Introduction. Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. Among the possible pathophysiological concepts, the largest evidence to date has been collected on the relationship of BPPV with a lack of vitamin D. Few studies have also been published on the assessment of factors of endothelial dysfunction (and, as a result, disturbances in the microcirculation of the inner ear) and BPPV. The problems of metabolic disorders in BPPV were still poorly highlighted in Russian sources.Objective. To investigate the levels of 25-OH-vitamin D and homocysteine among patients with BPPV and compare these factors depending on recurrence.Materials and methods. The study included 53 patients with BPPV, age 60 ± 12.6 (Me 62 [55; 68]), men accounted for 24.5%, women – 75.5%. All patients underwent a study of the neurological status and neurovestibularexamination, which included the Halmagi test, the head shake test, the Fukuda test, the Dix – Hallpike and McClure – Pagnini tests. Plasma 25-OH-vitamin D and homocysteine levels were assessed using enzyme-linked immunosorbent assay. The severity of vertigo was assessed using the dizziness handicap inventory (DHI).Results. The level of 25-OH vitamin D in with BPPV varied from 5.2 to 40 ng/ml, the average value was 19.53 ± 9.07 ng/ml, which corresponds to the deficit according to international recommendations (Me 17 [13; 24.8]). The level of 25-OH vitamin D in the group with recurrent BPPV was (Me 15 [12 and 22]), which was significantly lower than in the group with a single BPPV episode. The DHI score was significantly lower in the group with recurrent BPPV. There was a negative relationship between 25-OH-vitamin D levels and age, and a negative relationship between 25-OH-vitamin D and homocysteine in the DPPV group.Conclusion. There was a decrease in the level of 25-OH-vitamin D among patients with BPPV; in the group with recurrent BPPV, the level of 25-OH-vitamin D was significantly lower than in the group with a single dose of BPPV. The presence of an inverse correlation between the level of homocysteine and 25-OH-vitamin D indicates the advisability of more detailed studies of the potential contribution of endothelial dysfunction to the development of peripheral vestibular disorders due to impaired microcirculation of the otoconial apparatus.
Dizziness and instability are topical problem in the neurological practice. This health condition invades up to thirty percent of the whole population. However, pathogenic factors of development and tendency to chronic process of these nosological conditions are still poorly researched. The investigation of new pathogenic factors, including metabolic factors, is proceeding. The greatest amount of research was collected for benign paroxysmal positional vertigo (BPPV). The hypothesis of coincidence between BPPV, vitamin D deficiency and osteoporosis was created in 2003. However, the results are controversial. The complex of perfomed investigations let suspect vitamin D deficiency as biomarker of osteoporosis/osteopenia. But some other research works failed to support this conclusion. In some investigations the vitamin D deficiency as factor of recurrence of BPPV was discussed. The new hypothesis was correlation between otoneurological disorders and vitamin D deficiemcy due to its immunomodulation ability was proposed. Considerable part of the article deals with problem of endothelial dysfunction. The data about correlation between oxidative stress and BPPV was published, as far as the data about impact of hypehomocysteinemia to retardation of compensation for vestibular neuritis.
Objective: to assess vitamin D deficiency and hyperhomocysteinemia along with psychoemotional status in patients with vestibular migraine.Material and methods. The neurovestibular examination of 23 patients was performed. All patients were diagnosed with vestibular migraine in accordance with the international criteria. The levels of 25-hydroxyvitamin D and homocysteine were assessed by enzyme-linked immunosorbent assay (ELISA). The effect of dizziness on everyday life was assessed according to the Dizziness Handicap Inventory (DHI). Psychoemotional status was investigated for all patients by using the following scales: Beck depression scale, Spilber–Hanin Scale, Toronto Alexithymia Scale (TAS-26).Results. The mean level of 25-hydroxyvitamin D was 23±15 ng/ml, homocysteine – 11±3.4 μmol/L. The mean levels of situational and personal anxiety were 48.8±9 and 50.4±10.8, respectively. A correlation analysis revealed a significant positive correlation for Beck's depression parameters and DHI score (Spearman's criterion value 0.64, p=0.0016).Conclusion. The data obtained evidence about a rather frequent detection of 25-hydroxyvitamin D insufficiency and deficit among patients with vestibular migraine that requires further evaluation, including expanding patients sample and/or comparison with other groups of patients. Of significance was to find an elevated level of anxiety and a correlation between the severity of dizziness (according to DHI score) and the level of depression (based on the Beck Scale).
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The dizziness is a multidiscipline problem in management of neurologists, ototrhinolaryngologists, general practicioners. The first clinical goal seems to be the differentiation between central and peripherial vestibular syndrome. After that doctor should search the nosological form. It may become the challenge if the disease is rare. In such cases it is impossible to limit the therapy with vestibular rehabilitation with usement of the vertigolitic drugs. Accordingly to nososlogical form surgical methods, anticonvulsants, glucocorticoids or cytostatics may be needful.
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