后半规管良性发作性位置性眩晕不同手法复位的临床研究

目的比较改良Epley耳石复位法(即颗粒复位法)和Semont法治疗后半规管良性发作性位置性眩晕(PC-BPPV)的疗效。方法将50例PC-BPPV患者随机分为两组,分别使用改良Epley耳石复位法(耳石复位组,26例)和Semont法(Semont组,24例)进行治疗并观察疗效。结果耳石复位组复位总成功率和首次复位成功率分别为92.3%和38.5%,Semont组分别为62.5%和8.3%,两组比较差异均有统计学意义(均P0.05)。改良Epley耳石复位组复位成功所需次数较Semont组少(P0.01)。结论改良Epley耳石复位法治疗PC-BPPV患者的复位总成功率及首次复位成功率高于Semont法,且安全、易操作,有一定推广价值。     

联合手法复位治疗后半规管良性发作性位置性眩晕疗效观察

良性发作性位置性眩晕（BPPV）是因特定头位改变而诱发的阵发性短暂眩晕,是最常见的位置性眩晕,约占位置性眩晕患者的90%.BPPV可能涉及到各个半规管,但后半规管良性阵发性位置性眩晕（PC-BPPV）最常见[1].耳石复位法是治疗PC-BPPV的主要方法.现将我科2012-04-2013-02耳石复位法治疗68例PC-BPPV患者资料报告如下.     

Epley耳石复位法治疗后半规管良性阵发性位置性眩晕的疗效观察

目的观察Epley耳石复位法治疗后半规管良性阵发性位置性眩晕(PC-BPPV)的临床疗效。方法对72例PC-BPPV患者采用Epley耳石复位法进行治疗,观察治疗后即刻、15 d、1个月及3个月的疗效。结果本组患者经1次Epley手法复位治疗后痊愈47例(65.3%),改善15例,总有效率86.1%。15 d后痊愈55例(76.4%),改善12例,总有效率93.0%;1个月痊愈52例(72.2%),改善13例,总有效率90.2%;至3个月时,痊愈54例(75.0%),改善12例,总有效率91.7%。结论 Epley耳石复位法治疗PC-BPPV安全有效。     

不同麻醉方法对功能区肿瘤运动诱发电位监测的影响

目的 研究不同麻醉方法对术中皮质运动诱发电位（MEP）监测的影响。方法回顾分析功能区肿瘤62例，肿瘤位于中央沟或附近，术中监测MEP。按照麻醉维持用药，将病例分为3组：静脉麻醉药＋阿片类镇痛药组（n=16），吸入麻醉药＋阿片类镇痛药组（n=15），静脉麻醉药＋吸入麻醉药＋阿片类镇痛药组（n=31）。按照是否应用肌松剂，分为无肌松剂组（n=21）和肌松剂组（n=41）。结果不同麻醉维持用药组间MEP监测成功率的差异无统计学意义。无肌松剂组和肌松剂组的MEP监测成功率分别为76．2％和41．5％，两组之间差异具有统计学意义（P〈0．05）。结论在MEP监测过程中，麻醉维持应选择静脉麻醉药，并且不使用肌松剂。     

改良式耳石复位法联合益气聪明汤治疗良性阵发性位置性眩晕疗效观察

目的 探讨改良式耳石复位法联合益气聪明汤治疗良性阵发性位置性眩晕(BPPV)的疗效.方法 56例BPPV患者随机分为对照组(耳石复位法)和治疗组(改良式耳石复位法联合益气聪明汤),随访1 a,观察治疗效果.结果 经上述方法治疗后,眩晕症状完全消失或明显改善.对照组治愈率81.5%,有效率100%,复发率22.2%;治疗...     

改良式耳石复位法治疗良性阵发性位置性眩晕疗效观察

分别采用三种不同改良式耳石复位法治疗良性阵发性位置性眩晕患者,治愈率达89.58%(43/48),有效率100%,随访1年复发率6.25%(3/48).改良式耳石复位法治疗良性阵发性位置性眩晕无明显禁忌证.操作方法 简单.无特殊不良反应,具有缓解症状迅速、治疗费用低、复发率低等优点,适宜临床推广应用.     

