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Chu C, Chan YM, Tang J. Clinical Outcomes in Patients With Benign Paroxysmal Positional Vertigo and Vitamin D Deficiency: A Singaporean Perspective. Cureus 2024; 16:e60325. [PMID: 38883121 PMCID: PMC11177327 DOI: 10.7759/cureus.60325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/18/2024] Open
Abstract
INTRODUCTION Benign paroxysmal positional vertigo (BPPV) is the primary vestibular disorder causing peripheral vertigo. Given the role of vitamin D in maintaining otoconia homeostasis, its deficiency may elevate the risk of BPPV. Our study seeks to evaluate the correlation between vitamin D deficiency and clinical outcomes of patients with BPPV in the local Asian population. METHODOLOGY We performed a retrospective analysis of 149 consecutive adult patients referred to a tertiary center's Otolaryngology dizziness clinic between 2018 and 2021. All of these patients had both BPPV and vitamin D deficiency. RESULTS The mean serum vitamin D level was 19.4 ± 5.5 ng/mol. Approximately 51.7% (77/149) of patients experienced recurrent episodes of BPPV. Univariate Chi-square analyses demonstrated vitamin D levels (P < 0.001) and history of migraine (P = 0.04) were related to BPPV recurrence. On multivariate analyses, patients with higher serum vitamin D levels were 16.7% less likely to develop recurrent BPPV (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.76-0.90, P < 0.001). However, migraine history was not significantly related to BPPV recurrence (OR 0.38, 95% CI 0.14-1.00, P = 0.050). There was no statistically significant difference in the duration of BPPV episodes based on vitamin D levels (P = 0.327). CONCLUSIONS Patients with vitamin D deficiency are at higher risk of recurrent BPPV. Future research directions that would be beneficial include conducting a randomized controlled trial to evaluate both the effectiveness of vitamin D supplementation and its optimal dosage.
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Affiliation(s)
- Clarisse Chu
- Otolaryngology, Singapore General Hospital, Singapore, SGP
| | - Yew Meng Chan
- Otolaryngology, Singapore General Hospital, Singapore, SGP
| | - Joyce Tang
- Otolaryngology, Singapore General Hospital, Singapore, SGP
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2
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Salvago P, Immordino A, Vaccaro D, Plescia F, Dispenza F, Sireci F, Martines F. Benign paroxysmal positional vertigo and asymmetric hearing loss: is the worst hearing ear likely to suffer from otoconial displacement? Eur Arch Otorhinolaryngol 2024; 281:163-170. [PMID: 37436499 DOI: 10.1007/s00405-023-08119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/07/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE Benign paroxysmal positional vertigo (BPPV) may be found in patients complaining of hearing disorders. The aim of our investigation was to describe audiological findings in BPPV patients, focusing on subjects with asymmetric hearing loss (AHL), to better understand whether otoconial displacement may occur preferentially in the worst hearing ear. METHODS A prospective study was performed on 112 BPPV patients. We divided the sample into subjects who suffered from AHL (G1) and patients with did not (G2). Data regarding vestibular symptoms, tinnitus, migraine, antivertigo drug therapy, and vascular risk factors were collected. RESULTS Out of 30 AHL subjects, 83.33% of them were affected by sensorineural hearing loss (SNHL) in at least one ear, with a significant difference in the distribution of hearing loss type between groups (p = 0.0006). In 70% of cases, the ear affected by BPPV was the one with the worst hearing threshold (p = 0.02); threshold asymmetry predicted BPPV in the worst hearing ear (p = 0.03). The predictability depended neither on the hearing threshold gap between ears nor the severity of the hearing threshold in the worst ear (p > 0.05). No differences in vascular risk factors between groups were observed (p > 0.05). We evidenced a moderate correlation between age and hearing threshold (ρ = 0.43). Age did not result a predictive factor for residual dizziness or BPPV in the worst ear (p > 0.05). CONCLUSIONS Our study supports the likelihood of an otoconial displacement in the worse hearing ear in BPPV patients. Clinicians should start testing the worst hearing ear when managing AHL patients with suspected BPPV.
