New therapeutic maneuver for anterior canal benign paroxysmal positional vertigo

This article describes the clinical features of anterior semicircular canal benign paroxysmal positional vertigo (AC-BPPV) and a new therapeutic maneuver for its management. Our study was a retrospective review of cases from an ambulatory tertiary referral center. Thirteen patients afflicted with positional paroxysmal vertigo exhibiting brief positional down-beating nystagmus in positional tests (Dix–Hallpike and head-hanging position) were treated with a maneuver comprised of the following movements: Sequential head positioning beginning supine with head hanging 30° dependent with respect to the body, then supine with head inclined 30° forward, and ending sitting with head 30° forward. All cases showed excellent therapeutic response to our repositioning procedure, i.e. relief of vertigo and elimination of nystagmus. The maneuver described is an option for AC-BPPV treatment.     

Treatment of anterior canal benign paroxysmal positional vertigo by a prolonged forced position procedure

This report presents a therapeutic procedure for refractory benign paroxysmal positional vertigo (antBPPV) of the anterior canal. Two patients with refractory antBPPV were treated by a prolonged forced position procedure (PFPP). The technique is based on the assumption that the pathophysiological mechanism of antBPPV is similar to that generating posterior canal canalolithiasis. The patients recovered from refractory antBPPV after one or more PFPPs. The rationale for this therapy is that when the patient lies in the proposed forced position, the affected anterior canal is uppermost in an almost gravitationally vertical position. If the patient remains in this position for several hours, the floating particles lying in the non-ampullary arm of the canal can gradually slip out of the canal towards the vestibule due to gravity. We recommend trying PFPP when the side of lithiasis cannot be determined, in cases that are resistant to particle repositioning canal manoeuvres, and before considering canal plugging for refractory antBPPV.     

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).     

360°旋转复位与Epley手法复位治疗后半规管良性阵发性位置性眩晕的比较

目的:比较360°旋转复位与Epley手法复位治疗后半规管良性阵发性位置性眩晕的临床疗效。方法:69例后半规管良性阵发性位置性眩晕患者被随机分入研究组(35例,接受360°旋转复位治疗)和对照组(34例,接受Epley手法复位治疗)。比较2组患者的疗效以及痊愈后的残留症状。结果:研究组和对照组患者在接受1次治疗后即可获得治愈的患者所占比例分别为91.4%(32/35)和88.2%(30/34),需要接受2次治疗才能达到治愈的患者所占比例分别为8.6%(3/35)和11.8%(4/34),但2组之间的差异均无统计学意义(P值均0.05)。研究组治愈后有残留症状(包括头晕、行走不稳、颈部不适)的患者所占比例为17.1%(6/34),显著低于对照组患者[29.4%(10/35)](P0.05)。结论:360°旋转复位与Epley手法复位治疗后半规管良性阵发性位置性眩晕的疗效相似,但前者的残留症状更少,有助于提高患者的生活质量,且操作更加简便、舒适度更优,显示出较高的临床应用价值。     

颗粒复位手法治疗36例后半规管良性发作性位置性眩晕

目的　探讨颗粒复位手法 (PRM)对后半规管良性发作性位置性眩晕 (BPPV)的治疗效果。方法　从2 0 0 3年 1～ 12月 ,对 36例后半规管BPPV进行PRM治疗。结果　经 1次PRM治疗后 ,2 8例症状消失 ,首次治疗成功率为 77 8% ,其中病程在 1周内的 18例患者有 16例症状消失。 4例经 2次PRM治疗 ,2例经 3次PRM治疗后症状也消失 ,总治疗成功率为 94 4 %。 2例无效者行Semont锻炼 ,症状缓解 ,随访至今 ,3例复发 ,复发率 8 8% ,复发者再行PRM治疗仍有效。结论　PRM治疗后半规管BPPV安全有效 ,凡诊断明确均应给予PRM治疗。     

良性阵发性位置性眩晕的耳石复位治疗

目的探讨良性阵发性位置性眩晕(BPPV)耳石复位法的疗效。方法应用Epley手法、Barbecue翻滚法和Semont手法对12例BPPV患者进行治疗。结果12例患者经上述手法复位治疗48h后眩晕症状均完全消失,无明显不良反应,分别随访3～11个月无再发。结论耳石复位法治疗BPPV有效、简便、安全,可作为BPPV的首选治疗方法。     

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.     

