Benign paroxysmal vertigo - Treatment

The goal of treatment for benign paroxysmal vertigo

The main goal in the treatment of benign paroxysmal positional vertigo is to completely and promptly stop attacks of positional vertigo. Since the 1990s, the technique of therapeutic maneuvers for mechanical movement of free particles of the otolith membrane has been actively developed.

Non-drug treatment of benign paroxysmal vertigo

Among the exercises most often recommended for patients to perform independently, the Brindt-Daroff method should be noted. According to this method, the patient is recommended to perform exercises three times a day, five bends in both directions per session. If dizziness occurs at least once in the morning in any position, the exercises are repeated in the afternoon and evening. To perform the method, the patient must sit in the center of the bed after waking up, hanging his legs down. Then he lies down on one side with his head turned 45° upward and remains in this position for 30 seconds (or until the dizziness ends). After this, the patient gets into the original "sitting" position, in which he stays for 30 seconds, after which he quickly lies down on the opposite side with his head turned upward by 45 ^°. After 30 seconds, he returns to the original "sitting" position. In the morning, the patient performs five repeated bends in both directions. If dizziness occurs even once in any position, bending should be repeated during the day and in the evening.

The duration of such therapy is selected individually and can be defined as a period of 2-3 days after the last positional vertigo during the Brandt-Daroff exercises. The effectiveness of such a technique for stopping benign paroxysmal positional vertigo is about 60%. Despite the ineffectiveness of drug therapy for benign paroxysmal positional vertigo, it is possible to recommend betahistine (48 mg/day) for the period of therapeutic maneuvers in the case of high vegetative sensitivity. Probably, the effect of improving the blood supply to the inner ear that occurs against the background of the use of this drug will have a positive effect on the metabolic processes occurring during the development of this pathology.

Other therapeutic maneuvers require the direct participation of the attending physician. and their effectiveness can reach 95%. Another common therapeutic method is the Semont maneuver. The patient is seated on a couch with his legs hanging down. While sitting, the patient turns his head in a horizontal plane by 45 degrees to the healthy side. Then, fixing the head with his hands, the patient is laid on his side on the affected side. The patient remains in this position until the dizziness ends. Then the doctor, quickly moving his center of gravity, continuing to fix the patient's head in the same plane, lays the patient on the other side through the "sitting" position and fixes the head in the same plane (forehead down). The patient remains in this position until the dizziness disappears. Then, with the same position of the head relative to the plane of inclination, the patient is seated on the couch. If necessary, the maneuver can be repeated. It should be noted that the peculiarity of this method is the rapid movement of the patient from one side to the other, during which the patient with benign paroxysmal positional vertigo will experience significant dizziness, with possible vegetative reactions in the form of nausea and vomiting; therefore, in patients with cardiovascular diseases, this maneuver should be performed with caution and possible premedication. For this purpose, betahistine can be used (24 mg once 1 hour before the maneuver). In special cases, thiethylperazine and other centrally acting antiemetic drugs can be used for premedication.

Other therapeutic maneuvers for the treatment of benign paroxysmal positional vertigo can also be successfully applied. In case of pathology of the posterior semicircular canal, the Ellie maneuver is effective, also performed on the couch and has the greatest effectiveness. The peculiarity of this therapeutic maneuver is its implementation along a clear trajectory, without a high speed of transition from one position to another. The initial position of the patient is sitting on the couch along it. First, the patient's head is turned towards the pathology. Then, with the head fixed by the doctor's hands, he is laid on his back with the head thrown back by 45 degrees, the next turn of the fixed head is in the opposite direction in the same position on the couch. Then the patient is laid on his side, and the head is turned with the healthy ear down. Then the patient sits down, the head is tilted and turned towards the pathology, after which it is returned to the usual position - looking forward. The patient's stay in each position is determined individually based on the severity of the vestibulo-ocular reflex. Many specialists use additional means to accelerate the deposition of freely moving particles, which increases the effectiveness of treatment. As a rule, repeating 2-4 maneuvers per treatment session is sufficient to completely relieve benign paroxysmal positional vertigo.