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Affiliation(s)
- Pietro Salvago
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (BiND), Sezione di Audiologia, Università degli Studi di Palermo, Via del Vespro 129, 90127, Palermo, Italy.
| | - Angelo Immordino
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (BiND), Sezione di Otorinolaringoiatria, Università degli Studi di Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Davide Vaccaro
- UOSD Audiologia, A.O.U.P. "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, Italy
| | - Fulvio Plescia
- Dipartimento di Promozione Della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, Via del Vespro 133, 90127, Palermo, Italy
| | - Francesco Dispenza
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (BiND), Sezione di Otorinolaringoiatria, Università degli Studi di Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Federico Sireci
- UOC Otorinolaringoiatria, A.O.U.P. "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, Italy
| | - Francesco Martines
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (BiND), Sezione di Audiologia, Università degli Studi di Palermo, Via del Vespro 129, 90127, Palermo, Italy
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3
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Mishra P, Sindhu KLS, Chethana R, Kaushik M. Epleys Versus Semonts Manoeuvre in Posterior Canal Benign Paroxysmal Positional Vertigo. Indian J Otolaryngol Head Neck Surg 2023; 75:523-527. [PMID: 37206749 PMCID: PMC10188861 DOI: 10.1007/s12070-023-03624-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction: Benign paroxysmal positional vertigo (BPPV), the most common vestibular disorder is characterized by short-lived episodes of rotatory vertigo in association with rapid changes in head position. Diagnosis of BPPV is clinical. The principle of treatment of BPPV involves maneuvers comprising of head movements, in order to bring the free debris from the semicircular canal back to the utricle. In this study we tried to evaluate and compare Epleys and the Semonts manoeuvre in the treatment of Benign paroxysmal positional vertigo of the posterior semicircular canal in terms of subjective and objective improvement. Materials and methods: Study Design: This prospective randomized study included 200 vertigo patients attending ENT OPD of tertiary care centre with Dix Hallpike positive status. (September 2017 -August 2019). Objective improvement was compared in terms of Dix Hallpike positivity between both groups on weekly follow up for four weeks. Subjective improvement was compared in both the groups by dizziness Handicapp index ( DHI) on follow-ups. Results: Total 200 patients formed part of study, with 100 in each group. On comparing Dix Hallpike positivity between both groups on weekly follow ups there was no significant difference between both the groups. DHI, compared between both groups showed that Semonts Maneouver was significantly better. Conclusion: In patients of BPPV both Epleys and Semonts are equally effective objectively. However the subjective improvement was better in patients on whom Semonts manoeuvre was performed. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03624-5.
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Affiliation(s)
- Prasun Mishra
- Bharati vidyapeeth Deemed to be University Medical College, Pune, India
| | | | - R Chethana
- Bharati vidyapeeth Deemed to be University Medical College, Pune, India
| | - Maitri Kaushik
- Bharati vidyapeeth Deemed to be University Medical College, Pune, India
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4
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Shu Y, Liao N, Fang F, Shi Q, Yan N, Hu Y. The relationship between psychological conditions and recurrence of benign paroxysmal positional vertigo: a retrospective cohort study. BMC Neurol 2023; 23:137. [PMID: 37004007 PMCID: PMC10064541 DOI: 10.1186/s12883-023-03169-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Psychological conditions have been found to be associated with an increased risk of incident benign paroxysmal positional vertigo (BPPV). However, much less is known on whether and how psychological conditions such as anxiety, insomnia and obsessive-compulsive disorder (OCD) affect the recurrence of BPPV. METHODS A retrospective cohort study of 2,612 outpatients and inpatients diagnosed with BPPV between September 2012 and August 2020. BPPV recurrence was followed up until February 2021. The Cox proportional hazard regression was used to analyze the association between psychological conditions and the risk of the first recurrence. Poisson regression was applied to analyze the association between psychological conditions and the number of recurrences in patients with at least one relapse. RESULTS During the follow-up, 391 patients had at least one BPPV recurrence. Female BPPV patients were more likely than male patients to experience relapses than male patients, but the characteristics of BPPV recurrence (number of recurrences and duration between recurrences) did not differ between men and women. After adjustment for sex, age and comorbidities, a heightened risk of first BPPV recurrence was found to be associated with anxiety (hazard ratio [HR]: 1.30, 95% confidence interval [CI]: 1.01, 1.68) and OCD (HR: 2.15, 95% CI: 1.31, 3.52). An increased risk of first BPPV recurrence associated with insomnia was only observed in male patients (HR: 2.22, 95% CI: 1.24, 3.98) but not in female patients (HR: 0.91, 95% CI: 0.63, 1.31). None of these psychological conditions were associated with the number of recurrences in patients who experienced recurrence. CONCLUSIONS The presence of anxiety and OCD increased the risk of first BPPV recurrence, as well as insomnia for male patients. These psychological conditions were not associated with the number of BPPV recurrences. Diagnosis and treatment of these psychological conditions could be a useful strategy to prevent the recurrence of BPPV.
