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The German BMBF (German Ministry of Education and Research) has decided to establish an Integrated Center for Research and Treatment of Vertigo, Balance and Ocular Motor Disorders (IFB) in Munich in 2010. After funding over a 10-year period, the long-term continuation of the IFB by the medical faculty and the hospital is envisioned. Vertigo is one of the most common complaints in medicine. Despite its high prevalence patients with vertigo generally receive either inappropriate or inadequate treatment. This deplorable situation is internationally well known and its causes are multiple: insufficient interdisciplinary cooperation, no standardized diagnostics and therapy, the failure to translate findings of basic science into clinical applications and the scarcity of clinical multicenter studies. The IFB will constitute a suitable tool with which these structural, clinical, and scientific deficits can be overcome. It will also make possible the establishment of an international interdisciplinary referral center. Munich has become the site of a unique concentration of leading experts on vertigo, balance and ocular motor disorders, both in the clinical and basic sciences. Academic structures have paved the way for the creation of an interdisciplinary horizontal network that also allows structured, vertical academic career paths via the Bachelor's and Master's degree programs in neuroscience, a Graduate School of Systemic Neurosciences, and the Munich Center for Neuroscience'Brain and Mind'. The IFB has the following objectives with regard to structure and content: The IFB is a unique reference center worldwide. [ABSTRACT FROM AUTHOR]

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Establishment of the Chair of Neurology at the University of Munich in 1971 as well as the opening of the Neurology Department at the newly built Großhadern campus (1974) provide an occasion to review the 50 years that have passed since. Further, the early history of Munich neurology is described, with its slow pace of separation (in comparison to e.g. Heidelberg, Frankfurt and Hamburg) from the parent disciplines, psychiatry and internal medicine. In Munich, they were long shaped by psychiatrists such as Bernhard von Gudden, Emil Kraepelin, Kurt Kolle and Hanns Hippius and by Friedrich von Müller and, in particular, by Gustav Bodechtel in internal medicine.Once independent, further development of neurology in Munich was characterized by fast-paced, almost revolutionary changes in neuroimaging, electrophysiology, sonography, and engineering as well as in basic neuroscience, neurogenetics included. The new department thrived under the leadership of Adolf Schrader (from 1971), Thomas Brandt (from 1984) and Marianne Dieterich (from 2008) who enjoyed the support of an ever-increasing specialised clinical-scientific staff.Evidence-based treatment of neurological disorders became the overarching and internationally visible focus of Munich neurology, with respect to both practical implementation and to research. The exemplary diseases and syndromes of multiple sclerosis, epilepsy, stroke, movement disorders, dizziness and disorders of balance and gait as well as diseases of the musculature and peripheral nerves are cared for not only within the inpatient and outpatient sections of the Neurology Department but also by units such as the Friedrich Baur Institute (FBI), the German Dizziness and Balance Centre (DSGZ), the Institutes for Stroke and Dementia Research (ISD) and for Clinical Neuroimmunology as well as in the interdisciplinary Department of Palliative Care., (© 2022. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

This article critically discusses the current assessment guidelines valid since 2014 which must be applied to determine the driving aptitude of patients with dizziness and balance disorders (in the official document called "disorders of the sense of balance"). With all due respect for the meticulous work of the expert commission who established the guidelines - the likes of which are not known anywhere else - we consider their revision imperative. On the basis of our many years of experience in the German Center for Dizziness and Balance Disorders of the LMU Munich it is our opinion that these restrictions are too strict and the required dizziness-free intervals are too long.The guidelines now stipulate the following for drivers with a group 1 driving licence ("private"):1) Patients with Meniere's disease (attacks without prodromes) must have had no attacks for 2 years before it is possible to drive a car again.2) Patients with vestibular migraine without prodromes must not have had any attacks for 3 years.The following stipulations hold for drivers with a group 1 and group 2 driving licence ("professional driver"):3) Patients with bilateral vestibulopathy as a rule are considered to have a driving disability, likewise4) Patients with central vestibular forms of vertigo, e. g., oculomotor disorders like downbeat and upbeat nystagmus syndromes are also as a rule regarded as having a driving disability.5) Patients with functional (psychogenic) forms of dizziness (e. g., phobic postural vertigo) who have a group 1 driving licence are considered to have a driving disability if dizziness occurs while driving. Those with a group 2 driving licence are in general considered to have a driving disability. However, many patients with episodic or chronic dizziness have such minor symptoms that their driving fitness is not relevantly impaired or if they do have an attack, they are able to stop driving in a controlled manner. In contrast, the restrictions on other illnesses that are accompanied by attack-like disorders of cognition and consciousness like the epilepsies are less strict. Depending on the type of attack or its trigger, the attack-free interval for such patients with a group 1 driving licence amounts to 3 months up to 1 year, although they clearly are not fit to drive during an attack., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

There are currently different groups of drugs for the pharmacotherapy of vertigo, nystagmus and cerebellar disorders: antiemetics; anti-inflammatories, antimenieres, and antimigraineous medications and antidepressants, anticonvulsants, aminopyridines as well as acetyl-DL-leucine. In acute unilateral vestibulopathy, corticosteroids improve the recovery of peripheral vestibular function, but currently there is not sufficient evidence for a general recommendation. There is insufficient evidence to support the view that 16 mg t. i. d. or 48 mg t. i. d. betahistine has an effect in Menière's disease. Therefore, higher dosages are recommended. In animal studies, it was shown that betahistine increases cochlear blood flow. In vestibular paroxysmia, oxcarbazepine was effective (one randomized controlled trial (RCT)). Aminopyridines are recommended for the treatment of downbeat nystagmus (two RCTs) and episodic ataxia type 2 (EA2, one RCT). There has been no RCT on the efficacy of beta-blockers or topiramate but one RCT on flunarizine in vestibular migraine. Based on clinical experience, a treatment analogous to that for migraine without aura can be recommended. Acetyl-DL-leucine improved cerebellar ataxia (two observational studies); it also accelerated central compensation in an animal model of acute unilateral lesion, but RCTs were negative. There are ongoing RCTs on treatment of vestibular paroxysmia with carbamazepine (VESPA), acute unilateral vestibulopathy with betahistine (BETAVEST), vestibular migraine with metoprolol (PROVEMIG), benign paroxysmal positional vertigo with vitamin D (VitD@BPPV), EA2 with 4-aminopyridine versus acetazolamide (EAT-2-TREAT), and cerebellar ataxias with acetyl-DL-leucine (ALCAT)., Competing Interests: Interessenkonflikt: M. Strupp ist Herausgeber folgender Zeitschriften: Journal of Neurology, Frontiers of Neuro-otology und F1000. Er bezieht Sprechergelder von Abbott, Actelion, UCB, GSK, TEVA, Biogen, Pierre-Fabre, Heel, Eisai, MSD und Hennig Pharma. K. Feil, N. Böttcher, O. Kremmyda, C. Muth und Julian Teufel geben an, dass kein Interessenkonflikt besteht. Zahlreiche der beschriebenen Studien werden finanziert durch das BMBF (Grant No.01EO0901 and 01EO1401)., (Georg Thieme Verlag KG Stuttgart · New York.)