Another effective therapeutic maneuver for benign paroxysmal positional vertigo of horizontal semicircular sacrum is the Lemperg maneuver. The initial position of the patient is sitting along the couch. The doctor fixes the patient's head during the entire maneuver. The head is turned by 45 ° in the horizontal plane towards the pathology. Then the patient is laid on his back, the head is successively turned in the opposite direction; the patient is laid on the healthy side, the head accordingly turns with the healthy ear down. Then, in the same direction, the patient's body is turned and laid on the stomach; after that, the head is in the "nose down" position; in the course of the turn, the head is turned further; the patient is laid on the opposite side; the head - with the diseased ear down) sitting on the couch of the patient through the healthy side. The maneuver can be repeated. The time spent in each position of the maneuver is always individual and is determined by the vestibulo-ocular reflex.

The effectiveness of therapeutic maneuvers will be affected by the ability to accurately move the patient's head spatially in the plane of the pathological semicircular canal. Various forms of dorsopathies in the cervicothoracic spine will have an adverse effect on the ability to accurately position the patient's head during the therapeutic maneuver.

This is especially true for patients over 50 years of age. However, recently special electronic stands have been created that allow for high-precision patient movement in the plane of any semicircular canal by 360 degrees with the ability to stop rotation in stages and, in combination with video-oculography, to individually form a program of therapeutic maneuver. Such stands are a chair with the ability to fully fix the patient, have two axes of rotation, an electronic drive with a control panel and the ability to mechanically rotate in emergency situations. The effectiveness of the maneuver on such a stand is maximized and, as a rule, does not require repetition.

The effectiveness of maneuvers is significantly higher in patients with canalolithiasis, which is much more common than cupulolithiasis. In cupulolithiasis, the first sessions of therapy are not always effective and require repetition and a combination of different maneuvers. In special cases, Brandt-Daroff exercises can be recommended for a long period in order to form adaptation.

In the period after the maneuver, it is important for the patient to adhere to the regimen of limiting bends, and in the first day, the sleeping position should be with the head of the bed raised by 45-60°.

Surgical treatment

In 1-2% of all patients with benign paroxysmal positional vertigo, therapeutic maneuvers may be ineffective, and adaptation develops extremely slowly. Then the method of choice of treatment is surgical operations. First of all, the most specific is filling the affected semicircular canal with bone chips. This operation was actively used in foreign practice before the development of therapeutic maneuvers, but it, like other interventions on the inner ear, has complications. Filling the semicircular canals is an effective method for eliminating positional vertigo in benign paroxysmal positional vertigo while maintaining auditory function,

Other surgical methods of treatment lead to large volumes of destruction in the inner ear and are performed less frequently. These methods include selective neurectomy of the vestibular nerves, labyrinthectomy. In recent years, our country has accumulated experience in the use of laser destruction of the labyrinth. This method can probably be used to relieve positional vertigo in patients with benign paroxysmal positional vertigo, provided that therapeutic maneuvers are absolutely ineffective.

Treatment of benign paroxysmal positional vertigo usually does not require hospitalization. The exception may be patients with high autonomic sensitivity,

Further management

Recurrence of benign paroxysmal positional vertigo occurs in less than 6-8% of patients, so recommendations are limited to compliance with the tilt regimen.

The patient with benign paroxysmal positional vertigo is incapacitated for approximately one week. In the case of cupulolithiasis, this period may be extended. 5-7 days after the therapeutic maneuver, it is recommended to conduct repeated positional tests to decide on further therapy and treatment tactics.

The patient should be informed about his further behavior: in case of benign paroxysmal positional vertigo, first of all, you should limit movement, choose a comfortable lying position, try to turn less in bed and get up in such a way as not to cause dizziness; try to get to an appointment with a doctor (neurologist or otoneurologist) as soon as possible, which can be reached by any means, just not while driving a car.

Forecast

Favorable, with full recovery.

Prevention of benign paroxysmal vertigo

Prevention of benign paroxysmal positional vertigo has not been developed, since the exact cause of the disease has not been determined. Relapses after performing treatment measures to relieve dizziness occur in 6-8% of patients.

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