Epley Maneuver Research Articles

The Efficacy of a Home Treatment Program Combined With Office-Based Canalith Repositioning Procedure for Benign Paroxysmal Positional Vertigo-A Randomized Controlled Trial.

To compare the efficacy of the home treatment program combined with office-based canalith repositioning procedure (CRP) versus office-based CRP alone for benign paroxysmal positional vertigo (BPPV). Randomized controlled trial. One hundred six patients with BPPV were randomly assigned to the home treatment program combined with office-based CRP group and the office-based CRP only group. The canalith repositioning procedure was performed in all patients at an out-patient clinic. The patients in the home treatment group were additionally instructed to do the exercise tailored for their affected canal at home every day. The presence of nystagmus was recorded. The symptom of vertigo and its impact on daily life were evaluated by the Dizziness Handicap Inventory (DHI) and a visual analog scale (VAS). All outcomes were evaluated at 1, 2, and 4 weeks after the initial treatment. A cure was defined as a patient having no nystagmus on the appointment date. The success rate of the home treatment program combined with office-based CRP group and the office-based CRP only group were 100 and 91.67%, respectively (p = 0.043). The nystagmus duration, latency, DHI, and VAS scores decreased significantly from baseline at 1, 2, and 4 weeks for both groups (p < 0.001). No significant side effects were noted in either of the groups. The office-based CRP plus home treatment program was more effective than the CRP only group for BPPV. Both groups were effective in reducing the symptom of vertigo and its impact on daily life. Clinicaltrials.in.th/TCTR20160810001.

Benign paroxsymal positional vertigo - recommendations for treatment in primary care.

Background: Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo that can be easily diagnosed and treated in primary care.Purpose: We describe our experience with a large cohort of patients and include recommendations for diagnosis and treatment in the primary care setting.Patients and methods: Three hundred and fifty-nine patients were diagnosed with BPPV between June 2011 and March 2017 at the dizziness clinic of Fujian Provincial Hospital, Fuzhou, China. We mainly used Epley’s maneuver and barbecue roll for the treatment of PSC-BPPV and HSC-BPPV respectively.Results: Our results show that posterior semicircular canal (PSC) involvement is the most common (n=264, 73.5%), followed by horizontal semicircular canal (HSC, n=81, 22.5%) and multicanal (n=12, 3.3%) involvement. Anterior semicircular canal (ASC) BPPV is the rarest (n=2). Particle repositioning maneuvers (PRM) are the treatment of choice and have a high success rate (1 month after treatment), from 75% (9 out of 12) for multicanal to 95.8% (253 out of 264) for PSC, and to 100% for HSC and ASC involvement respectively.Conclusion: We recommend the use of the Epley’s maneuver and barbecue roll for the treatment of PSC-BPPV and HSC-BPPV, respectively. Patients should be reviewed regularly and repeated maneuvers can be performed. Unresolving symptoms require tertiary evaluation.

Effects of vestibular rehabilitation, with or without betahistine, on managing residual dizziness after successful repositioning manoeuvres in patients with benign paroxysmal positional vertigo: a protocol for a randomised controlled trial

IntroductionBenign paroxysmal positional vertigo (BPPV) is recognised as the leading cause of peripheral vertigo in adults. The canalith repositioning procedure (CRP) can be used for effective treatment of BPPV. However,...

