scholarly journals Vestibular rehabilitation in multiple sclerosis: study protocol for a randomised controlled trial and cost-effectiveness analysis comparing customised with booklet based vestibular rehabilitation for vestibulopathy and a 12 month observational cohort study of the symptom reduction and recurrence rate following treatment for benign paroxysmal positional vertigo

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
J. Marsden ◽  
M. Pavlou ◽  
R. Dennett ◽  
A. Gibbon ◽  
R. Knight-Lozano ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Benign Paroxysmal Positional Vertigo ◽  
Controlled Trial ◽  
Cost Effective ◽  
Vestibular Rehabilitation ◽  
Positional Vertigo ◽  
Peripheral Vestibulopathy ◽  
Randomised Controlled ◽  
Trial Participants ◽  
Paroxysmal Positional Vertigo

Abstract Background Symptoms arising from vestibular system dysfunction are observed in 49–59% of people with Multiple Sclerosis (MS). Symptoms may include vertigo, dizziness and/or imbalance. These impact on functional ability, contribute to falls and significant health and social care costs. In people with MS, vestibular dysfunction can be due to peripheral pathology that may include Benign Paroxysmal Positional Vertigo (BPPV), as well as central or combined pathology. Vestibular symptoms may be treated with vestibular rehabilitation (VR), and with repositioning manoeuvres in the case of BPPV. However, there is a paucity of evidence about the rate and degree of symptom recovery with VR for people with MS and vestibulopathy. In addition, given the multiplicity of symptoms and underpinning vestibular pathologies often seen in people with MS, a customised VR approach may be more clinically appropriate and cost effective than generic booklet-based approaches. Likewise, BPPV should be identified and treated appropriately. Methods/ design People with MS and symptoms of vertigo, dizziness and/or imbalance will be screened for central and/or peripheral vestibulopathy and/or BPPV. Following consent, people with BPPV will be treated with re-positioning manoeuvres over 1–3 sessions and followed up at 6 and 12 months to assess for any re-occurrence of BPPV. People with central and/or peripheral vestibulopathy will be entered into a randomised controlled trial (RCT). Trial participants will be randomly allocated (1:1) to either a 12-week generic booklet-based home programme with telephone support or a 12-week VR programme consisting of customised treatment including 12 face-to-face sessions and a home exercise programme. Customised or booklet-based interventions will start 2 weeks after randomisation and all trial participants will be followed up 14 and 26 weeks from randomisation. The primary clinical outcome is the Dizziness Handicap Inventory at 26 weeks and the primary economic endpoint is quality-adjusted life-years. A range of secondary outcomes associated with vestibular function will be used. Discussion If customised VR is demonstrated to be clinically and cost-effective compared to generic booklet-based VR this will inform practice guidelines and the development of training packages for therapists in the diagnosis and treatment of vestibulopathy in people with MS. Trial registration ISRCTN Number: 27374299 Date of Registration 24/09/2018 Protocol Version 15 25/09/2019

scholarly journals 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

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e026711
Author(s):  
Peixia Wu ◽  
Wenzhu Cao ◽  
Yan Hu ◽  
Huawei Li
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Negative Impact ◽  
Controlled Trial ◽  
Vestibular Rehabilitation ◽  
Dynamic Posturography ◽  
Positional Vertigo ◽  
Study Results ◽  
Randomised Controlled ◽  
Daily Function ◽  
Paroxysmal Positional Vertigo