利培酮与奋乃静治疗高龄精神障碍的对照研究

目的比较利培酮与奋乃静治疗高龄精神障碍的疗效与耐受性、安全性。方法68例患者被分为试验组（利培酮组,n=35例）和对照组（奋乃静组,n=33例）,治疗6周,比较简明精神病评定量表（BPRS）的变化和副作用。结果两组患者的精神症状均有显著性减少,两组之间差异没有显著性（P〉0.05）,两组出现轻、中度副作用的几率差异无显著性（P〉0.05）,利培酮组锥体系副作用低于对照组（P〈0.05）。结论利培酮治疗高龄精神障碍的效果比较理想,且副作用少。     

良性阵发性位置性眩晕残留症状的影响因素

目的 探讨良性阵发性位置性眩晕（BPPV）患者耳石复位后残留症状的影响因素。方法 本 研究为前瞻性研究，共收集42例门诊确诊BPPV的患者在发病时和耳石复位成功1周后的一般情况，以 及眩晕残障量表（DHI）、医院焦虑抑郁量表（HADS）和眼肌前庭诱发肌源性电位检查（oVEMP）的结果。按 照复位成功后有无残留症状进行分组比较，Logistic回归分析残留症状的影响因素。结果 41例患者完 成随访，发现12例（29.3%）患者耳石复位成功后出现残留症状。残留症状组平均年龄和病程均大于无残 留症状组（P＜ 0.05）；残留症状组oVEMP患侧的振幅在耳石复位后有明显增高（P＜ 0.05）；残留症状组的 DHI-E（情绪）和HADS总分均高于无残留症状组（P ＜ 0.01）。进行Logistic回归分析发现BPPV发病时的 情绪状态是复位后残留症状的独立危险因素（P＜0.05）。结论 BPPV复位后残留症状受多方面因素影响， 抑郁与焦虑情绪是主要影响因素，BPPV发病时心理情绪干预能预防或改善残留症状的发生。     

复发和非复发女性良性阵发性位置性眩晕的骨密度研究

目的比较复发和非复发女性特发性良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者间骨密度的差异。方法选取75例女性特发性BPPV患者为研究对象,采用双能X线吸收法进行骨密度检测。所有患者予耳石复位治疗,并随访12 m,记录耳石复位次数及复发情况。比较复发组与非复发组之间骨密度值的差异。结果 (1)复发组19例,复发率25.33%,骨密度T值-2.17±1.35;未复发组56例,骨密度T值-1.32±1.47。比较两组骨密度T值,差异有统计学意义(P0.05)。(2)所有患者平均接受1.47±0.68次耳石复位治疗达到治愈标准。骨密度T值在复位1次、复位2次和复位3次及以上亚组中分别为(-1.04±1.37)、(-1.96±1.09)和(-3.50±0.84),骨密度T值和耳石复位次数之间呈负相关(r=-0.528,P0.001)。结论女性特发性良性阵发性位置性眩晕患者的复发可能与骨密度下降有关,且骨密度水平和耳石复位次数存在负相关。     

颗粒复位手法治疗后半规管良性发作性位置性眩晕的对照研究

目的 评价颗粒复位手法(PRM)在治疗后半规管良性发作性位置性眩晕(PC-BPPV)中的作用.方法 将PC-BPPV患者随机分成2组,复位组给予PRM治疗,对照组给予假复位治疗.结果 复位组43例,对照组45例,第4天随访时复位组和对照组的治疗成功率分别为86.05%(37/43)和8.89%(4/45),两者差异显著(X2=49.56,P＜0.01);第7天时,两者的成功率分别为95.35%(41/43)和17.78%(8/45),仍差异显著(X2=50.52,P＜0.01).结论 PRM疗效明显高于对照组,凡PC-BPPV诊断明确者均应给予PRM治疗.     

Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure

The authors compared the efficacy of a self-applied modified Semont maneuver (MSM) with self-treatment with a modified Epley procedure (MEP) in 70 patients with posterior canal benign paroxysmal positional vertigo. The response rate after 1 week, defined as absence of positional vertigo and torsional/upbeating nystagmus on positional testing, was 95% in the MEP group (n = 37) vs 58% in the MSM group (n = 33; p < 0.001). Treatment failure was related to incorrect performance of the maneuver in the MSM group, whereas treatment-related side effects did not differ significantly between the groups.     

A modified Epley's procedure for self-treatment of benign paroxysmal positional vertigo.