57-Year-Old Man With Vertigo

57-Year-Old Man With Vertigo

Caloric tests in clinical practice in benign paroxysmal positional vertigo

Background: The value of caloric tests in benign paroxysmal positional vertigo (BPPV) patients is unclear.Objectives: To analyze the features and clinical significance of caloric tests in BPPV patients.Materials and methods: About 2192 patients (256 BPPV and 1936 non-BPPV) who complained of dizziness triggered by movement, accompanied by the symptom of hearing loss or a history of vertigo, participated in this prospective clinical study. All subjects received a caloric test, 213 BPPV patients underwent follow-up for at least 6 months after canalith repositioning procedures (CRPs).Results: (1) The abnormal canal paresis (CP) prevalence of BPPV was 57%. (2) The curative rate of single CRP decreased during follow-up from 90.1% after 7 days to 61% after 6 months and was significantly lower in patients with (54.1%) than in those without (70.1%) an abnormal CP at 6 months post-treatment (p = .01). (3) The recurrent rate was significantly higher in BPPV patients with abnormal CP (25.2%) than with normal CP (12.5%; p = .017).Conclusions and significance: Patients with abnormal CP needed more CRPs and were more prone to relapse. The value of the caloric test in treatment planning and predicting recurrence in BPPV patients should be emphasized.

A Chair-based Abbreviated Repositioning Maneuver (ChARM) for fast treatment of posterior BPPV.

To assess the effectiveness of a variation of the Epley maneuver, which we have titled "Chair-based Abbreviated Repositioning maneuver (ChARM)", in solving cases of benign positional paroxysmal vertigo (BPPV) of the posterior canal. ChARM addresses multiple issues of highly overloaded medical centers that delay its due and timely resolution. For example it does not necessitate an examination bed/table and requires only a backed chair, and less than 3 min to be performed. In combination with a recently published abbreviated diagnostic maneuver it can solve BPPV cases within few minutes of single medical visit. Patients being diagnosed with posterior BPPV by means of an abbreviated diagnostic maneuver were recruited. Immediately after diagnosis, a single attempt of ChARM was conducted. The patient was followed for 48h and at 1 month after these procedures to assess the persistence of symptomatology. 124 patients were treated with ChARM immediately after diagnosis during their very first medical visit. 92 patients (74.2%) solved their symptomatology completely after a single attempt of ChARM. The absence of symptoms persisted during the 30days of follow-up. ChARM showed high success rates in solving posterior BPPV. The entire diagnostic-treatment procedure takes less than 5min to perform and may allow direct treatment of patients, thereby avoiding unnecessary referrals or full vestibular testing. These abbreviated tools may be particularly useful in primary care settings or heavily overloaded otolaryngology or neurology departments.

540° versus 360° barbecue rotation for HSC-canalithiasis.

There are some variations of barbecue rotation to treat canalithiasis of horizontal semicircular canal (HSC-canalithiasis). But a 540° approach has never been reported. To compare a modified 540° to a traditional 360° barbecue rotation for treatment of HSC-canalithiasis. Sixty consecutive patients with HSC-canalithiasis were prospectively allocated to two groups of log roll treatment, either 540° or 360° barbecue rotation (Br540 or Br360). Only one application was allowed in each visit, with weekly repetitions until the resolution of positional nystagmus and vertigo. In each group, 2 patients were lost to follow-up so that 28 were analyzed. With "multi-canal sufferers" or "canal switchers" included, 25, 2, and 1 patients in the Br540 needed 1, 2 and 4 canalith repositioning procedures (CRP) respectively to cure the HSC-canalithiasis, while 17, 6, 5 in the Br360 required 1, 2 and 3 CRPs (p = 0.011). With "multiple canal sufferers" and "canal switchers" excluded from analysis, 19, 1, and 1 patients in the Br540 needed 1, 2 and 4 CRPs respectively, while 16, 6, 4 in the Br360 required 1, 2 and 3 CRPs (p = 0.027). The success rate with one application was higher in the 540° group than the 360° group, about 90% versus 61% (P < 0.05 in both analyses). A 540° barbecue rotation is probably superior to 360° for treatment of HSC-canalithiasis.

Optimal reassessment time for treatment response in posterior canal benign paroxysmal positional vertigo.