眼震形式预测后半规管良性阵发性位置性眩晕复位疗效观察

目的 探讨Epley手法第2、4步骤出现的眼震形式与复位效果的关系.方法 应用Epley 手法对73例确诊BPPV后半规管良性阵发性位置性眩晕(PC-BPPV)患者进行治疗,在裸眼状态下观察治疗过程中位置性眼震的特点,并根据Epley 手法复位第2步骤眼震形式将患者分为3组:带上跳性垂直成分的旋转性眼震(Ⅰ组)、相反方向的眼震(Ⅱ组)、无眼震(Ⅲ组).结果 在手法复位第2步骤,有56例患者出现带上跳性垂直成分的旋转性眼震(与其Dix-Hallpike试验第1步骤眼震一致),6例患者出现反向的眼震,11例患者未出现眼震.56例患者中有40例首次复位成功,12例第2次复位成功;相反,经过2次复位后,6例出现反向眼震的患者中有4例,11例无眼震的患者中有7例,均复位失败.在首次或第2次复位成功过程中, 42例的Ⅰ组患者在手法复位第4步骤时出现下跳性眼震.结论 Epley手法复位第2步骤出现带上跳性垂直成分的旋转性眼震以及第4步骤出现下跳性眼震,大多数可以预示着复位成功.     

Repeated vs single physical maneuver in benign paroxysmal positional vertigo

OBJECTIVES: To evaluate the effectiveness and possible side effects of a single session of repeated particle repositioning maneuver (PRM) to treat posterior canal benign paroxysmal positional vertigo (BPPV) and the usefulness of post-treatment restrictions. MATERIALS AND METHODS: A total of 125 consecutive patients with idiopathic BPPV participated in the study. Fifty patients received a single session of repeated PRM only (group I). Results were compared with those of 50 patients with BPPV who received a single PRM (group IIb), and 25 patients who received a single PRM followed by the use of a neck collar and keeping the head upright for 48 h (group IIa). RESULTS: Forty-six patients (92%) of group I, 40 patients (80%) of group IIb, and 21 patients (84%) of group IIa were completely free of signs and symptoms when re-examined 1 week after treatment. Transient nausea and disequilibrium following treatment were reported equally in all subgroups and well tolerated. Nearly all patients of group IIa considered the post-treatment restrictions very inconvenient. CONCLUSIONS: A single session of repeated physical procedure seems to be clinically superior to one single maneuver and well tolerated. Additional post-treatment measurements are inconvenient and should be abandoned.     

水平半规管良性发作性位置性眩晕的临床研究

目的 探讨水平半规管良性发作性位置性眩晕（HC—BPPV）的临床特点和治疗方法。方法 回顾性分析27例HC—BPPV患者的临床资料及Barbecue翻滚法耳石复位治疗的疗效。结果 27例HC—BPPV患者眩晕发作具有短暂性、变位性、潜伏期、无疲劳性的特点,平卧侧头时21例见水平向下性眼震,6例为水平向上性眼震。给予Barbecue翻滚法耳石复位治疗后,水平向下性眼震患者症状全部消失,水平向上性眼震患者症状未缓解。结论 根据临床特点和平卧侧头试验可确诊HC—BPPV,水平向下性眼震与半规管耳石症相关,水平向上性眼震与壶腹嵴帽耳石症相关,Barbecue翻滚法对出现水平向下性眼震的HC—BPPV有特效。     

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.     

Correction to: Update on benign paroxysmal positional vertigo

Journal of Neurology - The original version of this article unfortunately contained a mistake. Second author’s affiliation was incorrect.     

耳石复位法治疗良性阵发性位置性眩晕42例临床分析

目的 探讨耳石复位法治疗良性阵发性位置性眩晕(BPPV)的效果.方法 应用 Epley管石复位法、 Semont管石解脱法、Barbecue翻滚法治疗良性阵发性位置性眩晕42例.结果 42 例中经耳石复位法治愈36例(85.7%),有效4例(9.5%),复位失败2例(4.8%).失败的2例经前庭功能训练治愈.结论 耳石复位法是BPPV的首选治疗方法,对于复位失败的患者可试行前庭功能训练.