We compared the efficacy of a modified Epley's procedure (MEP) and Brandt-Daroff exercises (BDE) for self-treatment of benign paroxysmal positional vertigo of the posterior semicircular canal (PC-BPPV) in 54 patients. PC-BPPV resolved within 1 week in 18 of 28 patients (64%) using the MEP and in 6 of 26 patients (23%) performing BDE (p<0.01). Type and adequate performance of the maneuver predicted treatment outcome in the multivariate analysis. The frequency of side effects was not significantly different between the two groups. The MEP is more suitable for self-treatment of PC-BPPV than conventional BDE.     

Diagnostic Value of Straight Head Hanging in Posterior Canal Benign Paroxysmal Positional Vertigo

Background and PurposeTo determine the diagnostic value of straight head hanging (SHH) in benign paroxysmal positional vertigo involving the posterior semicircular canal (PC-BPPV).MethodsWe retrospectively included 62 patients (age=56.2±15.0 years, 47 female) with unilateral PC-BPPV who underwent both the Dix-Hallpike maneuver and SHH before receiving canalith repositioning therapy (CRT) between September 2017 and July 2020 at the Dizziness Center of Seoul National University Bundang Hospital in South Korea (16 patients, 25.8%) or the Neurology Outpatient Clinic of Aerospace Central Hospital in China (46 patients, 74.2%). SHH was performed before (n=29, group A) or after (n=33, group B) the Dix-Hallpike maneuver.ResultsTorsional upbeat nystagmus typical of PC-BPPV was induced during SHH in 52 (83.9%) patients, and the incidence of this type of positional nystagmus did not differ between the groups A and B (79.3% vs. 87.9%, p=0.569). The maximum slow-phase velocity of the induced upbeat nystagmus was higher during SHH than during the Dix-Hallpike maneuver toward the lesion side [range=2.0–60.0°/s (median=18.5°/s) vs. range=2.7–40.0°/s (median=13.4°/s), p<0.001]. Reversal of the positional nystagmus was observed upon resuming the sitting position after SHH in 47 (75.8%) patients and after the Dix-Hallpike maneuver in 54 (87.7%) patients, with no significant difference between the groups (p=0.082).ConclusionsSHH is effective for diagnosing PC-BPPV. Given its simplicity, SHH may be performed before the Dix-Hallpike maneuver, and CRT may be attempted thereafter when the typical positional nystagmus for unilateral PC-BPPV is induced during SHH.     

Double-blind randomized trial on short-term efficacy of the Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo

The need for Class I and II studies on the efficacy of Semont's liberatory maneuver (SLM) in the treatment of posterior canal benign paroxysmal positional vertigo (PC-BPPV) motivated the present double-blind randomized trial on the short-term efficacy of SLM. A total of 342 patients with unilateral PC-BPPV were recruited for a multicenter study. Patients were randomly assigned to treatment by SLM (n = 174) or sham treatment (n = 168). Subjects were followed up twice (1 and 24 h) with the Dix-Hallpike maneuver by blinded examiners. At the 1 and 24 h follow-up, 79.3 and 86.8%, respectively, of patients undergoing SLM had recovered from vertigo, compared to none of the patients undergoing the sham maneuver (p < 0.0001). Patients who manifested liberatory nystagmus at the end of SLM showed a significantly higher percentage of recovery (87.1 vs. 55.7%; p < 0.0001). To the best of our knowledge, this is the first Class I study on the efficacy of SLM. SLM proved highly effective with respect to the sham maneuver (p < 0.0001). Liberatory nystagmus was demonstrated to be a useful prognostic factor for the efficacy of treatment. The present Class I study of efficacy of SLM changes the level of recommendation of the maneuver for treating PC-BPPV from level C to level B.     

Asymmetric corticomotor excitability correlations in early Parkinson's disease.