The present study aimed to evaluate the optimal reassessment time for treatment response in posterior canal benign paroxysmal positional vertigo (PC-BPPV) following the initial Epley maneuver. Prospective, single-blinded, randomized study. One hundred eight patients with PC-BPPV agreed to participate. These patients received a single modified Epley maneuver (recommended by the 2008 American Academy of Otolaryngology-Head and Neck Surgery guidelines) daily until positional nystagmus disappeared during the Dix-Hallpike maneuver 24 hours after the treatment. Repeated Dix-Hallpike testing to reassess the treatment response was performed at 1 hour (post-1 hour), every 24 hours (post-24 hours) until the positional nystagmus resolved, 1 week (post-1 week), and 1 month (post-1 month) following the therapeutic maneuver. The difference in the resolution rates at post-1 hour and post-24 hours reassessment was analyzed, and the recurrence rates at post-1 week and post-1 month were evaluated. The resolution rate was 67.6% at post-1 hour, which increased to 79.6% at post-24 hours reassessment. There was a statistically significant difference in the results of the Dix-Hallpike test between post-1 hour and post-24 hours follow-up. After complete resolution, nine out of 108 patients (8.3%) demonstrated recurrence within 1 month. Reassessment after 24 hours following the initial Epley maneuver is more advantageous than a 1-hour follow-up in patients with PC-BPPV. This information may be helpful for clinicians in deciding the appropriate follow-up period after treatment for PC-BPPV. 1b Laryngoscope, 130:496-499, 2020.

Effects of Interval Time of the Epley Maneuver on Immediate Reduction of Positional Nystagmus: A Randomized, Controlled, Non-blinded Clinical Trial.

Objective: The Epley maneuver (EM) has an immediate effect: rapid reduction of positional nystagmus. Benign paroxysmal positional vertigo (BPPV) causes BPPV fatigue, which constitutes fatigability of positional nystagmus and vertigo with repeated performance of the Dix-Hallpike test; notably, BPPV fatigability becomes ineffective over time. We hypothesized that the immediate effect of the EM is caused by BPPV fatigue. Therefore, we suspected that performance of the EM with intervals between head positions would worsen the immediate reduction of positional nystagmus in patients with BPPV, because BPPV fatigability would become ineffective during performance of this therapy.Methods: Forty patients with newly diagnosed BPPV were randomly assigned to the following two groups; one group performed the EM without intervals between positions (group A), and the other group performed the EM with 3 min intervals between positions (group B). The primary outcome measure was the ratio of maximum slow-phase eye velocity (MSPEV) of positional nystagmus soon after the EM, compared with that measured before the EM. Secondary outcome included whether a 30 min interval after the EM enabled recovery of MSPEV of positional nystagmus to the original value. This study followed the CONSORT 2010 reporting standards.Results: In both groups A and B, the immediate effect of the EM could be observed, because MSPEV during the second Dix-Hallpike test was significantly smaller than MSPEV during the first Dix-Hallpike test (p < 0.0001 in group A, p < 0.0001 in group B). The primary outcome measure was larger in group B than in group A (p = 0.0029). The immediate effect faded 30 min later (secondary outcome).Conclusions: This study showed that the EM had an immediate effect both with and without interval time in each head position of the EM. Because setting interval time in each head position of the EM reduced the immediate effect of the EM, interval time during the EM adds less benefit. This finding can reduce the effort exerted by doctors, as well as the discomfort experienced by patients with pc-BPPV, during EM. However, this immediate effect may be caused by BPPV fatigue, and may fade rapidly.Classification of Evidence: 1b

Does cervical range of motion affect the outcomes of canalith repositioning procedures for posterior canal benign positional paroxysmal vertigo?