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, some patients experience residual dizziness (RD) even after successful CRP, resulting in a significant negative impact on their daily function and quality of life. Exercise-based vestibular rehabilitation (VR) has been proven as an effective method for managing dizziness and has been applied in patients with various vestibular disorders. However, the efficacy of VR to specifically target RD post-BPPV is unknown. This study aims to investigate the efficacy of VR, compared with betahistine or VR plus betahistine treatment, in the treatment of patients experiencing RD after successful CRP.Methods and analysisA randomised single-blinded controlled trial will be carried out to determine the efficacy of VR compared with betahistine or VR plus betahistine treatment in mitigating RD and improving balance function. Patients with BPPV who experience RD after successful CRP will be recruited. Participants will be randomised into one of three groups to receive VR, betahistine or VR plus betahistine. There will be 61 participants in each group. The primary outcomes will be changes in the patient’s daily function as measured by the Vestibular Activities and Participation questionnaire and balance ability assessed by computerised dynamic posturography. The secondary outcomes will be dizziness-related handicap, otolith function and duration of RD symptoms. Outcome measures will be noted at baseline and at 2, 4 and 8 weeks post-randomisation. This study has the potential to reduce unnecessary anti-vertigo drug prescriptions and may lead to a general consensus regarding the use of VR as a first-line treatment for RD in patients with BPPV.Ethics and disseminationThis trial received ethical approval from the Institutional Review Board of Eye and ENT Hospital of Fudan University (reference number 2017046). The study results will be disseminated via peer-reviewed journals and conferences.Trial registration numberNCT03624283; Pre-results.

scholarly journals Epley manoeuvre for posterior semicircular canal benign paroxysmal positional vertigo in people with multiple sclerosis: protocol of a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e046510
Author(s):  
Cristina García-Muñoz ◽  
María-Dolores Cortés-Vega ◽  
Juan Carlos Hernández-Rodríguez ◽  
Rocio Palomo-Carrión ◽  
Rocío Martín-Valero ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Randomised Controlled Trial ◽  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Controlled Trial ◽  
Vestibular Disorders ◽  
Posterior Semicircular Canal ◽  
Positional Vertigo ◽  
Randomised Controlled ◽  
Paroxysmal Positional Vertigo

IntroductionVestibular disorders in multiple sclerosis (MS) could have central or peripheral origin. Although the central aetiology is the most expected in MS, peripheral damage is also significant in this disease. The most prevalent effect of vestibular peripheral damage is benign paroxysmal positional vertigo (BPPV). Impairments of the posterior semicircular canals represent 60%–90% of cases of BPPV. The standard gold treatment for this syndrome is the Epley manoeuvre (EM), the effectiveness of which has been poorly studied in patients with MS. Only one retrospective research study and a case study have reported encouraging results for EM with regard to resolution of posterior semicircular canal BPPV. The aim of this future randomised controlled trial (RCT) is to assess the effectiveness of EM for BPPV in participants with MS compared with a sham manoeuvre.Methods and analysisThe current protocol describes an RCT with two-arm, parallel-group design. Randomisation, concealed allocation and double-blinding will be conducted to reduce possible bias. Participants and evaluators will be blinded to group allocation. At least 80 participants who meet all eligibility criteria will be recruited. Participants will have the EM or sham manoeuvre performed within the experimental or control group, respectively. The primary outcome of the study is changes in the Dix Hallpike test. The secondary outcome will be changes in self-perceived scales: Dizziness Handicap Inventory and Vestibular Disorders Activities of Daily Living Scale. The sample will be evaluated at baseline, immediately after the intervention and 48 hours postintervention.Ethics and disseminationThe study was approved by the Andalusian Review Board and Ethics Committee of Virgen Macarena-Virgen del Rocio Hospitals (ID 0107-N-20, 23 July 2020). The results of the research will be disseminated by the investigators to peer-reviewed journals.Trial registration numberNCT04578262.