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Affiliation(s)
- Yuexin Shu
- School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Nannan Liao
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, People's Republic of China
| | - Fang Fang
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, People's Republic of China
| | - Qiuling Shi
- School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Ning Yan
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, People's Republic of China.
| | - Yaoyue Hu
- School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China.
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5
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Mutlu B, Topcu MT. Investigation of the Relationship between Vestibular Disorders and Sleep Disturbance. Int Arch Otorhinolaryngol 2022; 26:e688-e696. [PMID: 36405483 PMCID: PMC9668417 DOI: 10.1055/s-0042-1742763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction
Vestibular pathologies cause physical and psychological symptoms, as well as cognitive problems.
Objective
To evaluate the deterioration in sleep quality associated with vestibular pathologies.
Methods
The Dizziness Handicap Inventory (DHI), the Beck Depression Inventory (BDI), the Pittsburgh Sleep Quality Index (PSQI), and the Limits of Stability test (LOS) were applied to the participants.
Results
We included 25 patients with Meniere's disease (MD), 22 patients with benign paroxysmal positional vertigo (BPPV), 21 patients with unilateral peripheral vestibular loss (UPVL), 23 patients with vestibular migraine (VM), and 43 controls. The total PSQI scores of the controls were better than those of the MD (
p
= 0.014), VM (
p
< 0.001), BPPV (
p
= 0.003), and UPVL (
p
= 0.001) groups. The proportion of poor sleepers in the MD (
p
= 0.005), BPPV (
p
= 0.018), and UPVL (
p
< 0.001) groups was significantly higher than that of the controls. The highest total DHI score (45.68 ± 25.76) was found among the MD group, and it was significantly higher than the scores of the BPPV (
p
= 0.007) and control (
p
< 0.001) groups. The highest BDI score was obtained in the VM group, and it was significantly higher than the scores of the BPPV (
p
= 0.046) and control (
p
< 0.001) groups. Moreover, the BDI scores of the MD (
p
= 0.001) and UPVL groups were also significantly worse than the score of the controls (
p
= 0.001).
Conclusion
The present study showed thatpatients with vestibular symptoms have physical and functional complaints, as well as increased psychosocial stress and decreased sleep quality. Evaluating multiple parameters of quality of life may contribute to a better understanding of vestibular physiology and symptoms, and may help establish a more effective therapeutic approach.
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Affiliation(s)
- Basak Mutlu
- Department of Audiology, School of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
| | - Merve Torun Topcu
- Department of Audiology, School of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
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Relationship between benign paroxysmal positional vertigo (BPPV) and sleep quality. Heliyon 2022; 8:e08717. [PMID: 35059515 PMCID: PMC8760439 DOI: 10.1016/j.heliyon.2022.e08717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/13/2021] [Accepted: 01/04/2022] [Indexed: 11/22/2022] Open
Abstract
Background Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo precipitated mainly by changes in head position for example during sleep. The relationship between sleep quality and BPPV has not been studied sufficiently. We decided to compare sleep quality between posterior canal BPPV patients and controls. Methods A total of 120 patients with posterior canal BPPV and 120 controls without BPPV were included. Demographic data as well as body mass index (BMI), cigarette smoking and medical history of the subjects were documented. The sleep quality of the participants was assessed using the Pittsburgh Sleep Quality Index (PSQI). Results Mean scores in subjective sleep quality (0.48 vs. 0.19; P = 0.002), sleep disturbances (2.97 vs. 1.85; P = 0.007), use of sleep medications (0.6 vs. 0.25; P = 0.001), and daytime dysfunction (0.76 vs. 0.47; P = 0.07) were significantly higher in the BPPV group than in control group. Poor sleep quality (i.e., total PSQI score >5) was found in 42 patients in the BPPV group (35%) and in 16 controls (13.3%); P < 0.001. Poor sleep quality was significantly more common in those whose vertigo attacks had been started more than 12 months earlier (19 of 33 cases, 57.6%) than the patients whose symptoms had started in the past 12 months (23 of 87 cases, 26.4%); P = 0.001. Conclusion Patients with posterior canal BPPV have poorer sleep quality when compared to controls without this condition, especially in women and those with disease duration longer than 12 months. These finding suggest that close attention should be paid to sleep quality of patients with BPPV.