Canalith repositioning procedure (CRP) for posterior canal benign positional paroxysmal vertigo (BPPV), also known as Epley maneuver, is a common procedure for the treatment of BPPV. This maneuver entails flexion, extension and rotation of the patient's neck. This study aims to investigate the impact of cervical range of motion (C-ROM) on CRP efficacy. The study included 47 patients with posterior canal BPPV treated by CRP. The procedure was considered successful if vertigo and nystagmus disappeared at the post-treatment evaluation. If CRP resulted ineffective, it was repeated up to three times per session. C-ROM was measured at BPPV diagnosis before treatment. Patients were followed up for 30 days. The first CRP was successful in 29 patients (61.7%), while it was ineffective in 18 patients (38.3%) requiring multiple repositioning maneuvers. Patients who needed two or more CRP showed lower C-ROM in extension (p = .003) and flexion (p = .042), and earlier recurrences (p = .006). Univariate regression analysis showed that lower cervical extension was significantly associated with the failure of the first CRP (OR: 0.899, 95% CI 0.831-0.973, p = .008). Our data suggest that a reduced C-ROM can require multiple CRPs to successfully treat BPPV and increase the risk of early recurrences.

A truly 'HANDI' resource.

GPs and patients have an increasing interest in the use of non-drug interventions to treat common conditions seen in primary care. Nearly half the thousands of clinical trials conducted each year are for evaluating non-drug treatments, such as diet, exercise, procedures, and devices. Advances in such treatments in the past few decades have been substantial and diverse — for example, exercise for heart failure and COPD, the Epley manoeuvre for benign paroxysmal positional vertigo, and CBT for depression. However, effective non-drug methods are less well known, less promoted, and less used than their pharmaceutical cousins. There are well-established drugs/medications formularies such as the British National Formulary . However, no such formulary or resource for non-drug treatments (interventions) currently exists in the UK. The Handbook of Non-Drug Interventions — HANDI — project was launched by the Royal Australian College of General Practitioners (RACGP) in 2013 to promote effective non-drug treatments. HANDI is an online formulary of …

Diagnosis and treatment choices of suspected benign paroxysmal positional vertigo: current approach of general practitioners, neurologists, and ENT physicians.

Benign paroxysmal positional vertigo (BPPV) is a frequently underdiagnosed cause of vertigo, potentially due to the underuse of diagnostic and therapeutic canalith repositioning procedures (CRPs). We aimed to investigate self-reported use of the diagnostic and therapeutic approach to BPPV patients by Lithuanian neurologists, ear, nose, and throat (ENT) physicians, and general practitioners (GPs), and to explore potential reasons for the underuse of the maneuvers. Neurologists, ENT physicians, and GPs were invited to complete a written questionnaire focused on diagnostic and therapeutic practices related to BPPV. Between-group differences and associations between responses were analyzed statistically. In total, 97 neurologists, 85 ENT physicians and 142 GPs (21.1%, 26.8%, and 5.7%, respectively, of all corresponding licensed Lithuanian physicians) completed the questionnaire. 24% of neurologists, 33% ENT physicians and 50% GPs do not perform diagnostic maneuvers for patients with suspected BPPV, and 28%, 61%, and 84%, respectively, do not perform CRPs. Years of clinical experience was a negative predictor of CRP performance [OR 0.97 (95% CI 0.95-0.99), p = 0.001]. Frequent reasons for not performing CRPs were time taken for the procedure, fear of provoking symptoms, and lack of knowledge. All physicians frequently ordered additional imaging or consultations for suspected BPPV and reported prescribing a range of medications. A significant proportion of Lithuanian neurologists, ENT physicians, and GPs do not employ diagnostic maneuvers and CRPs for BPPV patients, contrary to established guidelines. Lack of expertise and time available is a common culprit that leads to unnecessary drug prescribing and investigation.

RESOLUTION OF VESTIBULAR MIGRAINE COMPLICATED BY AUTOIMMUNE HYPOTHYROID WITH A PROGRAM OF MULTIMODAL NEUROREHABILITATION AND CLINICAL NUTRITION

