Research in Vestibular Science

Volume 22 (1); March 2023

Review

Treatment in Benign Paroxysmal Positional Vertigo: Factors that Affect Successful Treatment Outcome: Dae Bo Shim; Res Vestib Sci. 2023;22(1):1-6. Published online March 13, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.1.1

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Abstract PDF: Benign paroxysmal positional vertigo (BPPV) is the most common etiology of benign vestibulopathy. Various treatments for BPPV have been developed, and appropriate treatments for each subtype of BPPV have been provided and used in accordance with clinical practice guidelines published by the American Academy of Otorhinolaryngology-Head and Neck Surgery in 2008 and 2017. Although many therapeutic maneuvers have been reported to show high success rates in the treatment of BPPV patients, some cases are not effective even by appropriate therapeutic maneuvers. This article reviews various factors affecting the successful treatment of BPPV patients.

Original Articles

Dizziness in Patients with Vestibular Epilepsy: Wankiun Lee, Jae-Moon Kim; Res Vestib Sci. 2023;22(1):7-13. Published online March 13, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.1.7

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Abstract PDF: Objectives
Vestibular epilepsy refers to epilepsy in which vertigo is the sole or main symptom of a seizure. However, epilepsy is rarely considered as a differential diagnosis in patients complaining of dizziness. Here, we reviewed ten cases of vestibular epilepsy and analyzed the dizziness complained by the patient.
Methods
In this study, the medical records of dizziness patients with epileptic discharges observed on electroencephalogram were retrospectively analyzed. Patients who had other obvious causes of dizziness, lacked a description of dizziness, or were not taking antiseizure medications were excluded. We finally recruited 10 patients, and investigated their dizziness characteristic, brain imaging tests, electroencephalograms, and blood test findings.
Results
Patients with vestibular epilepsy usually felt dizzy abruptly while not moving, and often complained of dizziness in the form of spinning around or becoming dazed. Dizziness was short, usually between a few seconds and a few minutes, and the frequency of occurrence was variable, so there was no consistent trend. There were no abnormal findings in blood tests. In brain imaging test, most patients did not show significant abnormalities. The electroencephalographic abnormalities of the patients were mainly observed in the temporal lobe, and the dizziness they complained of improved when they started taking antiseizure medications.
Conclusions
If a patient with dizziness complains of dizziness that occurs suddenly and lasts for a short time, early electroencephalogram should be considered to prevent the diagnosis of epilepsy from being overlooked or delayed.

Clinical Characteristics of Benign Paroxysmal Positional Vertigo Positive on Bilateral Dix-Hallpike Test: Youngrok Jo, Gun Min Lee, Youn Jin Cho, Mi Joo Kim, Minbum Kim; Res Vestib Sci. 2023;22(1):14-18. Published online March 13, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.1.14

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Abstract PDF: Objectives
The purpose of this study is to investigate the clinical characteristics of benign paroxysmal positional vertigo (BPPV) which showed torsional nystagmus on bilateral Dix-Hallpike test, and to analyze the clinical features of pseudo-bilateral BPPV.
Methods
This study is a retrospective chart review of a total of 341 patients diagnosed with BPPV of posterior canal (PC-BPPV). Among them, patients who showed torsional nystagmus on bilateral Dix-Hallpike test were defined as “bilateral DixHallpike positive patients,” who were classified into true- and pseudo-bilateral PC-BPPV group through analysis of nystagmus direction. And pseudo-bilateral PC-BPPV were categorized into two subtypes according to their pathomechanisms. Clinical characteristics including sex, age, underlying vestibular disorders, recurrence and the number of Epley maneuvers were analyzed. Student t-test and Mann-Whitney U-test were used for statistical analysis.
Results
Among 341 patients, 27 patients (7.9%) were “bilateral Dix-Hallpike positive patients”. They received more Epley maneuvers than the group of unilateral PC-BPPV until the resolution of nystagmus (2.3 vs. 1.4, p＜0.001). Fifteen patients out of 27 were diagnosed with pseudo-bilateral PC-BPPV, who were classified into two subtypes according to their pathomechanisms. The number of Epley maneuvers was not different between true- and pseudo-bilateral PC-BPPV.
Conclusions
Patients with pseudo-bilateral PC-BPPV were common among “bilateral Dix-Hallpike positive patients.” For their better treatment, understanding of possible pathophysiology, accurate Dix-Hallpike test and detailed analysis of nystagmus direction are necessary.

Case Report

Visual Fixation-Induced Hemi-Seesaw Nystagmus: Hyun Sung Kim, Eun Hye Oh, Jae-Hwan Choi; Res Vestib Sci. 2023;22(1):19-22. Published online March 13, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.1.19

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1 Crossref

Abstract PDF Supplementary Material

Seesaw nystagmus (SSN) is characterized by conjugate torsional nystagmus with opposite vertical components in the two eyes. The waveform may be pendular or jerk (hemi-seesaw nystagmus, HSSN), in which the slow phase corresponds to one half-cycle and the quick phase to the other. Pendular SSN and HSSN have distinct clinical presentations and underlying causes. The pathophysiology of pendular SSN may be instability of visuovestibular interactions, while the underlying mechanism for HSSN may be related to the ocular tilt reaction or an imbalance in vestibular pathways. We report a patient with HSSN due to unilateral mesodiencephalic infarction that becomes apparent during visual fixation only.

Citations

Citations to this article as recorded by

Midbrain lesion-induced disconjugate gaze: a unifying circuit mechanism of ocular alignment?
Maximilian U. Friedrich, Laurin Schappe, Sashank Prasad, Helen Friedrich, Michael D. Fox, Andreas Zwergal, David S. Zee, Klaus Faßbender, Klaus-Ulrich Dillmann
Journal of Neurology.2024;[Epub] CrossRef

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