Benign paroxysmal vertigo: treatment

The goal of treating benign paroxysmal dizziness

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

Non-drug treatment of benign paroxysmal dizziness

Of the exercises, more often recommended to patients for self-fulfillment, it should be noted the method of the Brandt-Daroff. According to this technique, the patient is recommended to perform exercises three times a day for five inclines in both directions in one session. If there is dizziness at least once in the morning in any position, the exercises are repeated day and night. To perform the procedure, the patient needs to sit down in the center of the bed after waking up, dangling his legs down. Then it is laid on any side with a 45 ° turned head to the top and is in this position for 30 seconds (or until dizziness ends). After this, the patient rises to the starting position "sitting", in which arrives 30 s. Then quickly stacked on the opposite side with a head turn upward by 45 ^e. After 30 seconds, returns to the starting position "sitting." In the morning the patient makes five repeated inclinations in both directions. If dizziness has arisen at least once in any position, the slopes must be repeated in the afternoon and evening.

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

Other medical maneuvers require the direct involvement of the attending physician. And their effectiveness can reach 95%. Another of the common healing methods is the maneuver of Szemont. Sitting on the couch to a patient whose legs are hung down. Sitting, the patient turns his head in the horizontal plane by 45 degrees. In a healthy way. Then, fixing the head with his hands, the patient is laid not side to the affected side. In this position, the patient is kept all the time until dizziness ends. Then the doctor, moving his center of gravity rapidly, continuing to fix the patient's head in the same plane, puts the patient on the other side through the "sitting" position and fixes the head in the same plane (forehead downwards). The patient is in this position until the dizziness disappears. Further, with the same position of the head relative to the plane of inclination, the patient is seated on the couch. If necessary, it is possible to repeat the maneuver. 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; so in patients with cardiovascular disease this maneuver should be performed with caution and possible premedication. For this, betahistine (24 mg once a day before the maneuver) can be used. In special cases, it is possible to use the central action of thiethylperazine and other antiemetic drugs for premedication.

Other medical maneuvers for the treatment of benign paroxysmal positional vertigo can also be successfully applied. With the pathology of the posterior semicircular canal, Ellie's maneuver is also effective, also performed on the couch and having the greatest effectiveness. The peculiarity of this therapeutic maneuver is its execution on a clear trajectory, without a high speed of transition from one position to another. The patient's initial position is sitting on the couch along her. Preliminary the turn of a head of the patient towards a pathology is made. Then, with the head fixed by the doctor's hands, put on your back with a head bent backwards by 45 degrees, the next turn of the fixed head - in the opposite direction in the same position on the couch. Then the patient is laid on his side, and the head turns with a 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 - look forward. The patient's stay in each position is determined individually by 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. Typically, a repetition of 2-4 maneuvers per treatment session is sufficient to completely stop benign paroxysmal positional vertigo.

Another effective medical maneuver for the benign paroxysmal positional dizziness of a horizontal semicircular cannon is the Lemperga maneuver. The initial position of the patient sitting along the couch. The doctor fixes the patient's head during the entire maneuver. The head is turned 45 ° horizontally towards the pathology. Then the patient is placed on his back, the head turns in the opposite direction; The patient is placed on a healthy side, the head accordingly rotates with a healthy ear to the bottom. Further in the same direction, the patient's body is rotated and placed on the abdomen; after that the head is in the position of "nose down"; In the course of rotation, the head rotates further; the patient is placed on the opposite side; head - a sick ear to the bottom) sitting on the patient's couch through a healthy side. Maneuver can be repeated. The time spent in each maneuver position is always individual and is determined by the vestibulo-ocular reflex.

The effectiveness of therapeutic maneuvers will be affected by the possibility of an exact spatial displacement of the patient's head in the plane of the pathological semicircular canal. Various forms of dorsopathy in the cervico-thoracic spine will have an adverse effect on the possibility of accurate positioning of the patient's head during the execution of the therapeutic maneuver.

This is especially characteristic of patients over 50 years old. However, in recent years, special electronic stands have been created, allowing to accurately move the patient in the plane of any semicircular canal by 360 degrees. With the possibility of stage stops of rotation and, in combination with videooculography, individually form a program of therapeutic maneuver. Such stands are a chair with the possibility of full fixation of the patient, having two axes of rotation, an electronic drive with a control panel and the possibility of mechanical rotation in emergency situations. The effectiveness of the maneuver on such a stand is maximized and, as a rule, does not require a repetition.

The effectiveness of maneuvers is much higher in patients with cannolithiasis, which is much more common than cupulolithiasis. With cupulolithiasis, the first treatment sessions are not always effective and require the repetition and combination of various maneuvers. However, in special cases, Brandt-Daroff's exercises can be recommended for a long time in order to form an adaptation.

In the period after the maneuver is carried out, it is important to adhere to the patient's limited slope regime, and in the first day the position during sleep with an elevated head to 45-60 °.

Surgery

In 1-2% of all patients with benign paroxysmal positional dizziness, therapeutic maneuvers may not be effective, and adaptation is extremely slow. Then the method of choosing the treatment is surgical operations. First of all, the most specific is the sealing of the affected semicircular canal with bone shavings. This operation was actively used in foreign practice before the development of medical maneuvers, but it, like other interventions on the inner ear, has complications. Sealing of semicircular canals is an effective method of eliminating positional vertigo in benign paroxysmal positional vertigo with preservation of auditory function,

Other surgical methods of treatment lead to large amounts of destruction in the inner ear and are less frequent. These methods include selective neuroectomy of the vestibular nerves, labyrinthectomy. In recent years, experience has been accumulated in our country on the use of labyrinth laser erode. This method can probably be used to stop positional vertigo in patients with benign paroxysmal positional vertigo, provided absolute ineffectiveness of therapeutic maneuvers.

Treatment of benign paroxysmal positional dizziness, as a rule, does not require hospitalization. Exception can be made by patients with high autonomic sensitivity,

Further management

Relapse of benign paroxysmal positional vertigo occurs in less than 6-8% of patients, therefore, recommendations are limited to adherence to the slope regime.

Disability of the patient with benign paroxysmal positional dizziness lasts about a week. In the case of cupulolithiasis, these terms can be increased. After 5-7 days after the performance of the therapeutic maneuver, it is recommended to conduct repeated positional tests to decide on further therapy and therapeutic tactics.

It is necessary to inform the patient about his further behavior: in the case of benign paroxysmal positional dizziness, first of all, it is necessary to limit the movement, choose a comfortable lying position, try to turn less in the bed and rise so as not to cause dizziness; try, as soon as possible to get an appointment with a doctor (neurologist or otoneurologist), which can be reached by any means, but not at the wheel of the car.

Forecast

Favorable, with full recovery.

Prevention of benign paroxysmal dizziness

Prevention of benign paroxysmal positional vertigo has not been developed, since the cause of the disease has not been determined exactly. Relapses after performing therapeutic measures for dizziness relief occur in 6-8% of patients.

[1], [2], [3], [4], [5], [6]