Can Benign Paroxysmal Positional Vertigo Be Treated in a One Session?

Pérez-Guillén, Vanesa; Franco‐Gutiérrez, Virginia; Aguilar, Maria Teresa Gil; Zamora, Enrique García; Pérez-Vázquez, Paz

doi:10.1097/mao.0000000000002621

Cited by 6 publications

(3 citation statements)

References 19 publications

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“…In most cases, its characteristics can easily be interpreted as excitation/inhibition of ampullary vestibular receptors, followed by the inappropriate flow of endolymph associated with abnormal otoconia in semicircular canals [ 3 ]. The most common cause of BPPV is tubular stones in posterior canal (PC) and lateral semicircular canals (LC), and treatment is a physical operation that removes (repositions) the auricle from the canal [ 7 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Betahistine alleviates benign paroxysmal positional vertigo (BPPV) through inducing production of multiple CTRP family members and activating the ERK1/2-AKT/PPARy pathway

et al. 2022

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Background Betahistine is a clinical medication for the treatment of benign paroxysmal positional vertigo (BPPV). Otolin, a secreted glycoprotein with a C-terminal globular domain homologous to the immune complement C1q, has been identified as a biomarker for BPPV. However, the role of complement C1q/TNF-related proteins (CTRPs) with a C-terminal globular domain in BPPV is unclear, so we explored the change of CTRPs in betahistine treated BPPV. Methods We treated BPPV patients with Betahistine (12 mg/time, 3 times/day) for 4 weeks and observed the clinical efficacy and the expression of CTRP family members in BPPV patients. Then, we constructed a vertigo mice model of vestibular dysfunction with gentamicin (150 mg/Kg) and a BPPV model of Slc26a4loop/loop mutant mice. Adenoviral vectors for CTRP expression vector and small interfering RNA were injected via the intratympanic injection into mice and detected the expression of CTRP family members, phosphorylation levels of ERK and AKT and the expression of PPARγ. In addition, we treated mice of vestibular dysfunction with Betahistine (10 mg/Kg) and/or ERK inhibitor of SCH772984 (12 mg/Kg) and/or and PPARγ antagonist GW9662 (1 mg/Kg) for 15 days, and evaluated the accuracy of air righting reflex, the time of contact righting reflex and the scores of head tilt and swimming behavior. Results After treatment with Betahistine, the residual dizziness duration and the score of the evaluation were reduced, and the expression of CTRP1, 3, 6, 9 and 12 were significantly increased in BPPV patients. We also found that Betahistine improved the accuracy of air righting reflex, reduced the time of contact righting reflex and the scores of head tilt and swimming behavior in gentamicin-treated mice and Slc26a4loop/loop mutant mice. The expression levels of CTRP1, 3, 6, 9 and 12, phosphorylation levels of ERK and AKT, and PPARγ expression were significantly increased, and the scores of head tilt and swimming behavior were decreased in vestibular dysfunction mice with overexpression of CTRPs. Silencing CTRPs has the opposite effect. SCH772984 reversed the effect of Betahistine in mice with vestibular dysfunction. Conclusion Betahistine alleviates BPPV through inducing production of multiple CTRP family members and activating the ERK1/2-AKT/PPARy pathway.

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Section: Discussionmentioning

confidence: 99%

Betahistine alleviates benign paroxysmal positional vertigo (BPPV) through inducing production of multiple CTRP family members and activating the ERK1/2-AKT/PPARy pathway

et al. 2022

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“…There is strong evidence that the Epley maneuver is effective and safe in the treatment of PC-BPPV ( Hilton and Pinder, 2014 ). Varying results from different studies have raised questions about which is the best EM protocol ( Dorigueto et al., 2005 ; Korn et al., 2007 ; Perez-Guillen et al., 2020 ). Our goal in this study was to examine more closely the short-term therapeutic effect of two EM protocols in the demanding environment of the emergency department.…”

Section: Discussionmentioning

confidence: 99%

A comparative study of two methods for treatment of benign paroxysmal positional vertigo in the emergency department

et al. 2021

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Introduction Posterior canal benign paroxysmal positional vertigo (PC-BPPV) is considered the most common cause of peripheral vertigo in the emergency department (ED). Although the canalith repositioning maneuver (CRM) is the standard of care, the most effective method to deliver it in the ED has been poorly studied. Objective To compare two protocols of the Epley maneuver for the treatment of PC-BPPV. Patients and methods We prospectively recruited 101 patients with unilateral PC-BPPV on physical examination, randomizing them to either a single Epley maneuver (EM) (n = 46) or multiple maneuvers (n = 55) on the same visit. Measured outcomes included presence/absence of positional nystagmus, resolution of vertigo, and score on the dizziness handicap inventory (DHI) at follow-up evaluations. The DHI was stratified into mild (≤30) and moderate-severe (>30). Results Normalization of the Dix-Hallpike maneuver at day 5 was observed in 38% of the single EM group and 44.4% in the multiple EM group (p = 0.62). The DHI showed reduction from 42.2 (SD 18.4) to 31.9 (SD 23.7) in the single EM group and from 43.7 (SD 22.9) to 33.5 (SD 21.5) in the multiple EM group (p = 0.06). A higher number of patients improved from moderate-severe to mild DHI (p = 0.03) in the single EM group compared to the multi-EM group (p = 0.23). Conclusion There was no statistically significant difference between performing a single EM versus multiple EMs for treatment of PC-BPPV in the emergency department. The single EM approach is associated with shorter physical contact between patients and examiner, which is logically safer in a pandemic context.

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“…Third, as shown in the video, short interval time was set aside between repositioning and diagnostic maneuvers, which should be associated with the occurrence of CS or reentry in the reported case. Although repeated repositioning and diagnostic maneuvers within the same session is considered as a safe and effective approach to the management of BPPV, with a low risk of CS (15,16), enough interval between maneuvers should set aside to avoid the occurrence of CS or re-entry conditions (12–14). There is not yet a consensus on interval time between maneuvers (15), a study suggested that at least a 15-minitus interval time between maneuvers should be kept out, which may decrease the incidence of CS or re-entry (14).…”

mentioning

confidence: 99%

Re: Benign Paroxysmal Positional Vertigo: Canal Switching Affecting All Canals During a Single Session

Shan

Wang

2022

Otology &Amp; Neurotology

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Can Benign Paroxysmal Positional Vertigo Be Treated in a One Session?

Cited by 6 publications

References 19 publications

Betahistine alleviates benign paroxysmal positional vertigo (BPPV) through inducing production of multiple CTRP family members and activating the ERK1/2-AKT/PPARy pathway

Betahistine alleviates benign paroxysmal positional vertigo (BPPV) through inducing production of multiple CTRP family members and activating the ERK1/2-AKT/PPARy pathway

A comparative study of two methods for treatment of benign paroxysmal positional vertigo in the emergency department

Re: Benign Paroxysmal Positional Vertigo: Canal Switching Affecting All Canals During a Single Session

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