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Laurent G, Vereeck L, Verbecque E, Herssens N, Casters L, Spildooren J. Effect of age on treatment outcomes in benign paroxysmal positional vertigo: A systematic review. J Am Geriatr Soc 2021; 70:281-293. [PMID: 34698378 DOI: 10.1111/jgs.17485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/20/2021] [Accepted: 08/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Benign paroxysmal positional vertigo (BPPV) can lead to an increased fall risk in older adults. Therefore, we examined the influence of age on the effectiveness of canalith-repositioning procedures (CRPs) for the treatment of BPPV. METHODS Pubmed, Web of Science, and the bibliographies of selected articles were searched for studies conducted before September 2020 that examined the effectiveness of treatments for BPPV in various age groups. Meta-analyses were performed to compare treatment effectiveness and recurrence rates for younger and older adults. Odds ratios were calculated in a random-effects model. Mean differences were calculated using a fixed-effects model. A significance level of p < 0.05 (95% confidence interval) was set. The risk of bias and the methodological quality of all included articles were examined. RESULTS Forty-five studies were retrieved after full-text screening, of which 29 studies were included for a qualitative review. The remaining 16 studies were eligible for inclusion in the meta-analysis (3267 participants with BPPV). The success rate of a single CRP was higher in the younger group (72.5% vs. 67%, p < 0.001). An average of 1.4 and 1.5 CRPs was needed for complete recovery in the younger and older groups, respectively (p = 0.02). However, global treatment success did not differ between these groups (97.5% vs. 94.6%, p = 0.41). The recurrence rate was higher in the older population (23.2% vs. 18.6%, p = 0.007). CONCLUSIONS Although more CRPs are needed, the rate of complete recovery in older adults is similar to that observed in younger adults.
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Affiliation(s)
- Gwen Laurent
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy/MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Evi Verbecque
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Rehabilitation Sciences and Physiotherapy/MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Nolan Herssens
- Department of Rehabilitation Sciences and Physiotherapy/MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Rehabilitation Sciences, Gent university, Ghent, Belgium
| | - Laura Casters
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Joke Spildooren
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review. J Clin Med 2021; 10:jcm10194372. [PMID: 34640391 PMCID: PMC8509726 DOI: 10.3390/jcm10194372] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 12/04/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere’s disease, trauma, osteopenia or osteoporosis, vitamin D deficiency, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, migraine, bilateral/multicanal BPPV, cervical osteoarthrosis and sleep disorders. Patients with hyperlipidemia and hypertension had the highest recurrence rates of BPPV, 67.80% and 55.89%, respectively, indicating that vascular comorbidities increase the risk of BPPV recurrence. In addition, more than half of patients (53.48%) with diabetes mellitus and BPPV experienced recurrence of BPPV. Knowledge and awareness of risk factors for recurrence of BPPV are essential for the assessment and long-term prognosis of patients. Identification of these relapse risk factors may enhance the ability of clinicians to accurately counsel patients regarding BPPV and associated comorbidities.