Event Abstract Back to Event RESOLUTION OF VESTIBULAR MIGRAINE COMPLICATED BY AUTOIMMUNE HYPOTHYROID WITH A PROGRAM OF MULTIMODAL NEUROREHABILITATION AND CLINICAL NUTRITION David Schiller1* 1 Independent researcher, United States Background: A 51 year old female presented to a private clinic with a history of chronic dizziness that had been getting progressively worse over the last several months. She had been given a diagnosis of vestibular migraine by an Ear, Nose and Throat specialist. She had numerous episodes of Benign Paroxysmal Positional Vertigo (BPPV) previously in her history which were resolved with Epley's maneuver. She has a history of gastrointestinal symptoms that were diagnosed as Irritable Bowel Syndrome (IBS) and hypothyroid that was diagnosed as Hashimoto's. The patient describes the dizziness symptoms as her head is "a balloon floating above my body." Her autoimmune hypothyroid was being managed with medications by her endocrinologist. Methods: Neurological examination revealed paradoxical findings on multi position blood pressure with a rise in blood pressure when the patient changed from seated to supine. Convergence insufficiency was observed on the right during eye movement analysis. Optokinetic eye movements were insufficient leftward and upward. Alternating hand movements revealed dysdiadochokinesia (DDK) on the left. Saccodometry of 100 saccades revealed hypometria with leftward and rightward saccades. Computerized Dynamic Posturography (CDP) revealed an anterior center of pressure (aCOP) on perturbed surface testing. CDP testing with head in right rotation revealed an abnormal loss in stability. CDP testing with head in extension on a perturbed surface revealed a near fall. Palpation revealed several areas of aberrant spinal segmental movement in the cervical and thoracic spine. A program of multimodal neurorehabilitation included vestibular rehabilitation (VR), spinal manipulative therapy (SMT) and Low Level Laser Therapy (LLLT). VR included gaze stability exercises, passive and active vestibular canal stimulation, laser guided visual feedback and eye movement exercises. Results: Saccodometry revealed resolution of the hypometria. CDP revealed an improvement in stability with head to the right and in extension. There was a resolution of aCOP on perturbed surfaces. Convergence test normalized. OPK testing normalized. Patient reported a resolution of dizziness symptoms that now only rarely occur with extreme fatigue. Conclusion: this author recommends further investigation into multimodal neurorehabilitation protocols that include VR, LLLT and SMT for the treatment of chronic dizziness and vestibular migraine Keywords: Dizziness, dizziness and vertigo, vestibular migraine, Vertigo, Hashimoto's, autoimmune disease, Hypothyroid, IBS – Irritable bowel syndrome, Neck Pain, Shoulder Pain, Spinal manipulative therapy, Low level laser therapy ( LLLT), Vestibular Rehabilitation, Clinical Nutrition, Center of Pressure (COP), saccodometry, convergence insufficiency, Benign paroxysmal positional vertigo (BPPV), Migraine, dysautonomia, orthostatic blood pressure Conference: International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019. Presentation Type: Poster Presentation Topic: Clinical Neuroscience Citation: Schiller D (2019). RESOLUTION OF VESTIBULAR MIGRAINE COMPLICATED BY AUTOIMMUNE HYPOTHYROID WITH A PROGRAM OF MULTIMODAL NEUROREHABILITATION AND CLINICAL NUTRITION. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience. doi: 10.3389/conf.fneur.2019.62.00015 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Apr 2019; Published Online: 27 Sep 2019. * Correspondence: Dr. David Schiller, Independent researcher, Avon, United States, drschiller@comcast.net Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers David Schiller Google David Schiller Google Scholar David Schiller PubMed David Schiller Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Comparing the Effects of Epley Maneuver and Cinnarizine on Benign Positional Paroxysmal Vertigo; A Randomized Clinical Trial

Background: The fastest and safest treatment method of BPPV is repositioning maneuvers. In Iran, this methods are not widely used, and many physicians use medical therapy, despite their side effects, for management of BPPV. Materials and Methods: In this randomized clinical trial patients with BPPV were randomly allocated to Epley repositioning maneuver or Cinnarizine (25mg every 8 hours) for two weeks. The patients were evaluated for symptoms using visual analogue scale (VAS) scoring system before intervention, first and second weeks after intervention. In the second and third visitd the results of hallpike test was recorded for both groups. Results: 43 patients with a mean age of 46.88±11.08 years in two Epley and Cinnarizine group underwent analysis. The mean VAS score for improvement of symptoms after intervention was 1.66±1.06 in Epley and 1.50±0.91 in Cinnarizine group (P=0.57). Conclusion: we found that there is no significant difference between Epley maneuver and Cinnarizine for treatment and controlling symptoms of BPPV.

