Preview

Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Benign paroxysmal positional vertigo: diagnosis, treatment, rehabilitation. Current concepts on the role of betahistine in the complex treatment of patients with benign paroxysmal positional vertigo

https://doi.org/10.14412/2074-2711-2024-5-120-130

Abstract

The treatment of patients with benign paroxysmal positional vertigo (BPPV) is an urgent issue in modern medicine.

Expert Council on the diagnosis and treatment of BPPV was held in Moscow on June 1, 2024. Timely diagnosis and effective treatment play a key role in the management of patients with BPPV, reduce the risk of falls and related injuries, prevent the development of emotional disorders and impairment of daily activities. Accurate patient routing and selection of appropriate treatment can significantly reduce the duration of disability and the burden on the healthcare system. Relatively simple positional tests aimed at detecting involvement of various semicircular canals have been found to be of paramount importance in the diagnosis of BPPV. Repositioning maneuvers are of paramount importance in the treatment of patients with BPPV. They vary depending on the canal affected and aim to move the otoliths out of the semicircular canals to the vestibule of the labyrinth. If repositioning maneuvers can not be performed, effective methods of vestibular gymnastics can be used. When discussing drug therapy, it was found that the use of betahistine in addition to repositioning maneuvers or vestibular gymnastics increases the efficacy of therapy, accelerates the recovery process and prevents the development of residual non-positional vertigo.

About the Authors

V. A. Parfenov
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
Russian Federation

Vladimir Anatolyevich Parfenov - Department of Nervous Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine.

11, Rossolimo St., Build. 1, Moscow 119021


Competing Interests:

There are no conflict of interest



M. V. Zamergrad
Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia; N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
Russian Federation

Department of Neurology with a course of reflexology and manual therapy RMA CPE, Russian Clinical and Research Centre of Gerontology.

2/1, Barrikadnaya St., Build. 1, Moscow 125993; 16, 1st Leonova St., Moscow 129226


Competing Interests:

There are no conflict of interest



O. V. Zaitseva
The National Medical Research Center for Otorhinolaryngology, Federal Medico-Biological Agency of Russia
Russian Federation

30, Volokolamskoye Shosse, Build. 2, Moscow 123182


Competing Interests:

There are no conflict of interest



A. I. Guseva
N.I. Pirogov Russian Research Medical University, Ministry of Health of Russi
Russian Federation

Acad. B.S. Preobrazhensky Department of Otorhinolaryngology, Faculty of General Medicine.

18A, Zagorodnoe Shosse, Build. 2, Moscow 117152


Competing Interests:

There are no conflict of interest



S. V. Lilenko
Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, Ministry of Health of Russia; I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia
Russian Federation

Department of Otorhinolaryngology.

9, Bronnitzkaya St., St. Petersburg 190013; 47, Piskarevsky Prosp., pavilion 12, St. Petersburg 195067


Competing Interests:

There are no conflict of interest



O. A. Melnikov
Center for Dizziness and Balance Disorders GUTA Clinic
Russian Federation

4a, Fadeeva St., Build. 1, Moscow 127006


Competing Interests:

There are no conflict of interest



E. V. Baybakova
L.I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow Healthcare Department
Russian Federation

18A, Zagorodnoe Shosse, Build. 2, Moscow 117152


Competing Interests:

There are no conflict of interest



V. A. Voronov
I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia
Russian Federation

Department of Otorhinolaryngology.

47, Piskarevsky Prosp., pavilion 12, St. Petersburg 195067


Competing Interests:

There are no conflict of interest



References

1. You P, Instrum R, Parnes L. Benign paroxysmal positional vertigo. Laryngoscope Investig Otolaryngol. 2018 Dec 14;4(1):116-23. doi: 10.1002/lio2.230

2. Von Brevern M, Radtke A, Lezius F, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007 Jul;78(7):710-5. doi: 10.1136/jnnp.2006.100420. Epub 2006 Nov 29.

3. Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg. 2017 Mar;156(3_suppl):S1-S47. doi: 10.1177/0194599816689667

4. Kunelskaya NL, Melnikov OA, Guseva AL, Baibakova EV. The etiology, pathophysiology and differential diagnosis of benign paroxysmal positional vertigo. Zhurnal nevrologii i psihiatrii imeni S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry. 2016;116(4):79-84. doi: 10.17116/JNEVRO20161164179-84 (In Russ.).

