{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T14:11:24Z","timestamp":1785334284122,"version":"3.55.0"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T00:00:00Z","timestamp":1623888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>Despite the huge progress in the definition and classification of vestibular disorders within the last decade, there are still patients whose recurrent vestibular symptoms cannot be attributed to any of the recognized episodic vestibular syndromes, such as Meni\u00e8re's disease (MD), vestibular migraine (VM), benign paroxysmal positional vertigo (BPPV), vestibular paroxysmia, orthostatic vertigo or transient ischemic attack (TIA). The aim of the present international, multi-center, cross-sectional study was to systematically characterize the clinical picture of recurrent vestibular symptoms not otherwise specified (RVS-NOS) and to compare it to MD and VM. Thirty-five patients with RVS-NOS, 150 patients with VM or probable VM and 119 patients with MD were included in the study. The symptoms of RVS-NOS had been present for 5.4 years on average before inclusion, similar to VM and MD in this study, suggesting that RVS-NOS is not a transitory state before converting into another diagnosis. Overall, the profile of RVS-NOS vestibular symptoms was more similar to VM than MD. In particular, the spectrum of vestibular symptom types was larger in VM and RVS-NOS than in MD, both at group comparison and the individual level. However, in contrast to VM, no female preponderance was observed for RVS-NOS. Positional, head-motion and orthostatic vertigo were reported more frequently by patients with RVS-NOS than MD, while external vertigo was more prevalent in the MD group. At group level, the spectrum of attack durations from minutes to 3 days was evenly distributed for VM, while a small peak for short and long attacks in RVS-NOS and a big single peak of hours in MD were discernible. In general, vertigo attacks and associated vegetative symptoms (nausea and vomiting) were milder in RVS-NOS than in the other two disorders. Some patients with RVS-NOS described accompanying auditory symptoms (tinnitus: 2.9%, aural fullness and hearing loss: 5.7% each), migrainous symptoms (photophobia, phonophobia or visual aura in 5.7% each) or non-migrainous headaches (14%), but did not fulfill the diagnostic criteria for MD or VM. Absence of a life time diagnosis of migraine headache and attack duration of &amp;lt;5 min were further reasons not to qualify for VM. In some RVS-NOS patients with accompanying ear symptoms, attack durations of &amp;lt;20 min excluded them from being diagnosed with MD. These findings suggest that RVS-NOS is a stable diagnosis over time whose overall clinical presentation is more similar to VM than to MD. It is more likely to be composed of several disorders including a spectrum of mild or incomplete variants of known vestibular disorders, such as VM and MD, rather than a single disease entity with distinct pathognomonic features.<\/jats:p>","DOI":"10.3389\/fneur.2021.674092","type":"journal-article","created":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T10:04:38Z","timestamp":1623924278000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":33,"title":["Recurrent Vestibular Symptoms Not Otherwise Specified: Clinical Characteristics Compared With Vestibular Migraine and Meni\u00e8re's Disease"],"prefix":"10.3389","volume":"12","author":[{"given":"Julia","family":"Dlugaiczyk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Lempert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Antonio","family":"Lopez-Escamez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Teggi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"von Brevern","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Bisdorff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,6,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1016\/j.ncl.2015.04.010","article-title":"Overview of the international classification of vestibular disorders","volume":"33","author":"Bisdorff","year":"2015","journal-title":"Neurol Clin."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3233\/VES-2009-0343","article-title":"Classification of vestibular symptoms: towards an international classification of vestibular disorders","volume":"19","author":"Bisdorff","year":"2009","journal-title":"J Vestib Res."},{"key":"B3","doi-asserted-by":"publisher","first-page":"167","DOI":"10.3233\/VES-2012-0453","article-title":"Vestibular migraine: diagnostic criteria","volume":"22","author":"Lempert","year":"2012","journal-title":"J Vestib Res."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3233\/VES-150549","article-title":"Diagnostic criteria for Meni\u00e8re's disease","volume":"25","author":"Lopez-Escamez","year":"2015","journal-title":"J Vestib Res."},{"key":"B5","doi-asserted-by":"publisher","first-page":"105","DOI":"10.3233\/VES-150553","article-title":"Benign paroxysmal positional vertigo: diagnostic criteria","volume":"25","author":"Von","year":"2015","journal-title":"J Vestib Res."},{"key":"B6","doi-asserted-by":"publisher","first-page":"409","DOI":"10.3233\/VES-160589","article-title":"Vestibular paroxysmia: diagnostic criteria","volume":"26","author":"Strupp","year":"2016","journal-title":"J Vestib Res."},{"key":"B7","doi-asserted-by":"publisher","first-page":"45","DOI":"10.3233\/VES-190655","article-title":"Hemodynamic orthostatic dizziness\/vertigo: diagnostic criteria","volume":"29","author":"Kim","year":"2019","journal-title":"J Vestib Res."},{"key":"B8","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1136\/jnnp.42.4.363","article-title":"Benign recurrent vertigo","volume":"42","author":"Slater","year":"1979","journal-title":"J Neurol Neurosurg Psychiatry."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1288\/00005537-198101000-00001","article-title":"Recurrent vestibulopathy","volume":"91","author":"Leliever","year":"1981","journal-title":"Laryngoscope."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3233\/VES-200003","article-title":"Vestibular migraine of childhood and recurrent vertigo of childhood: Diagnostic criteria consensus document of the committee for the classification of vestibular disorders of the b\u00e1r\u00e1ny society and the international headache society","volume":"31","author":"Van","year":"2020","journal-title":"J Vestib Res."},{"key":"B11","doi-asserted-by":"publisher","first-page":"101","DOI":"10.3109\/00016489709124095","article-title":"Benign recurrent vertigo\u2013true or artificial diagnosis?","volume":"529","author":"Kentala","year":"1997","journal-title":"Acta Otolaryngol Suppl."},{"key":"B12","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1002\/lary.23188","article-title":"Clinical characteristics and natural course of recurrent vestibulopathy: a long-term follow-up study","volume":"122","author":"Lee","year":"2012","journal-title":"Laryngoscope."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e357","DOI":"10.1097\/MAO.0000000000001553","article-title":"R. 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