Comparing the Effects of Epley Maneuver and Cinnarizine on Benign Positional Paroxysmal Vertigo; A Randomized Clinical Trial

Background: The fastest and safest treatment method of BPPV is repositioning maneuvers. In Iran, this methods are not widely used, and many physicians use medical therapy, despite their side effects, for management of BPPV. Materials and Methods: In this randomized clinical trial patients with BPPV were randomly allocated to Epley repositioning maneuver or Cinnarizine (25mg every 8 hours) for two weeks. The patients were evaluated for symptoms using visual analogue scale (VAS) scoring system before intervention, first and second weeks after intervention. In the second and third visitd the results of hallpike test was recorded for both groups. Results: 43 patients with a mean age of 46.88±11.08 years in two Epley and Cinnarizine group underwent analysis. The mean VAS score for improvement of symptoms after intervention was 1.66±1.06 in Epley and 1.50±0.91 in Cinnarizine group (P=0.57). Conclusion: we found that there is no significant difference between Epley maneuver and Cinnarizine for treatment and controlling symptoms of BPPV. [GMJ.2019;8:e866]

Egocentric vertigo symptoms diminished by multi-modal neurorehabilitation treatment

Egocentric vertigo symptoms diminished by multi-modal neurorehabilitation treatment

15-year-old male with migraines and sleep disturbances after multiple concussions is treated to full resolution of symptoms

Event Abstract Back to Event 15-year-old male with migraines and sleep disturbances after multiple concussions is treated to full resolution of symptoms Shannon Leon1 and Jason Langhough1* 1 Dr. Shannon Leon Functional Neurology, United States Presentation Patient presents with radiological reports noting “mild apex levoscoliotic curvature centered approximately at T11” and a “bone age of 15 years.” He is prescribed Elavil 10mg for sleep quality enhancement. History taking reveals three concussions in the past. Clinical examination highlights reveal increased palmar sweating, decreased saccadic velocity rightward, left ocular accommodation in neutral gaze, resting nystgamus with directionality up-left and down-right, balance instability with head tilt into right posterior semicircular canal, and a decreased right arm swing during gait that improves with dual tasking. Intervention Central neural integration is enhanced first with vestibular recalibration using a right Epley maneuver. Cervical joint juxtaposition is manually adjusted at the levels of C2 and occiput. Appendicular proprioceptive input is manipulated using multiplanars of the right lower extremity and uniplanars of the left upper extremity. Carrick Eye Exercises of remembered target saccades are used in patient’s upper right field of view with directionality up-right; Brock String is angled up-right; finger-nose-finger is performed in upper right field of view. Outcome Patient reports “no pain, sleeping well, and no migraines” following one treatment. Perspective A patient with so many chief complaints, like migraine, sleep disturbance, and bodily pain, need not seek as many specialists. Our clinic observed his biomarkers with centrally-mediated phenomenology - with especial localizing weight attributed to vestibular and ocular concomitants - and used them to equilibrate his asymmetric, inefficient, and paradoxical reflexes. This clinical method of realtime observation-to-treatment is given scientific credence from evidence-based clinical outcome assessment tools, namely PHQ-15 and Epworth Sleepiness Scale, and affirmed effective from patient satisfaction. Keywords: Post concussion syndrome, concussion, Migraines, Sleep disturbance, carrick eye exercises Conference: International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019. Presentation Type: Poster Presentation Topic: Clinical Neuroscience Citation: Leon S and Langhough J (2019). 15-year-old male with migraines and sleep disturbances after multiple concussions is treated to full resolution of symptoms. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience. doi: 10.3389/conf.fneur.2019.62.00028 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 30 Mar 2019; Published Online: 27 Sep 2019. * Correspondence: Dr. Jason Langhough, Dr. Shannon Leon Functional Neurology, Woodbury, Minnesota, 11797, United States, j.langhough@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Shannon Leon Jason Langhough Google Shannon Leon Jason Langhough Google Scholar Shannon Leon Jason Langhough PubMed Shannon Leon Jason Langhough Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Comparing the Effects of Epley Maneuver and Cinnarizine on Benign Positional Paroxysmal Vertigo: A Randomized Clinical Trial

