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Kwon C, Ku Y, Seo S, Jang E, Kong HJ, Suh MW, Kim HC. Quantitative assessment of self-treated canalith repositioning procedures using inertial measurement unit sensors. J Vestib Res 2021; 31:423-431. [PMID: 33646186 DOI: 10.3233/ves-190747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Low success and high recurrence of benign paroxysmal positional vertigo (BPPV) after home-based self-treated Epley and Barbeque (BBQ) roll maneuvers is an important issue. OBJECTIVE To quantify the cause of low success rate of self-treated Epley and BBQ roll maneuvers and provide a clinically acceptable criterion to guide self-treatment head rotations. METHODS Twenty-five participants without active BPPV wore a custom head-mount rotation monitoring device for objective measurements. Self-treatment and specialist-assisted maneuvers were compared for head rotation accuracy. Absolute differences between the head rotation evaluation criteria (American Academy of Otolaryngology guidelines) and measured rotation angles were considered as errors. Self-treatment and specialist-treated errors in maneuvers were compared. Between-trial variations and age effects were evaluated. RESULTS A significantly large error and between-trial variation occurred in step 4 of the self-treated Epley maneuver, with a considerable error in the second trial. The cumulative error of all steps of self-treated BBQ roll maneuver was significantly large. Age effect occurred only in the self-treated BBQ roll maneuver. Errors in specialist-treated maneuvers ranged from 10 to 20 degrees. CONCLUSIONS Real-time feedback of head movements during simultaneous head-body rotations could increase success rates of self-treatments. Specialist-treated maneuvers can be used as permissible rotation margin criteria.
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Affiliation(s)
- Chiheon Kwon
- Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University, Seoul, Korea
| | - Yunseo Ku
- Department of Biomedical Engineering, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Shinhye Seo
- Department of Biomedical Engineering, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Eunsook Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyoun-Joong Kong
- Department of Biomedical Engineering, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Myung-Whan Suh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hee Chan Kim
- Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University, Seoul, Korea.,Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, Korea.,Department of Biomedical Engineering, College of Medicine, Seoul National University, Seoul, Korea
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Kim HJ, Song JM, Zhong L, Yang X, Kim JS. Questionnaire-based diagnosis of benign paroxysmal positional vertigo. Neurology 2019; 94:e942-e949. [PMID: 31888973 DOI: 10.1212/wnl.0000000000008876] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/29/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To develop a simple questionnaire for self-diagnosis of benign paroxysmal positional vertigo (BPPV). METHODS We developed a questionnaire that consisted of 6 questions, the first 3 to diagnose BPPV and the next 3 to determine the involved canal and type of BPPV. From 2016 to 2017, 578 patients with dizziness completed the questionnaire before the positional tests, a gold standard for diagnosis of BPPV, at the Dizziness Clinic of Seoul National University Bundang Hospital. RESULTS Of the 578 patients, 200 were screened to have BPPV and 378 were screened to have dizziness/vertigo due to disorders other than BPPV. Of the 200 patients with a questionnaire-based diagnosis of BPPV, 160 (80%) were confirmed to have BPPV with positional tests. Of the 378 patients with a questionnaire-based diagnosis of non-BPPV, 24 (6.3%) were found to have BPPV with positional tests. Thus, the sensitivity, specificity, and precision of the questionnaires for the diagnosis of BPPV were 87.0%, 89.8%, and 80.0% (121 of 161, 95% confidence interval 74.5%-85.5%). Of the 200 patients with a questionnaire-based diagnosis of BPPV, 30 failed to respond to the questions 4 through 6 to determine the involved canal and type of BPPV. The questionnaire and positional tests showed the same results for the subtype and affected side of BPPV in 121 patients (121 of 170, 71.2%). CONCLUSION The accuracy of questionnaire-based diagnosis of BPPV is acceptable. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that, in patients with dizziness, a questionnaire can diagnose BPPV with a sensitivity of 87.0% and a specificity of 89.8%.
