Department of Neurology, School of Medicine, Chonbuk National University, Jeonju, Korea.
Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea.
J Neurol. 2017 Sep;264(9):1892-1898. doi: 10.1007/s00415-017-8580-2. Epub 2017 Jul 28.
The objectives of this study is to compare the efficacy between repetition of Epley maneuver and switch to alternate Semont maneuver in treating posterior canal benign paroxysmal positional vertigo (PC-BPPV) that does not respond to the initial Epley maneuver. In the nationwide, seven dizziness clinics of Korea, 506 consecutive patients (303 women, age range 22-87, mean age ± SD = 64 ± 12, median = 61) with idiopathic PC-BPPV were initially treated with a single Epley maneuver. Of those, 144 (28.5%) patients, who did not respond to the therapy, were randomized to the repetition of Epley maneuver (n = 70) or switch to Semont maneuver (n = 74). The therapeutic efficacy was determined within 1 h by a blinded examiner after the trial of each second maneuver. The efficacy did not differ between the repetition of Epley maneuver and switch to Semont maneuver groups (38.6 vs. 27.0%, p = 0.14, Chi-square test). However, the patients with a long duration (p < 0.001, linear regression) and latency (p = 0.01) of the positional nystagmus during Dix-Hallpike maneuver showed a higher rate of the initial and second treatment failures. Either Epley or Semont maneuver may be applied as a second treatment to the patients with PC-BPPV refractory to the initial Epley maneuver. This study provides Class I evidence that repeated Epley and switch to Semont maneuver shows a similar efficacy in treating PC-BPPV that does not respond to the initial Epley maneuver.
NCT01822002.
本研究旨在比较 Epley 手法重复与 Semont 手法转换对初始 Epley 手法治疗无效的后半规管良性阵发性位置性眩晕（PC-BPPV）的疗效。在韩国的七个全国性眩晕诊所，对 506 例（303 名女性，年龄 22-87 岁，平均年龄±标准差=64±12，中位数=61）特发性 PC-BPPV 患者进行了初始 Epley 手法治疗。其中 144 例（28.5%）患者对治疗无反应，随机分为 Epley 手法重复组（n=70）或 Semont 手法转换组（n=74）。每种二次手法试验后 1 小时内，由盲法检查者确定治疗效果。Epley 手法重复组与 Semont 手法转换组的疗效无差异（38.6% vs. 27.0%，p=0.14，卡方检验）。然而，在 Dix-Hallpike 试验中位置性眼震持续时间（p<0.001，线性回归）和潜伏期（p=0.01）较长的患者，初始和二次治疗失败率较高。对于初始 Epley 手法治疗无效的 PC-BPPV 患者，Epley 或 Semont 手法均可作为二线治疗。本研究提供了 I 级证据，即重复 Epley 手法和转换为 Semont 手法治疗初始 Epley 手法治疗无效的 PC-BPPV 具有相似的疗效。
NCT01822002。
