BALANCE AND GAIT PERFORMANCE AFTER PARTICLE REPOSITIONING MANEUVER IN BENIGN PAROXYSMAL POSITIONAL VERTIGO PATIENTS WITH MIGRAINE AND MOTION SICKNESS

Abstract

Purpose: To examine subjective complaints, recurrence, balance, gait before and after Particle Repositioning Maneuver (PRM), and to investigate the comorbid factors as migraine and motion sickness in Benign Paroxysmal Positional Vertigo (BPPV) patients. 

Methods:  Fifty-seven patients were treated with PRM for posterior canal BPPV. The perception of vertigo was estimated with Visual Analogue Scale (VAS), gait with Dynamic Gait Index (DGI), balance with the modified Clinical Test of Sensory Integration and Balance (mCTSIB). If Dix-Hallpike test was still positive 1 week after PRM, the maneuver was repeated. When remission was confirmed, patients were recalled after 1 month to repeat all tests. If the patient suffered only from residual dizziness after 1 week, Brandt-Daroff exercises were recommended during 1 month. 

Results: VAS scores of all patients were improved significantly 1 month after PRM (p<0.001). The abnormal balance on foam stance before PRM were improved (p<0.05). DGI scores improved but there was no statistical difference (p>0.05). It was found that migraineurs had more severe imbalance and motion sickness complaints.   

Conclusion: Subjective complaints, balance and gait abilities improved in all patients. The recurrence rate, residual dizziness and motion sickness complaints were higher in migraineurs. The migraineurs had worse balance performance than non-migraineurs before as well as after PRM. Brandt-Daroff exercise didn’t prevent recurrence and residual dizziness.   

Keywords

• Benign paroxysmal positional vertigo,balance,gait,recovery,recurrence

BALANCE AND GAIT PERFORMANCE AFTER PARTICLE REPOSITIONING MANEUVER IN BENIGN PAROXYSMAL POSITIONAL VERTIGO PATIENTS

Abstract

Purpose: The purpose of this study was to examine subjective complaints, recurrence of benign paroxysmal positional vertigo (BPPV), balance and gait with a particle repositioning maneuver (PRM), and to investigate the effects of Brandt Daroff (BD) exercises and comorbid factors as migraine on recovery in BPPV patients.

Methods: Fifty-seven patients were treated with a PRM for posterior canal BPPV. The perception of vertigo was estimated with Visual Analogue Scale (VAS), gait with Dynamic Gait Index (DGI), balance with the modified Clinical Test of Sensory Integration and Balance (mCTSIB). If the Dix-Hallpike test was still positive one week after the PRM, the maneuver was repeated. When remission was confirmed, patients were called back after one month to repeat all tests. If the patient suffered only from residual dizziness after one week, BD exercises were recommended for one month.

Results: The VAS scores for all patients improved significantly one month after a PRM (p<0.001). The abnormal balance on foam stance before a PRM improved significantly (p<0.05). The DGI scores improved without a statistical difference (p>0.05). It was found that patients with migraine had complaints of more severe imbalance.

Conclusion: Subjective complaints, balance and gait abilities improved in all patients after PRM. BPPV patients with migraine have a greater risk of recurrence and lower improvement in balance and gait ability after PRM. BD exercises did not prevent recurrence and residual dizziness.

Keywords

• Benign Paroxysmal Positional Vertigo; Particle Repositioning Maneuver; Balance; Gait; Recurrence

References

1. Referans 1. Dix MR., Hallpike C. The Pathology, Symptomatology and Diagnosis of Certain Common Disorders of the Vestibular System. Proc R Soc Med. 1952; 44: 341-354.
2. Referans 2. Fife TD, Iverson DJ, Lempert T. Furman JM, Baloh RW, Tusa RJ et al. Practice Parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2008; 70: 2067-2074.
3. Referans3. Blatt PJ, Georgakakis GA, Herdman SJ, Clendaniel RA, Tusa RJ. The effects of the canalith repositioning maneuver on resolving postural instability in patients with benign paroxysmal positional vertigo. Am J Otol. 2000; 21: 356–63
4. Referans 4. Celebisoy N, Bayam E, Güleç F, Kose T, Akyürekli O. Balance in posterior and horizontal canal type benign paroxysmal positional vertigo before and after canalith repositioning maneuvers. Gait Posture 2009; 29(3): 520-523.
5. Referans 5. Ishiyama A, Jacobson KM, Baloh RW. Migraine and benign positional vertigo. Ann Otol Rhinol Laryngol. 2000; 109: 377–80.
6. Referans 6. Chu CH, Liu CJ, Lin LY, Chen TJ, Wang SJ. Migraine is associated with an increased risk for benign paroxysmal positional vertigo: a nationwide population-based study. J Headache Pain. 2015;16:62.
7. Referans 7. Kuritzky A, Toglia W, Thomas D. Vestibular function in migraine. Headache 1981;21:110-112
8. Referans 8. Drummond PD. Motion sickness and migraine: optokinetic stimulation increases scalp tenderness, pain sensitivity in the fingers and photophobia. Cephalalgia 2002;22(2):117-24.