Effects of balance Vestibular Rehabilitation Therapy in elderly with Benign Paroxysmal Positional Vertigo: a randomized controlled trial

2016 ◽  
Vol 39 (12) ◽  
pp. 1198-1206 ◽  
Author(s):  
Karyna Myrelly Oliveira Bezerra de Ribeiro ◽  
Raysa Vanessa de Medeiros Freitas ◽  
Lidiane Maria de Brito Macedo Ferreira ◽  
Nandini Deshpande ◽  
Ricardo Oliveira Guerra
Keyword(s):  
Randomized Controlled Trial ◽  
Benign Paroxysmal Positional Vertigo ◽  
Controlled Trial ◽  
Vestibular Rehabilitation ◽  
Rehabilitation Therapy ◽  
Randomized Controlled ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

Effects of customized vestibular rehabilitation plus canalith repositioning maneuver on gait and balance in adults with Benign Paroxysmal Positional Vertigo: A Randomized Controlled Trial

2021 ◽  
pp. 1-8
Author(s):  
Phui Lin Se To ◽  
Devinder Kaur Ajit Singh ◽  
Susan L. Whitney
Keyword(s):  
Randomized Controlled Trial ◽  
Benign Paroxysmal Positional Vertigo ◽  
Controlled Trial ◽  
Vestibular Rehabilitation ◽  
Posterior Canal ◽  
Randomized Controlled ◽  
Positional Vertigo ◽  
Dynamic Gait ◽  
Repositioning Maneuver ◽  
Paroxysmal Positional Vertigo

BACKGROUND: Adults with unilateral posterior canal benign paroxysmal positional vertigo (BPPV) may continue to present with residual dizziness and balance impairments after the canalith repositioning maneuver (CRM). Customized Vestibular rehabilitation (VR) in addition to the standard CRM may improve postural control in adults with BPPV. However, the effectiveness of this intervention for improving dyanmic gait measures in adults with BPPV is unknown. OBJECTIVE: We aimed to determine the effectiveness of customized VR in addition to the standard CRM on dynamic gait measures among adults with unilateral posterior canal BPPV. METHODS: In this double blind, randomized controlled trial, 28 adults with BPPV were randomized to either control (n = 14, age: 54.36±8.55) or experimental (n = 14, age: 50.71±9.88) groups. The experimental and control groups received customized VR plus standard CRM for six weeks and standard CRM for two weeks respectively. Dynamic gait measures (duration of a complete gait cycle, stride velocity, turning duration and number of steps while turning) were recorded using a portable mobility sensor (iTUG) at baseline, week 4 and 6. A mixed model ANOVA was used to estimate the main effects of the interventions. RESULTS: During walking, a group effect was demonstrated on gait duration, stride velocity, turning duration and number of steps while turning (p <  0.05). CONCLUSIONS: Six weeks of customized VR performed in addition to the standard CRM was more effective than the standard CRM alone in improving balance and gait in adults with posterior canal BPPV. (252 words)

The role of the vestibular assessment

2009 ◽  
Vol 123 (11) ◽  
pp. 1212-1215 ◽  
Author(s):  
J S Phillips ◽  
J E FitzGerald ◽  
A P Bath
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Vestibular Rehabilitation ◽  
Careful Consideration ◽  
Test Results ◽  
Positional Vertigo ◽  
Vestibular Assessment ◽  
Dizzy Patient ◽  
Paroxysmal Positional Vertigo

AbstractObjective:To evaluate the role of vestibular assessment in the management of the dizzy patient.Materials and methods:A retrospective review of case notes and vestibular assessment reports of 100 consecutive patients referred for vestibular assessment.Results:Sixty of the 100 patients had an abnormal vestibular assessment. Eleven patients had benign paroxysmal positional vertigo as the sole diagnosis, of whom nine had not had a Dix–Hallpike manoeuvre performed before referral. Of patients referred for vestibular rehabilitation, 76 per cent had an abnormal electrophysiological assessment. After vestibular assessment, 35 patients were discharged with no further follow-up appointments in the ENT department.Conclusions:All patients should have a Dix–Hallpike manoeuvre performed prior to referral for vestibular assessment. The majority of our patients undergoing vestibular rehabilitation had abnormal test results, although a significant number did not. Prior to referral, it is worth considering the implication of a ‘normal’ and ‘abnormal’ result for the management of the patient. Careful consideration should be given to the development of dedicated dizziness clinics run by practitioners with a specialist interest in balance disorders, in order to ensure appropriate requests for vestibular assessment.

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