Event Abstract Back to Event Acute episodic centrally maintained vestibulopathy in a patient with multiple sclerosis managed with brain and vestibular rehabilitative approach: a case report Troy May1 and Derek Barton2* 1 May Chiropractic Clinic, United States 2 Carrick Institute, United States Background A 31-year-old female patient presented to a functional neurology clinic with an idiopathic acute episode of vertigo which was constant and of varying intensity beginning four days prior. The patient reported a sensation of spinning to the left and falling backward and rated the level of disorientation she felt as 6/10 with 10 being severely disoriented. She reported head pain over the right parietal region and a seven year history of multiple sclerosis confirmed by MRI. The patient stated she was unable to work and had difficulty eating due to her level of disorientation. Methods Neurological examination revealed unsteady and guarded gait, mild slurring of speech, and distressed demeanor. The patient demonstrated an inability to hold steady gaze with square wave intrusions during gaze holding assessment. She also had horizontal square wave jerks during pursuit testing with pursuits to the left being more difficult. Romberg test was positive with the patient falling backward and to the left. The patient had intersegmental dysfunction of the upper cervical spine. The patient was diagnosed with a centrally maintained vestibulopathy and a treatment plan was implemented immediately. The patient received five right Halmagyi head thrusts and three three-second passes of upward optokinetic stimuli. Gaze stability exercises were then performed in the horizontal plane with passive sinusoidal movements to a central target. Gaze stability was first performed supine and then in a seated position. Manipulation of the second cervical vertebra was also performed. Results The patient experienced immediate improvement of her subjective complaints of disorientation and head pain. She rated her level of disorientation as 2/10 following Halmagyi head thrusts. Objective improvements were seen in the patient's ability to hold steady gaze on a target during gaze fixation and Romberg testing was performed without any fall. The patient followed up for the next two days in the office with only a minor increase in symptoms. The patient was treated with a similar protocol and given at-home therapy exercises of horizontal 1x viewing for two minutes every two hours. Conclusions This case follows the treatment of a centrally maintained vestibular issue in a patient suffering from multiple sclerosis. The patient experienced immediate relief from her symptoms after a protocol utilizing brain activation and vestibular stimulation. Further investigation is necessary to determine if this approach would be beneficial for a larger population of multiple sclerosis patients suffering with vertigo issues. Keywords: Multiple Sclerosis, Vertigo, Dizziness, Neuro rehabilitation, falls Conference: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015. Presentation Type: Poster Presentation Topic: Case Reports for Poster Presentation Citation: May T and Barton D (2015). Acute episodic centrally maintained vestibulopathy in a patient with multiple sclerosis managed with brain and vestibular rehabilitative approach: a case report. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration. doi: 10.3389/conf.fneur.2015.58.00027 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 31 Oct 2015; Published Online: 02 Nov 2015. * Correspondence: Dr. Derek Barton, Carrick Institute, Cape Canaveral, FL, United States, derekabarton@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. 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