9. Referans 9. Marcus DA, Furman JM, Balaban CD. Motion sickness in migraine sufferers. Expert Opin Pharmacother. 2005; 6 (15): 2691-7.
10. Referans 10. Lempert T, von Brevern M. “Migrainous vertigo” In Handbook Of Clinical Neurophysiology. Vol 9. Vertigo and Imbalance: Clinical Neurophysiology of the Vestibular System. S.D.Z. Eggers & D.S. Zee, Eds.2010: 440–450. Elsevier. Amsterdam, The Netherlands.
11. Referans 11. Grunfeld E, Gresty MA. Relationship between motion sickness, migraine and menstruation in crew members of a ‘round the world’ yacht race. Brain Res Bulletin 1999: 47: 433-436
12. Referans 12. Takeda N, Morita M, Horii A, Nishiike S, Kitahara T, Uno A. Neural mechanisms of motion sickness. J Med Invest 2001;48:44-59.
13. Referans 13. Lipton RB, Dodick D, Sadovsky R, Kolodner K, Endicott J, Hettiarachchi J et al. A self-administered screener for migraine in primary care: The ID Migraine validation study. Neurology 2003; 61(3): 375-82.
14. Referans 14. Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S et al. American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2008; 139: 47-81.
15. Referans 15. Kammerlind AS, Hakansson JK, Skogsberg MC. Effects of balance training in elderly people with non-peripheral vertigo and unsteadiness. Clin Rehabil 2001; 15: 463–70.
16. Referans 16. Shumway-Cook A, Woollacott M. Assessment and treatment of the patient with mobility disorders. In: A. Shumway-Cook, M. Woollacott (Eds.), Motor Control: Theory and practical Applications. Baltimore, MD: Lippincott Williams & Wilkins, 1995, p.315-54.
17. Referans 17. Chang WC, Yang YR, Hsu LC, Chern CM, Wang RY. Balance improvement in patients with benign paroxysmal positional vertigo. Clin Rehabil 2008; 22: 338–347
18. Referans 18. Horak FB. Clinical measurements of postural control in adults. Phys Ther. 1987; 67: 1881-1885.
19. Referans 19. Jackson R.T, Epstein CM. Effect of head extension on equilibrium in normal subjects. Ann Otol Rhinol Laryngol. 1991; 100: 63-67.
20. Referans 20. Golding J.F. Motion sickness susceptibility questionnaire revised and its relationship to other forms of sickness. Brain Res Bull. 1998; 47: 507–516
21. Referans 21. Paillard AC, Quarck G, Paolino F, Denise P, Paolino M, Golding JF et al. Motion sickness susceptibility in healthy subjects and vestibular patients: Effects of gender, age and trait-anxiety. J Vestib Res. 23 (2013) 203–210
22. Referans 22. Radtke A, von Brevern M, Tiel-Wilck K, Mainz-Perchalla A, Neuhauser H, Lempert T. Self-treatment of benign paroxysmal positional vertigo: semont maneuver vs Epley procedure. Neurology 2004;63:150-2
23. Referans 23. Tanimoto H, Doi K, Katata K, Nibu KI. Self-treatment for benign paroxysmal positional vertigo of the posterior semicircular canal. Neurology 2005;65:1299-300
24. Referans 24. Helminski JO, Janssen I, Kotaspouikis D, Kovacs K, Sheldon P, McQueen K et al. Strategies to prevent recurrence of benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 2005; 131(4):344–8
25. Referans 25. Helminski JO, Janssen I, Hain TC. Daily Exercise Does Not Prevent Recurrence of Benign Paroxysmal Positional Vertigo. Otol Neurotol 2008; 29(7): 976-981
26. Referans 26. Teggi R, Giordano L, Bondi S. Fabiano B, Bussi M. Residual dizziness after successful repositioning maneuvers for idiopathic benign paroxysmal positional vertigo in the elderly. Eur Arch Otorhinolaryngol. 2011; 268: 507–511
27. Referans 27. Amor-Dorado JC, Barreira-Fernández MP, Aran-Gonzalez I, Casariego-Vales E, Gonzalez-Gay MA. Particle repositioning maneuver versus Brandt-Daroff exercise for treatment of unilateral idiopathic BPPV of the posterior semicircular canal: a randomized prospective clinical trial with short and long-term outcome. Otol Neurotol 2012; 33: 1401-7.
28. Referans 28. Faralli M, Ricci G, Ibba MC, Crognoletti M, Longari F, Frenguelli A. Dizziness in patients with recent episodes of benign paroxysmal positional vertigo: real otolithic dysfunction or mental stress? J Otolaryngol Head Neck Surg. 2009; 38: 375–380.
29. Referans 29. von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007; 78: 710–715.
30. Referans 30. Akdal G, Dönmez B, Öztürk V, Angın S. Is Balance Normal in Migraineurs Without History of Vertigo? Headache. 2009; 49: 419-425.
31. Referans 31. Akdal G, Dönmez B, Angın S, Öztürk V, Halmaghyi GM. A longitudinal study of balance in migraineurs. Acta Oto-Laryngol. 2012; 132 (1): 27-32.
32. Referans 32. Akdal G, Ozge A, Ergör G. The prevalence of vestibular symptoms in migraine or tension-type headache. J Vestib Res. 2013; 23(2): 101-6.
33. Referans 33. Steenerson RL, Cronin GW. Comparison of the Canalith Repositioning Procedure and Vestibular Habituation Training in Forty Patients with Benign Paroxysmal Positional Vertigo. Otolaryngol Head Neck Surg. 1996; 114: 61-4.