Interaction of somatoform and vestibular disorders

BACKGROUND: The high coincidence of organic vestibular and somatoform vertigo syndromes has appeared to support pathogenic models showing a strong linkage between them. It was hypothesised that a persisting vestibular dysfunction causes the development of anxiety disorders. OBJECTIVE: To determine the relation between vestibular deficits and somatoform vertigo disorders in an interdisciplinary prospective study. METHODS: Participants were divided into eight diagnostic groups: healthy volunteers (n=26) and patients with benign paroxysmal positioning vertigo (BPPV, n=11), vestibular neuritis (n=11), Menière's disease (n=7), vestibular migraine (n=15), anxiety (n=23), depression (n=12), or somatoform disorders (n=22). Neuro-otological diagnostic procedures included electro-oculography with rotatory and caloric testing, orthoptic examination with measurements of subjective visual vertical (SVV) and ocular torsion, and a neurological examination. Psychosomatic diagnostic procedures comprised interviews and psychometric instruments. RESULTS: Patients with BPPV (35.3%) and with vestibular neuritis (52.2%) had pathological test values on caloric irrigation (p<0.001). Otolith dysfunction with pathological tilts of SVV and ocular torsion was found only in patients with vestibular neuritis (p<0.001). Patients with Menière's disease, vestibular migraine, and psychiatric disorders showed normal parameters for vestibular testing but pathological values for psychometric measures. There was no correlation between pathological neurological and pathological psychometric parameters. CONCLUSIONS: High anxiety scores are not a result of vestibular deficits or dysfunction. Patients with Menière's disease and vestibular migraine but not vestibular deficits showed the highest psychiatric comorbidity. Thus the course of vertigo syndromes and the possibility of a pre-existing psychopathological personality should be considered pathogenic factors in any linkage between organic and psychometric vertigo syndromes.     

苯磺酸氨氯地平片对正常高值血压的疗效观察

[目的]观察苯磺酸氨氯地平片对伴有头晕、头痛的正常高值血压的治疗作用.[方法]选择伴有头晕、头痛症状的正常高值血压患者106例,随机分为对照组和治疗组,每组各为53例.对照组给予非药物治疗,治疗组给予非药物治疗加用苯磺酸氨氯地平片.[结果]对照组为总有效率33.9%,治疗组为86.8%,治疗组明显高于对照组(P<0.01).2组治疗后与同组治疗前比较,对照组收缩压(SBP)和舒张压(DBP)有所降低,但差异无统计学意义(均P>0.05),治疗组SBP和DBP均明显降低(P<0.01);治疗组治疗后SBP和DBP与对照组治疗前比较均明显降低(P<0.01).[结论]苯磺酸氨氯地平片治疗伴有头晕、头痛症状的正常高值血压有效、安全.     

Effectiveness of vestibular rehabilitation on concussion-induced vertigo: a systematic review

Background: Approximately 5% of all Americans have experienced a concussion sometime during their lifetime. The predominant symptoms associated with a concussion are physical issues, cognitive issues, emotional issues, and sleep disturbances; and one of the most common physical issues is vertigo.

Objectives: The purpose of this systematic review was to investigate the effectiveness of vestibular rehabilitation on concussion-induced vertigo.

Methods: Those databases that were utilized for search terms included CINAHL Complete, Proquest Medical Library, and PubMed. Each of these databases was examined from inception through the end of 2017. The search terms were ‘concussion’ OR ‘brain injury’ OR ‘head injury’ AND ‘vestibular rehabilitation’ OR ‘vestibular therapy’ AND ‘vertigo’ OR ‘dizziness’. The Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence system was used to assess the evidence level of each included study, and methodological rigor was assessed utilizing criteria set forth in a systematic review by Medlicott and Harris.

Results: Seven articles met the inclusion criteria and were included in the qualitative synthesis. Six of the seven studies had an evidence level of less than two, and four of the seven studies had weak methodological rigor. Despite these limitations, this systematic review demonstrated that vestibular rehabilitation is generally an effective intervention for individuals with concussion-induced vertigo, even in the presence of visual disorders.

Conclusions: Vestibular rehabilitation should be considered as a component of the plan of care for individuals who experience vertigo following a concussion.     

杜雨茂教授运用八味肾气丸治疗高血压的经验

肾阴阳两虚型高血压病在临床辨证论治过程中常常被忽视,杜雨茂教授运用经方仲景八味肾气丸双补阴阳治疗肾阴阳两虚型高血压病经验丰富,临床疗效显著。     

Poor Treatment Outcomes Following Repositioning Maneuvers in Younger and Older Adults With Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-analysis

Objective

This systematic review aimed to methodically review the available evidence on poor treatment outcomes after repositioning maneuver treatments in adults with BPPV and whether there are differences in the outcomes for older and younger adults.

