Predicting a successful treatment in posterior canal benign paroxysmal positional vertigo.
OBJECTIVE
To elucidate the characteristics and prognostic value of positioning nystagmus during the second position of the Epley maneuver (90 degrees contralateral head turn from the initial Hallpike maneuver).


METHODS
The Epley maneuver was performed in 126 patients with confirmed posterior canal benign paroxysmal positional vertigo (PC-BPPV). The characteristics of positioning nystagmus were investigated using video Frenzel goggles.


RESULTS
During the second position, 99 patients developed torsional upbeating nystagmus, which was in the same direction (orthotropic nystagmus) as during the first position (Hallpike maneuver), whereas 15 patients showed a reversed pattern. In 12 patents, nystagmus was not induced during the second position. All 99 patients with orthotropic nystagmus had resolution of BPPV after the first or second trial of the Epley maneuver. In contrast, 12 of the 15 patients with reversed nystagmus and 8 of the 12 patients without nystagmus failed to resolve.


CONCLUSIONS
During the second position of the Epley maneuver, an orthotropic pattern of nystagmus predicts a successful repositioning, whereas reversed nystagmus or no nystagmus is suggestive of poor response to repositioning.
Oh
Hui Jong
HJ
MTV (Migraine, Tinnitus, and Vertigo) Clinic, Oh Neurology Center, 200-13, Icheon-dong, Nam-gu, Daegu 705 - 836, South Korea. byung_in@hotmail.com.
Kim
Ji Soo
JS
Han
Byung In
BI
Lim
Jeong Geun
JG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009759:Nystagmus, Pathologic / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D017063:Outcome Assessment, Health Care / Q000379:methods*; D026741:Physical Therapy Modalities; D011187:Posture; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014717:Vertigo / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D014724:Vestibular Function Tests / Q000379:methods*