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9
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Eckert P, Marchetta P, Manthey MK, Walter MH, Jovanovic S, Savitska D, Singer W, Jacob MH, Rüttiger L, Schimmang T, Milenkovic I, Pilz PKD, Knipper M. Deletion of BDNF in Pax2 Lineage-Derived Interneuron Precursors in the Hindbrain Hampers the Proportion of Excitation/Inhibition, Learning, and Behavior. Front Mol Neurosci 2021; 14:642679. [PMID: 33841098 PMCID: PMC8033028 DOI: 10.3389/fnmol.2021.642679] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/26/2021] [Indexed: 12/16/2022] Open
Abstract
Numerous studies indicate that deficits in the proper integration or migration of specific GABAergic precursor cells from the subpallium to the cortex can lead to severe cognitive dysfunctions and neurodevelopmental pathogenesis linked to intellectual disabilities. A different set of GABAergic precursors cells that express Pax2 migrate to hindbrain regions, targeting, for example auditory or somatosensory brainstem regions. We demonstrate that the absence of BDNF in Pax2-lineage descendants of BdnfPax2KOs causes severe cognitive disabilities. In BdnfPax2KOs, a normal number of parvalbumin-positive interneurons (PV-INs) was found in the auditory cortex (AC) and hippocampal regions, which went hand in hand with reduced PV-labeling in neuropil domains and elevated activity-regulated cytoskeleton-associated protein (Arc/Arg3.1; here: Arc) levels in pyramidal neurons in these same regions. This immaturity in the inhibitory/excitatory balance of the AC and hippocampus was accompanied by elevated LTP, reduced (sound-induced) LTP/LTD adjustment, impaired learning, elevated anxiety, and deficits in social behavior, overall representing an autistic-like phenotype. Reduced tonic inhibitory strength and elevated spontaneous firing rates in dorsal cochlear nucleus (DCN) brainstem neurons in otherwise nearly normal hearing BdnfPax2KOs suggests that diminished fine-grained auditory-specific brainstem activity has hampered activity-driven integration of inhibitory networks of the AC in functional (hippocampal) circuits. This leads to an inability to scale hippocampal post-synapses during LTP/LTD plasticity. BDNF in Pax2-lineage descendants in lower brain regions should thus be considered as a novel candidate for contributing to the development of brain disorders, including autism.
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Affiliation(s)
- Philipp Eckert
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany
| | - Philine Marchetta
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany
| | - Marie K Manthey
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany.,Department of Neuroscience, Sackler School of Biomedical Sciences, Tufts University School of Medicine, Boston, MA, United States
| | - Michael H Walter
- Department for Animal Physiology, Institute of Neurobiology, University of Tübingen, Tübingen, Germany
| | - Sasa Jovanovic
- School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Daria Savitska
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany
| | - Wibke Singer
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany
| | - Michele H Jacob
- Department of Neuroscience, Sackler School of Biomedical Sciences, Tufts University School of Medicine, Boston, MA, United States
| | - Lukas Rüttiger
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany
| | - Thomas Schimmang
- Instituto de Biología y Genética Molecular, Consejo Superior de Investigaciones Científicas, Universidad de Valladolid, Valladolid, Spain
| | - Ivan Milenkovic
- School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Peter K D Pilz
- Department for Animal Physiology, Institute of Neurobiology, University of Tübingen, Tübingen, Germany
| | - Marlies Knipper
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany
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10
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Chen J, Zhang S, Cui K, Liu C. Risk factors for benign paroxysmal positional vertigo recurrence: a systematic review and meta-analysis. J Neurol 2020; 268:4117-4127. [DOI: 10.1007/s00415-020-10175-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/15/2020] [Accepted: 08/18/2020] [Indexed: 12/17/2022]
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11
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Li S, Wang Z, Liu Y, Cao J, Zheng H, Jing Y, Han L, Ma X, Xia R, Yu L. Risk Factors for the Recurrence of Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis. EAR, NOSE & THROAT JOURNAL 2020; 101:NP112-NP134. [PMID: 32776833 DOI: 10.1177/0145561320943362] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Benign paroxysmal positional vertigo (BPPV) has a high recurrence rate, but the risk factor-associated recurrence are elusive. METHODS Searches were performed in PubMed, Embase, Cochrane library, Web of science, Chinese National Knowledge Infrastructure, and Sino Med up to November 3, 2019. The effect size was analyzed by odds ratio and 95% CI. Data from eligible studies were meta-analyzed using Stata version 15.0. RESULTS Our search resulted in a total of 4076 hits. Twenty-four outcomes of sixty articles were included in the meta-analysis. Risk factors for the recurrence of BPPV included female gender, age (≥65years), hyperlipidemia, diabetes, hypertension, migraine, cervical spondylosis, osteopenia/osteoporosis, head trauma, otitis media, abnormal vestibular evoked myogenic potential, and long use of computers. No significant differences were found in side, type of the involved semicircular canals, smoking, alcohol consumption, stroke, ear surgery, duration of vertigo before treatment, the times of repositioning, Meniere disease, sleep disorders, hypercholesterolemia, and 25-hydroxy vitamin D. CONCLUSION These findings strengthen clinical awareness of early warning to identify patients with potential relapse risk of BPPV and clinicians should counsel patients regarding the importance of follow-up after diagnosis of BPPV.
