Head‐Up Sleep May Cure Patients With Intractable Benign Paroxysmal Positional Vertigo: A six‐Month Randomized Trial

Horinaka, Akira; Kitahara, Tadashi; Shiozaki, Tomoyuki; Ito, Taeko; Wada, Yoshiro; Yamanaka, Toshiaki; Nario, Kazuhiko

doi:10.1002/lio2.270

Cited by 15 publications

(9 citation statements)

References 22 publications

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“…17,18 After appropriate emergency triage, statistically speaking, we should recognize that most vertigo/dizziness diseases are PVDs and that BPPV is the most common. 19,20 However, BPPV can sometimes cause a persistent vertiginous sensation because of chronic otolith damage 21 and lead to psychological distress, resulting in the unfortunate classification of PSY or unknown origin. 4,22 We would like to propose an idealistic approach to differential diagnosis after emergency triage: checking positional/positioning nystagmus for BPPV and Romberg ratios/ foam rubber ratios for PSY.…”

Section: Discussionmentioning

confidence: 99%

Posturographic Findings in Patients With Psychological Dizziness

Matsumura

Ito²,

Yamanaka³

et al. 2021

The Neurologist

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Background:The diagnosis and treatment of patients with psychogenic vertigo (PSY) is difficult because of the lack of reliable objective findings for this condition. We examined the characteristics of foam posturography in patients with peripheral vestibular disorders (PVD) and those with PSY. In particular, we focused on the objective findings of foam posturography in PSY.Methods: Between January 2010 and December 2011, 2-legged stance tasks were conducted in patients with vertigo/dizziness under 4 conditions: eyes opened with/without foam rubber and eyes closed with/ without foam rubber. In terms of the velocity of movement of the center of pressure, we examined Romberg ratios, that is, the ratios of changes in visual conditions under the fixed foam rubber conditions, and foam rubber ratios, that is, the ratios of changes in foam rubber conditions under fixed visual conditions. These ratios were compared among 3 groups: healthy controls (CONT) (n = 195), PVD (n = 178), and PSY (n = 32).Results: Romberg ratios using foam rubber in the PVD group were significantly higher than those in the CONT group. Those in the PSY group were significantly lower. Likewise, the foam rubber ratios in the PVD group were significantly higher than those in the CONT group when the eyes were closed. Those in the PSY group were significantly lower. Conclusion:Judging from scores in Romberg ratios using foam rubber and foam rubber ratios when eyes were closed, foam posturography might have the potential to differentiate PSY from PVD.

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Section: Discussionmentioning

confidence: 99%

Posturographic Findings in Patients With Psychological Dizziness

Matsumura

Ito²,

Yamanaka³

et al. 2021

The Neurologist

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“…Furthermore, the head-up posture during sleep for 3 months may be helpful to reduce the subjective symptoms and subjective visual vertical tilt in the intractable BPPV over 3 months, which was irrelevant to the involved semicircular canal (13). If the otolithic debris may float freely in the utricle, the head-up posture can prevent the debris to fall into the semicircular canal (14).…”

Section: Discussionmentioning

confidence: 99%

Effect of the Epley Maneuver and Brandt-Daroff Exercise on Benign Paroxysmal Positional Vertigo Involving the Posterior Semicircular Canal Cupulolithiasis: A Randomized Clinical Trial

et al. 2020

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Objective: To investigate the therapeutic efficacies of the Epley maneuver and Brandt-Daroff (BD) exercise in patients with benign paroxysmal positional vertigo involving the posterior semicircular canal cupulolithiasis (PC-BPPV-cu).Methods: We conducted a randomized clinical trial to evaluate the therapeutic effect of the Epley maneuver and BD exercise in patients with PC-BPPV-cu. Patients were randomly assigned to undergo the Epley maneuver (n = 29) or BD exercise (n = 33). The primary outcome was an immediate resolution of positional nystagmus within 1 h after a single treatment of each maneuver on the visit day. Secondary outcomes included the resolution of positional nystagmus at 1 week, the change of maximal slow phase velocity (mSPV) of positional nystagmus, and dizziness handicap inventory (DHI) immediately and at 1 week.Results: Immediate resolution occurred in none of 29 patients in the Epley maneuver group and only 1 of 33 patients in the BD exercise group. The Epley maneuver and BD exercise had an equivalent effect at 1 week in treating PC-BPPV-cu in terms of resolving positional nystagmus (48 vs. 36%, p = 0.436) and the decrease of mSPV and DHI.Conclusion: Neither the Epley maneuver nor BD exercise has an immediate therapeutic effect in treating PC-BPPV-cu. Clear classification of PC-BPPV should be required at the time of different pathology and different treatment response.

