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As the world turns, why do some people adapt to vestibular failure and others do not?

Chronic vertigo and oscillopsia are 2 of the most vexing problems that neurologists encounter. Even when the etiology is known, there is often a limit to the therapy that can be offered to the patient beyond vestibular rehabilitation. Oscillopsia diminishes over time in many individuals, but the mechanism for this adaptive change is unclear. In this issue of Neurology®, Ahmad et al.1 examine the central mechanisms that may be responsible for adaptation after bilateral vestibular failure. Most of the cases in this cohort had vestibular failure from either idiopathic or autoimmune causes. Ahmad et al. found that the patients with bilateral vestibular failure had reduced visual cortical excitability compared to controls under both static and motion conditions.