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Affiliation(s)
- Hyo-Jung Kim
- From the Research Administration Team (H.-J.K.) and Department of Neurology (J.-M.S., J.-S.K.), Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurology (L.Z.), Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine; Department of Neurology (X.Y.), Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China; and Department of Neurology (J.-S.K.), College of Medicine, Seoul National University, Korea
| | - Jeong-Mi Song
- From the Research Administration Team (H.-J.K.) and Department of Neurology (J.-M.S., J.-S.K.), Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurology (L.Z.), Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine; Department of Neurology (X.Y.), Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China; and Department of Neurology (J.-S.K.), College of Medicine, Seoul National University, Korea
| | - Liqun Zhong
- From the Research Administration Team (H.-J.K.) and Department of Neurology (J.-M.S., J.-S.K.), Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurology (L.Z.), Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine; Department of Neurology (X.Y.), Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China; and Department of Neurology (J.-S.K.), College of Medicine, Seoul National University, Korea
| | - Xu Yang
- From the Research Administration Team (H.-J.K.) and Department of Neurology (J.-M.S., J.-S.K.), Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurology (L.Z.), Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine; Department of Neurology (X.Y.), Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China; and Department of Neurology (J.-S.K.), College of Medicine, Seoul National University, Korea
| | - Ji-Soo Kim
- From the Research Administration Team (H.-J.K.) and Department of Neurology (J.-M.S., J.-S.K.), Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurology (L.Z.), Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine; Department of Neurology (X.Y.), Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China; and Department of Neurology (J.-S.K.), College of Medicine, Seoul National University, Korea.
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Kim HJ, Kim JS. The Patterns of Recurrences in Idiopathic Benign Paroxysmal Positional Vertigo and Self-treatment Evaluation. Front Neurol 2017; 8:690. [PMID: 29326650 PMCID: PMC5736533 DOI: 10.3389/fneur.2017.00690] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/04/2017] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Benign paroxysmal positional vertigo (BPPV) recurs frequently. This study aims to determine that each patient with BPPV has a predilection for a specific canal and the type of recurred BPPV can be predicted from that observed during the previous attack. Methods The involved side (right, left, and bilateral) and affected canal (posterior, geotropic horizontal, apogeotropic horizontal, anterior, and mixed) were analyzed in 224 pairs of consecutive attacks of BPPV confirmed in 167 patients at the Dizziness Clinic of Seoul National Bundang Hospital from 2003 to 2017. We defined the recurrence when patients had the redevelopment of BPPV at least 1 week after resolution of the previous one. Results During the initial attack, the involved canals were posterior in 134 (59.8%), geotropic horizontal in 53 (23.7%), apogeotropic horizontal in 27 (12.1%), anterior in 5 (2.2%), and mixed in 5 (2.2%). The right ear was more commonly affected than the left ear [132 (58.9%) vs. 90 (40.2%)]. Two patients (0.9%) showed bilateral involvements. During the recurrences, the proportions of involved canals and affected side were similar irrespective of those during the former event. Only 24% of the patients showed the recurrence in the same canal on the same side. Conclusion The patterns of recurrences are usually discordant in patients with BPPV. Instruction for self-administration of a specific canalith repositioning procedure based on the previous type of BPPV may have a limited efficacy in this frequently recurrent disorder.
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Affiliation(s)
- Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji-Soo Kim
- Department of Neurology, College of Medicine, Seoul National University, Seoul National University Bundang Hospital, Seongnam, South Korea
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Kerber KA, Burke JF, Skolarus LE, Callaghan BC, Fife TD, Baloh RW, Fendrick AM. A prescription for the Epley maneuver: www.youtube.com? Neurology 2012; 79:376-80. [PMID: 22826542 DOI: 10.1212/wnl.0b013e3182604533] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Video-sharing Web sites are being used for information about common conditions including dizziness. The Epley maneuver (EM) is a simple and effective treatment for benign paroxysmal positional vertigo (BPPV) of the posterior canal. However, the maneuver is underused in routine care. In this study, we aimed to describe and analyze the available information about the EM on youtube.com. METHODS A YouTube search was performed on August 31, 2011, for videos that demonstrated the entire EM. Detailed data were abstracted from each video and corresponding Web site. Videos were rated on the accuracy of the maneuver by 2 authors, with differences resolved by adjudication. Comments posted by viewers were assessed for themes regarding video use. RESULTS Of the 3,319 videos identified, 33 demonstrated the EM. The total number of hits for all videos was 2,755,607. The video with the most hits (802,471) was produced by the American Academy of Neurology. Five of the videos accounted for 85% of all the hits. The maneuver demonstration was rated as accurate in 64% (21) of the videos. Themes derived from the 424 posted comments included patients self-treating with the maneuver after reviewing the videos, and providers using the videos as a prescribed treatment or for educational purposes. CONCLUSION Accurate video demonstration of the Epley maneuver is available and widely viewed on YouTube. Video-sharing media may be an important way to disseminate effective interventions such as the EM. The impact of video Web sites on outcomes and costs of care is not known and warrants future study.