Background: The fastest and safest treatment method of BPPV is repositioning maneuvers. In Iran, these methods are not widely used, and many physicians use medical therapy, despite their side effects, for management of BPPV. Materials and Methods: In this randomized clinical trial patients with BPPV were randomly allocated to Epley repositioning maneuver or Cinnarizine (25mg every 8 hours) for two weeks. The patients were evaluated for symptoms using visual analogue scale (VAS) scoring system before the intervention, first and second weeks after intervention. In the second and third visitd, the results of the hallpike test were recorded for both groups. Results: 43 patients with a mean age of 46.88±11.08 years in two Epley and Cinnarizine group underwent analysis. The mean VAS score for improvement of symptoms after the intervention was 1.66±1.06 in Epley and 1.50±0.91 in Cinnarizine group (P=0.57). Conclusion: we found that there is no significant difference between Epley maneuver and Cinnarizine for treatment and controlling symptoms of BPPV. [GMJ.2019;Inpress:e866]

Improvements in Cognition, Chronic Migraine Headaches with Aura and Benign Paroxysmal Positional Vertigo (BPPV) in a 35-year-old Female Patient Following Neurological and Vestibular Rehabilitation.

Event Abstract Back to Event Improvements in Cognition, Chronic Migraine Headaches with Aura and Benign Paroxysmal Positional Vertigo (BPPV) in a 35-year-old Female Patient Following Neurological and Vestibular Rehabilitation. Trevor D. Eason1* 1 Carrick Institute, United States Presentation: A 35-year-old female patient presented with cognitive decline, persistent episodes of benign paroxysmal positional vertigo, and chronic, persistent migraine headaches. The history included episodes of chronic migrainous headaches originating when she was 12-years-old. The migraine headaches are normally preceded by scintillations. The patient stated that she had never been able to ride in the back of a car, participate at amusement parks and has frequent dizziness and described oscillopsia. The origination of the episodes of benign paroxysmal positional vertigo occurred 2 years ago spontaneously upon arising one morning. The patient stated that medication she has been prescribed does not have the same effect as it once did concerning her migraine episodes. Findings: During neurocognitive testing on the C3 Logix program, upon intake, Trails A time was measured at 40.8 seconds while Trails B time was measured at 45.2 seconds. Her simple reaction time was 383 milliseconds and her choice reaction time was 411 milliseconds. Her initial symptom severity score was 86% based on the associated subjective questionnaire where 0% is no symptoms. A Comprehensive Assessment of Postural Systems (CAPS®) (Pagnacco 2014) was performed assessing the patient's balance and stability, on both a solid and foamed surface, with his eyes opened, eyes closed, and with multiple head positions. Her average balance and stability score on intake was calculated as 27.12%. Videonystagography (VNG®) demonstrated mixed torsional, geotropic, upbeat nystagmus when placed in a Dix-Halpike maneuver for the right posterior canal. A 2-3 Hz. left beat nystagmus was also observed with gaze fixation eliminated in primary position. Methods: A 12-day multi-modal neurological rehabilitation program was administered in 12 one-hour treatment sessions (Carrick, 2017). Initial treatment consisted of an Epley maneuver to alleviate the right posterior canal debris. Each session after consisted of neurological and vestibular rehabilitation exercises directed towards the right vestibular apparatus and cerebellum integration, somatosensory evoked potentials, cognitive exercises, orthoptic training, and off-vertical axis rotation (Gdowski 1999) using a multi-axis rotational chair. Initially, she was placed on a paleo diet and a supplement protocol. Based on clinical symptoms indicating alterations in energy production, she was placed on multiple nutrient formulas containing Vitamin E (11 mg), docosahexaenoic acid (1200 mg), Phosphatidylcholine (60 mg) 1 x daily. CoQ10 (200 mg) and Pyrroloquinoline quinone disodium salt (PQQ) (5 mg) were also administered in a 5 ml. dose 1 x daily. She was advised to reduce smoking and enroll in smoking cessation counseling. Outcomes: Upon discharge, Trails A time decreased to 23.5 seconds (-42.4%), and Trails B time decreased to 32.7 seconds (-27.7%). Simple reaction time decreased to 277 seconds (-27.7%), and choice reaction time decreased to 312 seconds(-24.1%). Symptom severity score decreased to 7 (-91.9%) where 0 is no symptoms. The average balance and stability score improved resulting in a score of 85.37% (+214.9%). Upon Videonystagography (VNG®), no mixed torsional, geotropic, upbeat nystagmus was observed when placed in a Dix-Halpike maneuver for the right posterior canal. No nystagmus was observed with gaze fixation eliminated in a neutral gaze or primary ocular position. Concurrently, full resolution of her migraine headaches occurred after the BPPV was eliminated. Conclusions: The author suggests further investigation into the use of multi-modal neurological, vestibular rehabilitation strategies and supplemental clinical nutrition strategies for the treatment of BPPV, and migraine headaches with aura. The author also suggests further investigation into multi-modal, intensive approaches to improve stability scores, simple and choice reaction times, symptom severity scores and stability of eye movements associated with proper neurological and vestibular function. Acknowledgements The author would like to thank and acknowledge Professor Frederick Carrick and his pioneering work in the field of clinical neuroscience. The author would also like to thank the Carrick Institute for providing the education utilized to create the multi-modal treatments implemented in this case study.