前庭康复训练对原发性良性阵发性位置性眩晕患者复位后残余症状的疗效分析

目的 探讨早期前庭康复训练对原发性良性阵发性位置性眩晕(BPPV)复位成功后残余症状的疗效.方法 纳入2016年3月至12月就诊于第二军医大学长征医院神经内科的原发性BPPV且复位成功的100例患者,将其中复位24 h后仍存在残余症状的38例随机分为前庭康复训练组及对照组,各19例.对照组患者未接受特殊处理,前庭康复训练组接受Cawthorne-Cooksey前庭康复训练,两组均随访4周,每周由神经科医师进行1次随访,行眩晕残障问卷(DHI)量表评估患者疗效.结果 两组患者随访1～4周的DHI评分较复位后24 h评分均有好转(P均＜0.05).复位后24 h及第1周随访时两组间DHI评分差异均无统计学意义(P=0.609、P=0.627),第2～4周随访时前庭康复训练组DHI评分均低于对照组(P均＜0.05).结论 复位后早期给予前庭康复训练可有效缓解BPPV复位后的残余症状,降低功能残障发生率.     

特发性水平半规管良性阵发性位置性眩晕复发相关因素分析

目的 研究特发性水平半规管良性阵发性位置性眩晕(HSC-BPPV)复位次数、前庭冷热试验、复位后残余眩晕是否与复发率存在关系。方法 2016年1月—2018年1月门诊手法复位成功的84例特发性HSC-BPPV的患者纳入本研究,所有患者均行Barbecue滚转手法复位。根据复位次数分为A组(<3次)和B组(≥3次);根据患者复位后有无残余眩晕,分为C组(无残余眩晕)和D组(残余眩晕),观察复发率。所有患者均行前庭冷热试验检查。结果 本研究显示A组(20.9%)与B组(26.8%)的复发率无明显差异;C组(11.8%)与D组(32.0%)复发率差异具有统计学意义(P=0.033);复位后存在残余眩晕患者前庭功能异常率高;复位后存在残余眩晕并伴有前庭冷热试验异常的患者复发率最高(66.7%);复发率最低的为复位次数<3次且复位后无残余眩晕的患者(6.3%)。结论 HSC-BPPV复发率与复位次数无关,冷热试验异常与残存眩晕相关,复位后残余眩晕伴前庭冷热试验异常提示患者复发率增高。     

高血压病辨治四法

原发性高血压病发病原因交织重叠,辨证分型纷繁复杂。临床将该病分为肝火亢盛、痰热上扰,肝肾阴虚、肝阳上亢,脾肾阴虚、痰湿内蕴,气血亏虚、痰瘀阻络四大类型治疗,疗效较理想。     

The evidence base for the evaluation and management of dizziness

Objectives  Dizziness presentations pose many clinical challenges. The objective of this study is to broadly summarize the evidence base that supports clinical decisions in dizziness presentations.
Methods  MEDLINE (1966 to September 2007), Web of Science and The Cochrane Library were searched for articles with clinical relevance on topics concerning dizziness. Additional sources were also searched for clinical practice guidelines. The following information was abstracted from each article: year of publication, journal type, type of article and the topics of the article.
Results  Of nearly 3000 articles identified, 1244 articles met the inclusion criteria. The most common article type was a case report or case series, followed by expert opinion or review articles, studies of medical tests and clinical trials. Meta-analyses and systematic reviews were found on benign paroxysmal positional vertigo and Meniere's disease, but only a few other topics. No clinical practice guidelines were found that focus specifically on dizziness.
Conclusions  The evidence base for the evaluation and management of dizziness seems to be weak. Future work to establish or summarize evidence in clinically meaningful ways could contribute to efforts to optimize patient care and health care utilization for one of the most common presenting symptoms.     

Visual fixations and visually induced dizziness: An exploratory study

BackgroundVisually induced dizziness can develop as a sequala of a vestibular disorder and is characterized by symptoms of nausea, dizziness, and imbalance in rich visual environments such as supermarkets and shopping malls. To date the mechanisms underlying visually induced dizziness are poorly understood.Research questionWhat are the characteristics of visual fixations and postural sway in adults with visually induced dizziness compared to healthy adults when exposed to increasingly complex visual environments?MethodsWe recruited 20 adults with visually induced dizziness and 20 healthy adults to this cross-sectional exploratory study. Participants were instructed to maintain gaze on letters projected on a large screen with backgrounds of differing visual complexity. The number of visual refixations, movement of the centre of pressure, and movement of the head and body centres of mass were recorded.ResultsAdults with visually induced dizziness showed a significantly higher number of visual refixations (F= 10.592, p < 0.01), and increased mean velocity of head and body centres of mass movement (F= 14.034, p < 0.01 and F= 6.553, p < 0.05 respectively) compared to healthy adults.SignificanceAdults with visually induced dizziness exhibited visual fixational instability and increased postural and head sway compared to healthy adults. This was mainly observed in conditions with complex and moving backgrounds. This may account for reports from adults with visually induced dizziness of worsening symptoms in busy environments. The results from the study may assist in guiding intervention development to reduce symptoms of visually induced dizziness.