Home-based video-oculography during spontaneous vertigo attacks: A proof-of-concept feasibility study in Ménière’s disease and vestibular migraine

Background Episodic vestibular disorders like Ménière’s disease (MD) and vestibular migraine (VM) pose diagnostic challenges because patients are often assessed between attacks, when clinical signs are absent. Recording ictal eye movements could provide objective phenotypic data; however, the practicality of using unsupervised home-based video-oculography in everyday clinical settings remains poorly studied. Methods We conducted a prospective proof-of-concept study in patients with episodic vertigo. Participants were given portable, wireless video-oculography goggles for unsupervised home use and instructed to record eye movements during spontaneous vertigo attacks. Diagnoses were made according to the Bárány Society criteria, independent of eye-movement data. Recordings were checked for adequacy, and slow-phase velocity (SPV) was measured using a custom automated algorithm. Results 50 patients participated in the study. Of these, 36 (72%) experienced vertigo during the period, and 34 of them (94%) successfully recorded ictal eye movements. The quality of recordings was sufficient for diagnostic interpretation in 97% of the participants with recordings. The median spontaneous SPV was notably higher in MD patients than in VM patients (29°/s vs 3°/s, p < 0.001) among participants who obtained multiple recordings from the same attack and was positively correlated with low-frequency hearing loss (ρ = 0.70, p < 0.001). Direction-changing nystagmus was observed in MD and mixed MD + VM phenotypes but was absent in VM alone. Conclusions Home-based video-oculography during spontaneous vertigo attacks is practical and produces high-quality data on ictal eye movements. SPV and nystagmus patterns offer objective phenotypic details that enhance current diagnostic criteria, especially for diagnosing Ménière’s disease.