We studied corticomotor excitability (CE) between the more and less affected sides in early Parkinson's disease (PD) patients using transcranial magnetic stimulation (TMS). Sixteen-PD patients within the first 3 years of diagnosis were studied with single-pulse TMS over each motor cortex with intensities from 40% to 100% stimulator output. Active motor evoked potentials (MEP) and cortical silent period durations (CSP) were recorded, fitted with sigmoid curves, summarized as maximal MEP/CSP, maximal MEP/CSP slope, and intensity where MEP/CSP is half-maximal (MEP/CSP-Int50), and correlated with Unified Parkinson's Disease Rating Scale scores (UPDRS). On the more affected side, higher (worse) UPDRS scores were correlated with shorter maximal CSP (r=-0.51, P=0.046). On the less affected side, higher UPDRS scores were correlated with higher MEP-Int50 (r=0.51, P=0.043) and CSP-Int50 (r=0.54, P=0.029). For the less affected side, altered CE, as indexed by higher MEP or CSP-Int50 intensities, may contribute to early clinical symptoms. On the more affected side, increases in CE, indexed by shorter CSP, may account for a greater proportion of PD symptoms. These findings are consistent with an evolution of neurophysiologic correlates in early PD patients from a less to more symptomatic state.     

Self-treatment for benign paroxysmal positional vertigo of the posterior semicircular canal

The authors compared the efficacy of the Epley procedure with and without self-treatment in 80 patients with benign paroxysmal positional vertigo of the posterior semicircular canal. The self-treatment group (88%) had better results than the Epley-alone group (69%) based on both symptoms and nystagmus (p = 0.048). Complications occurred in 2.6% of the Epley-alone group and in 7.5% of the self-treatment group (p = 0.62).     

齐拉西酮与利培酮治疗精神分裂症对照分析

目的:探讨齐拉西酮治疗精神分裂症的疗效和安全性。方法:将80例精神分裂症患者随机分为齐拉西酮组和利培酮组,每组40例。疗程8周。用阳性与阴性症状量表(PANSS)和治疗中出现的症状量表(TESS)评定临床疗效和不良反应。结果:治疗8周后,齐拉西酮组显效率和有效率分别为65.0%和85.0%,利培酮组分别为67.5%及87.5%,两组疗效相当;两组治疗后PANSS总分和各因子分均较治疗前有明显下降,但两组间比较差异无显著性。不良反应总发生率齐拉西酮组显著低于利培酮组。结论:齐拉西酮治疗精神分裂症有较好的疗效,与利培酮相当,不良反应比利培酮更少。     

乌灵胶囊和黛力新治疗广泛性焦虑症对照研究

目的观察乌灵胶囊对广泛性焦虑症的疗效与安全性。方法采用平行对照研究方法,治疗组30例患者给予口服乌灵胶囊3粒,3次／日;对照组30例患者给予口服黛力新1片,2次／日。于治疗前及治疗后第1周、2周、4周、6周分别以汉密顿焦虑量表（Hamilton Anxiety Scale,HAMA）、汉密顿抑郁量表（Hamilton Depression Scale,HAMD）、治疗时出现的症状量表（Treatment Emergent Symptoms．TESS）及实验室检查评估疗效与安全性。结果治疗组、对照组总有效率分别为73％、77％,二组之间疗效无显著差异。治疗组未见明显不良反应,对照组不良反应发生率为11％,主要为口干、过度镇静和头痛。结论乌灵胶囊是治疗广泛性焦虑症疗效可靠、安全的药物。     

Effective and safe but forgotten: methsuximide in intractable epilepsies in childhood.

The efficacy and safety of methsuximide (MSM) was evaluated in children with intractable epilepsies in a prospective uncontrolled study. MSM was added to the therapeutic regimen of 112 children with intractable epilepsy under inpatient conditions, all of whom were therapeutically refractory to various first-line antiepileptic drugs (AED) or combinations of other AED. Titration of MSM was performed following a uniform protocol. Administration of MSM resulted in a 50% or greater reduction in seizure frequency in 40 patients after a short-term observation period (mean 9.1 weeks). After a mean of 3.7 years, the rate of seizures and side effects were re-evaluated in 39 patients who were still receiving MSM as part of their antiepileptic regimen. Twenty two of these patients derived long-term benefit from MSM. In patients with good seizure control, fasting plasma levels of N-desmethylmethsuximide, the principal active metabolite of MSM, were 25.3-44.7 mg l(-1)(mean 36.0 mg l(-1)). Thus effective plasma levels of N-desmethylmethsuximide in children were found to be higher than previously described. Forty one of 112 patients (28.9%) developed side effects during MSM treatment. No serious or irreversible side effects were seen. Our study demonstrates the value of MSM as an 'add-on' drug in intractable epilepsies.