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Affiliation(s)
- Shichang Li
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Zijing Wang
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Yan Liu
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Jie Cao
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Hongwei Zheng
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Yuanyuan Jing
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Lin Han
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Xin Ma
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Ruiming Xia
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Lisheng Yu
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
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Jalali MM, Gerami H, Saberi A, Razaghi S. The Impact of Betahistine versus Dimenhydrinate in the Resolution of Residual Dizziness in Patients with Benign Paroxysmal Positional Vertigo: A Randomized Clinical Trial. Ann Otol Rhinol Laryngol 2020; 129:434-440. [DOI: 10.1177/0003489419892285] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Objectives: The aim of this study was to compare the effects of betahistine with dimenhydrinate on the resolution of residual dizziness (RD) of patients with benign paroxysmal positional vertigo (BPPV) after successful Epley maneuver. Methods: In this double-blind, randomized clinical trial, patients with posterior semicircular canal type of BPPV were included. After execution of the Epley maneuver, patients were assigned randomly to one group for 1 week: betahistine, dimenhydrinate or placebo. The primary outcomes were scores of the Dizziness Handicap Inventory (DHI) and the modified Berg balance scale (mBBS). All patients were asked to describe the characteristics of their subjective residual symptoms. Binary logistic regression analysis was performed to examine the predictors of improved RD. All analyses were conducted using SPSS 19.0. Results: In total, 117 patients (age range: 20-65 years) participated in this study. After the Epley maneuver, 88 participants had RD. After the intervention, 38 patients exhibited an improved RD. Less than 50% of participants in the three groups showed mild to moderate dizziness handicap. However, there was no significant difference between mBBS scores of groups before or after the intervention. Logistic regression was shown that patients with receiving betahistine were 3.18 times more likely to have no RD than the placebo group. Increasing age was associated with a decreased likelihood of improving RD ( P = .05). Conclusion: The analysis of data showed that the use of betahistine had more effect on improving RD symptoms. We recommended future studies using objective indicators of residual dizziness.
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Affiliation(s)
- Mir Mohammad Jalali
- Professor of Otology/Neurotology, Otorhinolaryngology Research Center, Otorhinolaryngology Department, Medical Faculty, Guilan University of Medical Sciences, Rasht, Iran
| | - Hooshang Gerami
- Associate professor of Otorhinolaryngology, Otorhinolaryngology Research Center, Otorhinolaryngology Department, Medical Faculty, Guilan University of Medical Sciences, Rasht, Iran
| | - Alia Saberi
- Professor of Neurology, Neurosciences Research Center, Neurology Department, Medical Faculty, Guilan University of Medical Sciences, Rasht, Iran
| | - Siavash Razaghi
- Otrhinolaryngology Research Center, Otorhinolaryngology Department, Medical Faculty, Guilan University of Medical Sciences, Rasht, Iran
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Valko Y, Werth E, Imbach LL, Valko PO, Weber KP. The eyes wake up: Screening for benign paroxysmal positional vertigo with polysomnography. Clin Neurophysiol 2020; 131:616-624. [PMID: 31972505 DOI: 10.1016/j.clinph.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE While positional nystagmus of benign paroxysmal positional vertigo (BPPV) has been shown to be detectable in electrooculography (EOG) tracings of polysomnography (PSG), the frequency of undiagnosed BPPV in patients referred for sleep-wake examination has never been investigated. METHODS Prospective evaluation of positional nystagmus in 129 patients, referred to a neurological sleep laboratory for sleep-wake examination with PSG. Both in the evening and morning, patients had diagnostic positioning maneuvers under ongoing EOG-PSG registration, followed by visual inspection of EOG for positional nystagmus. RESULTS In 19 patients (14.7%), we found patterns of positional nystagmus, typically appearing few seconds after changes in head position. In 9 of these patients (47%), the nystagmus was also provoked by the positioning maneuvers. Nystagmus only occurred during wakefulness, not during sleep. In a patient with severe cupulolithiasis, we observed disappearance of nystagmus while entering N1 sleep stage. Nocturnal positional nystagmus was independently associated with positive positioning maneuvers. CONCLUSIONS Inspection of EOG-PSG demonstrated that positional nystagmus is common, occurring only when wake, and independently associated with positive positioning maneuvers. SIGNIFICANCE By routinely searching for positional nystagmus in PSG, sleep physicians may substantially contribute to the identification of patients with so-far undiagnosed BPPV.
