Strupp Michael, Goldschagg Nicolina, Vinck Anne-Sophie, Bayer Otmar, Vandenbroeck Sebastian, Salerni Lorenzo, Hennig Anita, Obrist Dominik, Mandalà Marco
Department of Neurology, German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany.
Department of Otolaryngology, Algemeen Ziekenhuis Brugge, Brugge, Belgium.
Front Neurol. 2021 Apr 14;12:652573. doi: 10.3389/fneur.2021.652573. eCollection 2021.
To compare the efficacy of the Sémont maneuver (SM) with the new "SémontPLUS maneuver" (SM+) in patients with posterior canal BPPV canalolithiasis (pcBPPVcan). In a prospective trinational (Germany, Italy, and Belgium) randomized trial, patients with pcBPPVcan were randomly assigned to SM or SM+; SM+ means overextension of the head by 60+° below earth horizontal line during the movement of the patient toward the affected side. The first maneuver was done by the physician, and the subsequent maneuvers by the patients 9 times/day on their own. Each morning the patient documented whether vertigo could be induced. The primary endpoints were: "How long (in days) does it take until no attacks can be induced?" and "What is the efficacy of a single SM/SM+?" In the 194 patients analyzed (96 SM, 98 SM+), it took 2 days (median, range 1-21 days, mean 3.6 days) for recovery with SM and 1 day (median, range 1-8 days, mean 1.8 days) with SM+ ( = 0.001, Mann-Whitney -test). There was no difference in the second primary endpoint (chi-test, = 0.39). This prospective trial shows that SM+ is more effective than SM when repeated therapeutic maneuvers are performed but not when a single maneuver is performed. It also supports the hypothesis of the biophysical model: overextension of the head during step 2 brings the clot of otoconia beyond the vertex of the canal, which increases the effectivity. This study provides Class I evidence that SM+ is superior to SM for multiple treatment maneuvers of pcBPPVcan.
比较Sémont手法（SM）与新的“SémontPLUS手法”（SM+）治疗后半规管耳石症（pcBPPVcan）患者的疗效。在一项前瞻性三国（德国、意大利和比利时）随机试验中，将pcBPPVcan患者随机分为SM组或SM+组；SM+是指患者向患侧移动时头部在地球水平线以下过度伸展60°以上。首次手法由医生操作，随后患者自行每天进行9次手法操作。每天早晨患者记录是否能诱发眩晕。主要终点为：“直到不能诱发发作需要多长时间（以天为单位）？”以及“单次SM/SM+的疗效如何？”在分析的194例患者中（96例SM组，98例SM+组），SM组恢复时间为2天（中位数，范围1 - 21天，平均3.6天），SM+组为1天（中位数，范围1 - 8天，平均1.8天）（Mann-Whitney U检验，P = 0.001）。第二个主要终点无差异（卡方检验，P = 0.39）。这项前瞻性试验表明，当进行重复治疗手法时，SM+比SM更有效，但单次手法操作时并非如此。它还支持生物物理模型的假设：在步骤2中头部过度伸展使耳石凝块越过半规管嵴顶，从而提高了有效性。本研究提供了I级证据，表明在pcBPPVcan的多次治疗手法中，SM+优于SM。