5. Parfyonov VA, Zamergrad MV, Mel'nikov OA. Vertigo: diagnosis and treatment, common diagnostic errors. Moscow: MIA; 2019. 208 p. (In Russ.).

6. Bronshtein A, Lempert T. Dizziness. Moscow: GEOTAR-Media; 2022. 216 p. (In Russ.).

7. Дикс М, Спенсер Харрисон М. Позиционное головокружение. В кн.: Дикс МР, Худ ДжД, редакторы. Головокружение. Москва: Медицина; 1987. С. 160-73. [Dix M, Spencer Harrison M. Positional vertigo. In: Dix MR, Hood JD, eds. Vertigo. Moscow: Medicine; 1987. P. 160-73 (In Russ.)].

8. Della Santina CC, Potyagaylo V, Migliaccio AA, et al. Orientation of human semicircular canals measured by three-dimensional multiplanar CT reconstruction. J Assoc Res Otolaryngol. 2005 Sep;6(3):191-206. doi: 10.1007/s10162-005-0003-x

9. Fatterpekar GM, Doshi AH, Dugar M, et al. Role of 3D CT in the evaluation of the temporal bone. Radiographics. 2006 Oct;26 Suppl 1:S117-32. doi: 10.1148/rg.26si065502

10. Schuknecht HF. Cupulolithiasis. Arch Otolaryngol. 1969 Dec;90(6):765-78. doi: 10.1001/archotol.1969.00770030767020

11. Baloh RW, Honrubia V, Jacobson K. Benign positional vertigo: clinical and oculographic features in 240 cases. Neurology. 1987 Mar;37(3):371-8. doi: 10.1212/wnl.37.3.371

12. Lynn S, Pool A, Rose D, et al. Randomized trial of the canalith repositioning procedure. Otolaryngol Head Neck Surg. 1995 Dec;113(6):712-20. doi: 10.1016/S019459989570010-2

13. Burton MJ, Eby TL, Rosenfeld RM. Extracts from the Cochrane Library: modifications of the Epley (canalith repositioning) maneuver for posterior canal benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2012 Sep;147(3):407-11. doi: 10.1177/0194599812457134. Epub 2012 Aug 11.

14. Nylen CO. Positional nystagmus; a review and future prospects. J Laryngol Otol. 1950 Jun;64(6):295-318.

15. Antonenko LM, Parfyonov VA. Vestibular vertigo. Zhurnal nevrologii i psihiatrii imeni S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry. 2020;120(6):12530. doi: 10.17116/JNEVRO2020120061125 (In Russ.).

16. Ruckenstein MJ, Shepard NT. The canalith repositioning procedure with and without mastoid oscillation for the treatment of benign paroxysmal positional vertigo. ORL J Otorhinolaryngol Relat Spec. 2007;69(5):295-8. doi: 10.1159/000105265. Epub 2007 Jul 6.

17. Furman JM, Cass SP. Benign paroxysmal positional vertigo. N Engl J Med. 1999 Nov 18;341(21):1590-6. doi: 10.1056/NEJM199911183412107

18. Whitney SL, Marchetti GF, Morris LO. Usefulness of the dizziness handicap inventory in the screening for benign paroxysmal positional vertigo. Otol Neurotol. 2005 Sep;26(5):1027-33. doi: 10.1097/01.mao.0000185066.04834.4e

19. Lilenko S, Yanov Yu, Sitnikov V. Balance disorders. Part I. Etiopathogenesis and diagnostics. St. Petersburg: RIA-AMI; 2005. 128 c. (In Russ.).

20. Kunel'skaya NL, Mokrysheva NG, Guseva AL, et al. Benign paroxysmal positional vertigo: Modern concepts of its etiology and pathogenesis. Vestnik otorinolaringologii. 2017;82:75-9. doi: 10.17116/OTORINO201782375-79 (In Russ.).

21. Pal'chun VT, Guseva AL, Chistov SD. Benign paroxysmal positional vertigo: clinical aspects of diagnosis and treatment. Consilium Medicum. 2015;17:46-52 (In Russ.).

22. Lebedeva NV, Zamergrad MV, Parfyonov VA, Antonenko LM. Diagnosis and treatment of benign paroxysmal positional vertigo in common clinical practice. Ter Arkh. 2017;89:57-61. doi: 10.17116/TERARKH201789157-61 (In Russ.).