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Affiliation(s)
- Yulia Valko
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland.
| | - Esther Werth
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Sleep & Health Zurich, University Hospital Zurich, University of Zurich, Switzerland
| | - Lukas L Imbach
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland
| | - Philipp O Valko
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Sleep & Health Zurich, University Hospital Zurich, University of Zurich, Switzerland
| | - Konrad P Weber
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland
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Vestibular rehabilitation: advances in peripheral and central vestibular disorders. Curr Opin Neurol 2019; 32:137-144. [DOI: 10.1097/wco.0000000000000632] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Korkmaz T, Bicer YO, Serin E, Seyhan S, Sanal SK. Salivary α-amylase levels in vertigo: Can it be an autonomic dysfunction? EAR, NOSE & THROAT JOURNAL 2019; 97:278-282. [PMID: 30273427 DOI: 10.1177/014556131809700917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
We aim to demonstrate possible autonomic dysfunction based on salivary α-amylase measurements during and after the vertigo attacks associated with Ménière disease (MD) and benign paroxysmal positional vertigo (BPPV). Patients admitted to the emergency room with a diagnosis of vertigo attacks caused by either MD (n = 15) or BPPV (n = 9) constituted the study groups. The control group (n = 10) consisted of volunteer patients admitted to the emergency department with minor soft-tissue trauma. The first saliva samples were obtained immediately during the attacks and the second and third samples were obtained on the third and fifteenth days of the attack, respectively. In the controls, the first sample was obtained after admission to the hospital and the second sample was obtained on the third day. Salivary α-amylase levels were evaluated. The difference between salivary α-amylase levels in patients with MD and BPPV was not significant. The amylase value measured early after the BPPV attack was significantly lower than that of the controls (p = 0.008). Although not significant, an undulating pattern of salivary α-amylase levels was observed with both diseases. An autonomic imbalance could be partly demonstrated by salivary α-amylase measurement early after the attack in patients with BPPV. Therefore, amylase may be a promising marker that is worth further investigation.
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Affiliation(s)
- Tanzer Korkmaz
- Department of Emergency, Izmir Medicalpark Hospital, Izmir, Turkey.
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Analysis of Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo: An 11-Year Nationwide Population-Based Study. ACTA ACUST UNITED AC 2019. [DOI: 10.3342/kjorl-hns.2017.00899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wan TJ, Yu YC, Zhao XG, Tang P, Gong YS. Efficacy of betahistine plus cognitive behavioral therapy on residual dizziness after successful canalith repositioning procedure for benign paroxysmal positional vertigo. Neuropsychiatr Dis Treat 2018; 14:2965-2971. [PMID: 30464481 PMCID: PMC6223332 DOI: 10.2147/ndt.s182809] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Some patients still complain of residual dizziness after successful canalith repositioning procedure (CRP) for benign paroxysmal positional vertigo (BPPV). Previous study found that compared to the low-dose betahistine, the high-dose betahistine could yield better efficacy in treating residual dizziness. Therefore, this study was conducted to assess whether the addition of cognitive behavioral therapy (CBT) could make low-dose betahistine produce similar results to high-dose betahistine in treating residual dizziness. METHODS The recruited patients were randomly assigned to receive either low-dose betahistine (6 mg/time, three times/day) or high-dose betahistine (12 mg/time, three times/day). Patients in the low-dose group also received CBT (twice a week, 1 hour per time). The treatment was continued for 4 weeks. The duration of residual dizziness, 25-item Dizziness Handicap Inventory (DHI), Hamilton Anxiety Rating Scale (HARS), and Hamilton Depression Rating Scale (HDRS) were recorded and analyzed. The duration of residual dizziness and DHI score were the primary outcomes, and the HARS and HDRS scores were the secondary outcomes. RESULTS Each group had 50 patients. After treatment, the average DHI scores, HDRS scores, and HARS scores were significantly decreased in both groups. The duration of residual dizziness and average DHI score were nonsignificantly different (P=0.08; P=0.06) between the two groups, although they were lower in the low-dose group. Compared to the high-dose group, the low-dose group had the significantly lower average HDRS score (P=0.007) and HARS score (P=0.02). Meanwhile, four patients in the high-dose group experienced intolerable stomach upset. CONCLUSION These results demonstrated that the addition of CBT could make low-dose beta-histine produce similar results to high-dose betahistine in treating residual dizziness. Moreover, the low-dose betahistine plus CBT showed some advantages over high-dose betahistine in relieving depressive and anxiety symptoms and should be further explored.