Effectiveness of the Epley manoeuvre in posterior canal benign paroxysmal positional vertigo: a randomised clinical trial in primary care.

Evidence on the effectiveness of the Epley manoeuvre in primary care is scarce. To evaluate effectiveness at 1 week, 1 month, and 1 year of a single Epley manoeuvre versus a sham manoeuvre in primary care. Multicentre, double-blind randomised controlled trial in two primary care practices in Spain from November 2012 to January 2015. Patients were ≥18 years diagnosed with subjective or objective posterior benign paroxysmal positional vertigo (vertigo only, or vertigo and nystagmus after a Dix-Hallpike test [DHT]). The intervention group received the Epley manoeuvre, and the control group received a sham manoeuvre. Betahistine was prescribed following the same regimen in both groups. The main outcome measures were the DHT result classified as negative (neither vertigo nor nystagmus) or positive. Positive results were further divided into a positive result for both vertigo and nystagmus (positive DHT with nystagmus), and a positive result for vertigo only (positive DHT without nystagmus); self-reported resolution of vertigo; and self-reported severity of vertigo evaluated on a 10-point Likert scale (10 = worst imaginable vertigo). In total, 134 patients were randomised to either the intervention group (n = 66) or the sham group (n = 68). The intervention group showed better results in the unadjusted analyses at 1 week, with a lower rate of positive DHT with nystagmus (P = 0.022). A positive baseline DHT with nystagmus was associated with a reduction in vertigo severity (marginal effect for 10-point Likert-like question -1.73, 95% confidence interval [CI] = -2.95 to -0.51) and better positive DHT rates in the intervention group (adjusted odds ratio 0.09, 95% CI = 0.01 to 0.92) in the multivariate analyses. A single Epley manoeuvre performed in primary care is an effective treatment for reversing a positive DHT and reducing vertigo severity in patients with baseline nystagmus in the DHT.