23. Zamergrad MV, Guseva AL, Shapovalova MV. Bedside examination elderly patient with vertigo and dizziness. Rossiyskiy zhurnal geriatricheskoy meditsiny = Russian Journal of Geriatric Medicine. 2020;(3):212-6. doi: 10.37586/26868636-3-2020-212-216 (In Russ.).

24. Amelin AV, Lilenko SV, Zamergrad MV, et al. Patient management with complaints of vertigo at the first visit. RMZh. Meditsinskoye obozreniye. 2023;(7):658-65. doi: 10.32364/2587-6821-2023-7-10-8 (In Russ.).

25. Kulesh AA, Dyomin DA, Guseva AL, et al. Vestibular vertigo in emergency neurology. Rossiyskiy nevrologicheskiy zhurnal = Russian Neurological Journal. 2021;26(4):50-9. doi: 10.30629/2658-7947-2021-26-4-50-59 (In Russ.).

26. Zamergrad MV, Parfyonnov VA, Yakhno NN, et al. The diagnosis of systemic vertigo in out-patient practice. Nevrologicheskij zhurnal. 2014;19:23-9 (In Russ.).

27. Lilenko SV, Anikin IA, Khamgushkeeva NN. Acute peripheral vestibular dysfunction: Diagnostics and treatment. Meditsinskiy sovet. 2020;(6):114-21. doi: 10.21518/2079-701X-2020-6-114-121 (In Russ.).

28. Kudriavtseva AS, Amelin AV, Lilenko SV, Skoromets AA. The differential diagnosis of recurrent episodes of vertigo. Zhurnal nevrologii i psihiatrii imeni S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry. 2016;116(4):4-9. doi: 10.17116/JNEVRO2016116414-9 (In Russ.).

29. Zamergrad MV, Masueva SS. Benign paroxysmal positional vertigo in the older adults. Rossiyskiy zhurnal geriatricheskoy meditsiny = Russian Journal of Geriatric Medicine. 2022;(1):37-42. doi: 10.37586/2686-8636-1-2022-37-42 (In Russ.).

30. Voronov VA, Demidenko DYu, Levina EA, et al. Benign paroxysmal positional vertigo in the practice of ambulance doctor. Skoraya meditsinskaya pomoshch' = Emergency Medical Care. 2018;19(4):38-42. doi: 10.24884/20726716-2018-19-4-38-42 (In Russ.).

31. Zamergrad MV, Masueva SS, Guseva AL, Grachev SP. 'Otolithic' dizziness. Medical alphabet. 2022;(10):40-4. doi: 10.33667/20785631-2022-10-40-44 (In Russ.).

32. Grigoriev G. On the classification of positional nystagmus. Vestnik otorinolaringologii. 1981;(2):20-4 (In Russ.)].

33. Brandt T, Steddin S. Current view of the mechanism of benign paroxysmal positioning vertigo: cupulolithiasis or canalolithiasis? J Vestib Res. 1993 Winter;3(4):373-82.

34. Imai T, Ito M, Takeda N, et al. Natural course of the remission of vertigo in patients with benign paroxysmal positional vertigo. Neurology. 2005 Mar 8;64(5):920-1. doi: 10.1212/01.WNL.0000152890.00170.DA

35. Semont A, Freyss G, Vitte E. Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol. 1988;42:290-3. doi: 10.1159/000416126

36. Epley JM. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 1992 Sep;107(3):399-404. doi: 10.1177/019459989210700310

37. Cohen HS. Side-lying as an alternative to the Dix-Hallpike test of the posterior canal. Otol Neurotol. 2004 Mar;25(2):130-4. doi: 10.1097/00129492-200403000-00008

38. Pal'chun VT, Kryukov AI, Guseva AL, Makarov SA. Clinical features of BPPV and their influence on the choice of the doctor's tactics. Vestnik otorinolaringologii. 2021;86:4-8. doi: 10.17116/OTORINO2021860414 (In Russ.).

39. Еzgirgin ON, Kingma H, Manzari L, Lacour M. Residual dizziness after BPPV management: exploring pathophysiology and treatment beyond canalith repositioning maneuvers. Front Neurol. 2024 May 24;15:1382196. doi: 10.3389/fneur.2024.1382196. Erratum in: Front Neurol. 2024 Jul 29;15:1461600. doi: 10.3389/fneur.2024.1461600

40. Kryukov AI, Guseva AL, Olimpieva SP, Kubryak OV. Diagnosis and rehabilitation of anterior canal benign paroxysmal positional vertigo. Vestnik otorinolaringologii. 2022;87:4-10. doi: 10.17116/OTORINO2022870614 (In Russ.).