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Affiliation(s)
- Tian-Ju Wan
- Department of Emergency, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Yi-Chuan Yu
- Department of Emergency, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Gang Zhao
- Department of Emergency, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Tang
- Department of Emergency, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Yong-Shu Gong
- Department of Pediatrics, Yongchuan Hospital of Chongqing Medical University, Chongqing, China,
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Pérez-Vázquez P, Franco-Gutiérrez V, Soto-Varela A, Amor-Dorado JC, Martín-Sanz E, Oliva-Domínguez M, Lopez-Escamez JA. Practice Guidelines for the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Otoneurology Committee of Spanish Otorhinolaryngology and Head and Neck Surgery Consensus Document. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.otoeng.2018.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wang Y, Xia F, Wang W, Hu W. Assessment of sleep quality in benign paroxysmal positional vertigo recurrence. Int J Neurosci 2018; 128:1143-1149. [PMID: 29883234 DOI: 10.1080/00207454.2018.1486835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Yun Wang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Fei Xia
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing China
| | - Wei Wang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Pollak L, Huna-Baron R, Osherov M, Roni M. In whom does horizontal canal BPPV recur? Am J Otolaryngol 2018; 39:410-412. [PMID: 29650422 DOI: 10.1016/j.amjoto.2018.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/03/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE The objective of this study is to examine the rate of horizontal canal BPPV recurrence of the same type and search for predisposing factors.
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Affiliation(s)
- L Pollak
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel affiliated to Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - R Huna-Baron
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel affiliated to Sackler Faculty of Medicine Tel Aviv University, Israel
| | - Michael Osherov
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel affiliated to Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Milo Roni
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel affiliated to Ben Gurion University of the Negev, Beer Sheva, Israel
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Practice Guidelines for the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Otoneurology Committee of Spanish Otorhinolaryngology and Head and Neck Surgery Consensus Document. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 69:345-366. [PMID: 28826856 DOI: 10.1016/j.otorri.2017.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/04/2017] [Indexed: 11/21/2022]
Abstract
Benign Paroxysmal Positional Vertigo is the most frequent episodic vestibular disorder. The purpose of this guide, requested by the committee on otoneurology of the Spanish Society of Otolaryngology and Head and Neck Surgery, is to supply a consensus document providing practical guidance for the management of BPPV. It is based on the Barany Society criteria for the diagnosis of BPPV. This guideline provides recommendations on each variant of BPPV, with a description of the different diagnostic tests and the therapeutic manoeuvres. For this purpose, we have selected the tests and manoeuvres supported by evidence-based studies or extensive series. Finally, we have also included a chapter on differential diagnosis and a section relating to general aspects in the management of BPPV.
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Abstract
PURPOSE OF REVIEW This article summarizes an approach to evaluating dizziness for the general neurologist and reviews common and important causes of dizziness and vertigo. RECENT FINDINGS Improved methods of diagnosing patients with vertigo and dizziness have been evolving, including additional diagnostic criteria and characterization of some common conditions that cause dizziness (eg, vestibular migraine, benign paroxysmal positional vertigo, chronic subjective dizziness). Other uncommon causes of dizziness (eg, superior canal dehiscence syndrome, episodic ataxia type 2) have also been better clarified. Distinguishing between central and peripheral causes of vertigo can be accomplished reliably through history and examination, but imaging techniques have further added to accuracy. What has not changed is the necessity of obtaining a basic history of the patient's symptoms to narrow the list of possible causes. SUMMARY Dizziness and vertigo are extremely common symptoms that also affect function at home and at work. Improvements in the diagnosis and management of the syndromes that cause dizziness and vertigo will enhance patient care and cost efficiencies in a health care system with limited resources. Clinicians who evaluate patients with dizziness will serve their patient population well by continuing to manage patients with well-focused workup and attentive care.
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