight to clinical medicine and physiotherapy.

7 At theXXIV B ar any Society Meeting 2006 in Uppsala, Swe-den, the General Assembly decided to launch an initia-tive to elaborate a classification of Vestibular small working group of clinicians formed a Classifi-cation Committee and began to draft the concept of theapproach, analysing what existed in this area and whatprior models to follow. The international HeadacheSociety s international Classification of Headache Dis-orders [7] provided the most there is no consensus on the use of terms todescribe Vestibular symptoms, the Committee decidedto initiate the classification process by first defining andbuilding consensus around formalized definitions ofkey document would then,in turn, serve as a basis for a subsequent classificationof specific vestibulardisorders.

8 It was agreed uponthat the definitions should cover all principal symptomsthought to arise from disturbances of the vestibularsystem, with this system defined broadly as the sensoryinputs, central processing and motor outputs that relateto discussion gradually involved members andopinion leaders worldwide, mainly through electroniccommunications as well as several in-person meetingsand phone conferences. The task was to make the bestcompromise between traditional use of terms, moderndevelopments, and practicability in the Research andclinical settings. A first draft was presented at the XXVB ar any Society Meeting in Kyoto in April 2008 [8,9]with the opportunity for the delegates to discuss andcast votes on controversial issues from the Committee input from the Kyoto Meeting was very help-ful for the Classification Committee to see what defi-nitions were easily accepted and which were rejectedor required further clarification.

9 The draft was thendiscussed at the annual meeting in May 2008 in Lau-sanne, Switzerland of the French speaking Soci et e In-ternationale d Otoneurologie. Members of the lattersociety as well as members of the Spanish Comisi onde Otoneurolog a de la Sociedad Espa nola de Otorrino-laringolog a and the American Academy of Otolaryn-gology Head and Neck Surgery (AAOHNS) joinedthe B ar any Society s Classification Committee to final-ize the present ResultsIn the attached document (Appendix 1), we presentthe first iteration of a consensus classification ofvestibular symptoms (ICVD-I: Classification of Symp-toms v ) produced by the committee. The commit-tee also developed an algorithm to facilitate coding ofA.

10 Bisdorff et al. / Classification of Vestibular symptoms: Towards an international classification of Vestibular disorders3symptoms observed in a particular patient (Appendix2). Several broad principles were agreed upon as partof the consensus building process:1) Symptoms chosen for definition should be broadenough to cover the spectrum of clinical symp-toms typically resulting from Vestibular disordersyet specific enough to enable effective ) No Vestibular symptom has a totally specificmeaning in terms of topology or nosology and itspathogenesis is likely to be incompletely ) Symptom definitions should be as purely phe-nomenological as possible without reference to atheory on pathophysiology or a particular ) Definitions for symptoms are clearest if they arenon-overlapping and non-hierarchical but allowone or more symptoms to coexist in a )