Importance of different therapeutic procedures in the treatment and reccurence of benign paroxysmal positional vertigo

Abstract

Benign paroxysmal positional vertigo (BPPV) is a syndrome that is manifested by sudden brief attacks of vertigo that are provoked by certain head positions. In last two decades of last century since the introduction into clinical practice of new repositioning therapeutic maneuvers, there has been significant progress in the treatment of these patients. As part of the treatment protocol, to patients with PCBPPV, are advised postmaneuver instructions. Application of postmaneuver instructions at the end of the maneuver was suppose to prevent the return of otoconia from utricle back into the semicircular canals. In recently, controversy appeared in the literature over the necessity of application of postmaneuver instructions. During the treatment of PC-BPPV, liberating (orthotropic), secondary nystagmus was noticed, and it appeared in the third position of Epley maneuver and in the second position of Semont maneuver. According to the some authors, its appearance is a positive prognostic factor for treatment efficacy. In a number of patients there is a lacking of success in the treatment of the disease or there are relapses in a very short period of time after recovery. Potential risk factors responsible for the poor results of the treatment of various forms of BPPV and relapses are still subject to debate. The aims of this study were to evaluate the effect of postmaneuver instructions on treatment outcome and recurrence of PC-BPPV in patients treated with the modified Epley maneuver and patients treated with Semont maneuver, investigate the existence of a correlation between the liberating nystagmus and outcome of modified Epley or Semont maneuver and to identify potential risk factors that can lead to the treatment failure and recurrence of BPPV. Four-year, prospective cohort study included 400 patients with BPPV, which were previously not treated with any of therapeutic maneuvers for vertigo. BPPV of the posterior semicircular canal was present in 344 patients, BPPV of the horizontal semicircular canal in 49 and BPPV of the anterior semicircular canal in 7...

Benigni paroksizmalni pozicioni vertigo (BPPV) je sindrom koji se manifestuje iznenadnim kratkotrajnim napadima vrtoglavice koji su provocirani odreñenim položajem glave. U poslednje dve decenije prošlog veka uvoñenjem u kliničku praksu novih repozicionih terapijskih manevara, došlo je do značajnog napredka u lečenju ove grupe pacijenata. Kao deo terapijskog protokola pacijentima sa PC-BPPVom su savetovane odreñene postmanevarske instrukcije. Primena postmanevarskih instrukcija bi po završetku manevra trebala da spreči vraćanje otokonija iz utrikulusa nazad u polukružne kanale. U novije vreme u literaturi su se pojavile kontroverze oko neophodnosti primene postmanevarskih instrukcija. Prilikom lečenja PC-BPPV-a zapažena je pojava sekundarnog nistagmusa koji je nazvan oslobañajući (ortotropni), a pojavljuje se u trećem položaju Epley-evog i u drugom položaju Semont-ovog manevra. Po mišljenju pojedinih autora, njegova pojava predstavlja pozitivan prognostički faktor za efikasnost tretmana. Kod odreñenog broja pacijenata izostaje uspeh u lečenju ili se pojavljuju recidivi u vrlo kratkom periodu nakon izlečenja. Potencijalni faktori rizika odgovorni za lošije rezultate lečenja različitih oblika BPPVa i pojavu recidiva, još uvek su predmet debate. Ciljevi ove disertacije su da se ispita uticaj postmanevarskih instrukcija na ishod lečenja i pojavu recidiva PC-BPPV-a kod pacijenata tretiranih modifikovanim Epley-evim i pacijenata tretiranih Semont-ovim manevrom, utvrdi postojanje korelacije izmedju pojave oslobañajućeg nistagmusa i ishoda modifikovanog Epleyevog ili Semont-ovog manevra i utvrde potencijalni faktori rizika značajni za pojavu loših rezulta lečenja i nastajanje recidiva BPPV-a. Četvorogodišnja kohortna studija sa prospektivnim pristupom obuhvatila je 400 pacijenata sa BPPV-om, koji predhodno nisu lečeni nekim od terapijskih manevara zbog vrtoglavice. BPPV zadnjeg polukružnog kanala bio je prisutan kod 344, BPPV horizontalnog polukružnog kanala kod 49 i BPPV gornjeg polukružnog kanala kod 7 pacijenata...