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“…In the first cycle, an orthotropic UBN with left torsion was observed in the first and second positions, mild DBN in the right side lying position and no positional nystagmus on return to upright. Activity restrictions were provided due to the complexity of BPPV ( 12 ) and were consistent with those provided to patients with intractable BPPV ( 30 ). Restrictions included sleeping with the head of the bed elevated to 40°, sleeping on the back or right side, and limiting up/down head movements for 1 week ( 30 ).…”

Section: First Variant: Peripheral Dbn Dh Positionsmentioning

confidence: 99%

Case report: Atypical patterns of nystagmus suggest posterior canal cupulolithiasis and short-arm canalithiasis

Helminski

2022

Front. Neurol.

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BackgroundAtypical posterior canal (PC) positional nystagmus may be due to the changes in cupular response dynamics from cupulolithiasis (cu), canalithiasis of the short arm (ca-sa), or a partial/complete obstruction—jam. Factors that change the dynamics are the position of the head in the pitch plane, individual variability in the location of the PC attachment to the utricle and the position of the cupula within the ampulla, and the location of debris within the short arm and on the cupula. The clinical presentation of PC-BPPV-cu is DBN with torsion towards the contralateral side in the DH positions and SHHP or no nystagmus in the ipsilateral DH position and no nystagmus upon return to sitting from each position. The clinical presentation of PC-BPPV-ca-sa is no nystagmus in the DH position and upbeat nystagmus (UBN) with torsion lateralized to the involved side upon return to sitting from each position.Case descriptionA 68-year-old woman, diagnosed with BPPV, presented with DBN associated with vertigo in both DH positions and without nystagmus or symptoms on sitting up. In the straight head hanging position (SHHP), the findings of a transient burst of UBN with left torsion associated with vertigo suggested ipsicanal conversion from the left PC-BPPV-cu to canalithiasis. Treatment included a modified canalith repositioning procedure (CRP), which resulted in complete resolution. BPPV recurred 17 days later. Clinical presentation of BPPV included no nystagmus/symptoms in both the contralateral DH position and SHHP, DBN in the ipsilateral DH position without symptoms, and UBN with left torsion associated with severe truncal retropulsion and nausea on sitting up from provoking position. The findings suggested the left PC-BPPV-cu-sa and PC-BPPV-ca-sa. Treatment included neck extension, a modified CRP, and demi-Semont before complete resolution.ConclusionAn understanding of the biomechanics of the vestibular system is necessary to differentially diagnose atypical PC-BPPV. DH test (DHT) findings suggest that PC-BPPV-cu presents with DBN or no nystagmus in one or two DH positions and sometimes SHHP and without nystagmus or no reversal/reversal of nystagmus on sitting up. The findings suggest PC-BPPV-ca-sa has no nystagmus in DH positions or DBN in the ipsilateral DH position and UBN with torsion lateralized to the involved side on sitting up.

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Head‐Up Sleep May Cure Patients With Intractable Benign Paroxysmal Positional Vertigo: A six‐Month Randomized Trial

Cited by 15 publications

References 22 publications

Posturographic Findings in Patients With Psychological Dizziness

Posturographic Findings in Patients With Psychological Dizziness

Effect of the Epley Maneuver and Brandt-Daroff Exercise on Benign Paroxysmal Positional Vertigo Involving the Posterior Semicircular Canal Cupulolithiasis: A Randomized Clinical Trial

Case report: Atypical patterns of nystagmus suggest posterior canal cupulolithiasis and short-arm canalithiasis

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