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Affiliation(s)
- Kevin A Kerber
- Department of Neurology, University of Michigan Health System, Ann Arbor, Michigan, USA.
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Endogenous Opioids Regulate Expression of Experimental Autoimmune Encephalomyelitis: A New Paradigm for the Treatment of Multiple Sclerosis. Exp Biol Med (Maywood) 2009; 234:1383-92. [DOI: 10.3181/0906-rm-189] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Preclinical investigations utilizing murine experimental auto-immune encephalomyelitis (EAE), as well as clinical observations in patients with multiple sclerosis (MS), may suggest alteration of endogenous opioid systems in MS. In this study we used the opioid antagonist naltrexone (NTX) to invoke a continuous (High Dose NTX, HDN) or intermittent (Low Dose NTX, LDN) opioid receptor blockade in order to elucidate the role of native opioid peptides in EAE. A mouse model of myelin oligodendrocyte glycoprotein (MOG)-induced EAE was employed in conjunction with daily treatment of LDN (0.1 mg/kg, NTX), HDN (10 mg/kg NTX), or vehicle (saline). No differences in neurological status (incidence, severity, disease index), or neuropathological assessment (activated astrocytes, demyelination, neuronal injury), were noted between MOG-induced mice receiving HDN or vehicle. Over 33% of the MOG-treated animals receiving LDN did not exhibit behavioral signs of disease, and the severity and disease index of the LDN-treated mice were markedly reduced from cohorts injected with vehicle. Although all LDN animals demonstrated neuropathological signs of EAE, LDN-treated mice without behavioral signs of disease had markedly lower levels of activated astrocytes and demyelination than LDN- or vehicle-treated animals with disease. These results imply that endogenous opioids, evoked by treatment with LDN and acting in the rebound period from drug exposure, are inhibitory to the onset and progression of EAE, and suggest that clinical studies of LDN are merited in MS and possibly in other autoimmune disorders.
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Bagnato F, Riva M, Antonelli G. Neutralising antibodies to IFN-β in patients with multiple sclerosis. Expert Opin Biol Ther 2006; 6:773-85. [PMID: 16856799 DOI: 10.1517/14712598.6.8.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The development of neutralising antibodies (NABs), or neutralising activity in the absence of NABs, is a potential complication of therapy with interferon (IFN)-beta for patients with multiple sclerosis, limiting therapeutic efficacy. Discontinuation of IFN-beta therapy in patients found to have sustained titres of NABs > 1:100 over an interval of 3 - 6 months has been recently proposed as a Level A recommendation. The extent to which NABs are causative, rather than an epiphenomenon, in determining drug failure has been a matter of numerous investigations and is still controversial. Thus, further studies are warranted for determining the role that NABs may play in reducing the response to the drug. In particular, the effects of NABs in reducing the efficacy of IFN-beta therapy beyond clinical relapse rate and lesion load on conventional imaging are not as yet fully understood.
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Affiliation(s)
- Francesca Bagnato
- National Institute of Neurological Disorders and Stroke, Neuroimmunology Branch, NIH, 10 Center Drive, Building 10, Room 5B16, Bethesda, MD, 20892-1400 MSC, USA.
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