41. Zaitseva OV, Overchenko KV, Khirnetkina AF. Vestibular vertigo: to help the practicing physician. RMJ. 2018;3(II):58-61 (In Russ.).

42. Ivanova GE, Kunelskaya NL, Parfenov VA, et al. Vestibular rehabilitation in complex therapy of vestibular vertigo (consensus of experts). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2024;16(1):114-21. doi: 10.14412/2074-2711-2024-1-114-121 (In Russ.).

43. Bressi F, Vella P, Casale M, et al. Vestibular rehabilitation in benign paroxysmal positional vertigo: Reality or fiction? Int J Immunopathol Pharmacol. 2017 Jun;30(2):113-22. doi: 10.1177/0394632017709917. Epub 2017 May 9.

44. Han BI, Song HS, Kim JS. Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises. J Clin Neurol. 2011 Dec;7(4):184-96. doi: 10.3988/jcn.2011.7.4.184. Epub 2011 Dec 29.

45. Brandt T, Daroff RB. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol. 1980 Aug;106(8):484-5. doi: 10.1001/archotol.1980.00790320036009

46. Brandt T, Steddin S, Daroff RB. Therapy for benign paroxysmal positioning vertigo, revisited. Neurology. 1994 May;44(5):796-800. doi: 10.1212/wnl.44.5.796

47. Jung HJ, Koo JW, Kim CS, et al. Anxiolytics reduce residual dizziness after successful canalith repositioning maneuvers in benign paroxysmal positional vertigo. Acta Otolaryngol. 2012 Mar;132(3):277-84. doi: 10.3109/00016489.2011.637179. Epub 2011 Dec 27.

48. Li W, Sun J, Zhao Z, et al. Efficacy of Epley's maneuver plus betahistine in the management of PC-BPPV: A systematic review and meta-analysis. Medicine (Baltimore). 2023 Mar 31;102(13):e33421. doi: 10.1097/MD.0000000000033421

49. 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 May;129(5):434-40. doi: 10.1177/0003489419892285. Epub 2019 Dec 6.

50. Hong X, Christ-Franco M, Moher D, et al. Vitamin D Supplementation for Benign Paroxysmal Positional Vertigo: A Systematic Review. Otol Neurotol. 2022 Aug 1;43(7):e704-e711. doi: 10.1097/MAO.0000000000003586

51. Jeong SH, Kim JS, Kim HJ, et al. Prevention of benign paroxysmal positional vertigo with vitamin D supplementation: A randomized trial. Neurology. 2020 Sep 1;95(9):e1117-e1125. doi: 10.1212/WNL.0000000000010343. Epub 2020 Aug 5.

52. Lacour M, Sterkers O. Histamine and betahistine in the treatment of vertigo: elucidation of mechanisms of action. CNS Drugs. 2001;15(11):853-70. doi: 10.2165/00023210-200115110-00004

53. Lacour M. Betahistine treatment in managing vertigo and improving vestibular compensation: clarification. J Vestib Res. 2013;23(3):139-51. doi: 10.3233/VES-130496

54. Kaur J, Shamanna K. Management of Benign Paroxysmal Positional Vertigo: A Comparative Study between Epleys Manouvre and Betahistine. Int Tinnitus J. 2017 Jun 1;21(1):30-4. doi: 10.5935/0946-5448.20170007

55. Wu P, Cao W, Hu Y, Li H. 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 Jun 18;9(6):e026711. doi: 10.1136/bmjopen-2018-026711

56. Ke Y, Ma X, Jing Y, et al. Risk factors for residual dizziness in patients with benign paroxysmal positional vertigo after successful repositioning: a systematic review and metaanalysis. Eur Arch Otorhinolaryngol. 2022 Jul;279(7):3237-56. doi: 10.1007/s00405-02207288-9. Epub 2022 Feb 26.


Review

For citations:


Parfenov VA, Zamergrad MV, Zaitseva OV, Guseva AI, Lilenko SV, Melnikov OA, Baybakova EV, Voronov VA. Benign paroxysmal positional vertigo: diagnosis, treatment, rehabilitation. Current concepts on the role of betahistine in the complex treatment of patients with benign paroxysmal positional vertigo. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2024;16(5):120-130. (In Russ.) https://doi.org/10.14412/2074-2711-2024-5-120-130

Views: 301


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)