Effects of Interval Time of the Epley Maneuver on Immediate Reduction of Positional Nystagmus: A Randomized, Controlled, Non-blinded Clinical Trial
Effects of Interval Time of the Epley Maneuver on Immediate Reduction of Positional Nystagmus: A Randomized, Controlled, Non-blinded Clinical Trial
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DOI：
10.3389/fneur.2019.00304
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发表时间：
2019-04-04
影响因子：
3.4
通讯作者：
Inohara, Hidenori
中科院分区：
文献类型：
--
作者：
Imai, Takao;Okumura, Tomoko;Inohara, Hidenori
目的：Epley手法具有立竿见影的效果：位置性眼球震颤迅速减少。良性阵发性位置性眩晕(BPPV)会导致BPPV疲劳，这构成反复进行Dix-Hallpike试验的位置性眼球震颤和眩晕的疲劳性；值得注意的是，BPPV的疲劳性随着时间的推移而变得无效。我们假设EM的即时效应是由BPPV疲劳引起的。因此，我们怀疑头位间隔的EM会恶化BPPV患者即刻减少位置性眼球震颤的效果，因为BPPV的疲劳性在这种治疗过程中会变得无效。方法：将40例新诊断的BPPV患者随机分为以下两组，一组进行不间隔头位的EM(A组)，另一组进行间隔3min的EM(B组)。主要的结果衡量指标是EM术后即刻的位置性眼球震颤的最大慢相眼速(MSPEV)与EM术前的比值。次要结果包括EM后30分钟间隔是否使位置性眼球震颤的MSPEV恢复到原始值。结果：A、B两组均能观察到EM的即时效应，因为第二次Dix-Hallpike试验的MSPEV明显小于第一次Dix-Hallpike试验的MSPEV(A组P<；0.0001，B组P<；0.0001)。B组的主要结局指标大于A组(p=0.0029)。30分钟后即刻效应消失(次要结果)。结论：本研究显示EM在每个头位有间歇时间和无间歇时间均有即刻效应。因为在EM的每个头部位置设置间隔时间降低了EM的即时效果，所以EM期间的间隔时间增加的好处较少。这一发现可以减少医生的努力，以及PC-BPPV患者在EM期间所经历的不适。然而，这种立竿见影的效果可能是由BPPV疲劳引起的，并可能很快消退。
Objective: The Epley maneuver (EM) has an immediate effect: rapid reduction of positional nystagmus. Benign paroxysmal positional vertigo (BPPV) causes BPPV fatigue, which constitutes fatigability of positional nystagmus and vertigo with repeated performance of the Dix-Hallpike test; notably, BPPV fatigability becomes ineffective over time. We hypothesized that the immediate effect of the EM is caused by BPPV fatigue. Therefore, we suspected that performance of the EM with intervals between head positions would worsen the immediate reduction of positional nystagmus in patients with BPPV, because BPPV fatigability would become ineffective during performance of this therapy.Methods: Forty patients with newly diagnosed BPPV were randomly assigned to the following two groups; one group performed the EM without intervals between positions (group A), and the other group performed the EM with 3 min intervals between positions (group B). The primary outcome measure was the ratio of maximum slow-phase eye velocity (MSPEV) of positional nystagmus soon after the EM, compared with that measured before the EM. Secondary outcome included whether a 30 min interval after the EM enabled recovery of MSPEV of positional nystagmus to the original value. This study followed the CONSORT 2010 reporting standards.Results: In both groups A and B, the immediate effect of the EM could be observed, because MSPEV during the second Dix-Hallpike test was significantly smaller than MSPEV during the first Dix-Hallpike test (p < 0.0001 in group A, p < 0.0001 in group B). The primary outcome measure was larger in group B than in group A (p = 0.0029). The immediate effect faded 30 min later (secondary outcome).Conclusions: This study showed that the EM had an immediate effect both with and without interval time in each head position of the EM. Because setting interval time in each head position of the EM reduced the immediate effect of the EM, interval time during the EM adds less benefit. This finding can reduce the effort exerted by doctors, as well as the discomfort experienced by patients with pc-BPPV, during EM. However, this immediate effect may be caused by BPPV fatigue, and may fade rapidly.