Manobra de Epley repetida em uma mesma sessão na vertigem posicional paroxística benigna

Abstract

Aim: To assess whether more than one Epley's maneuver in the same session, compared to a single one, decreases the number of sessions necessary to suppress positional nystagmus. Method: Epley's maneuver was done in 123 patients with BPPV due to unilateral posterior semicircular canal canalolithiasis. The number of sessions for positional nystagmus suppression was compared in two groups of patients. Group I consisted of 75 patients submitted to a single Epley's maneuver on weekly sessions and group II consisted of 48 patients that were submitted to four Epley's maneuvers during the first session. Results: Group II showed greater nystagmus latency and duration than group I (p<0.05). The number of sessions and standard deviation showed by group I was greater than in group II (p=0.008). We observed a significant association between number of sessions and group (p=0.039) studied. Group II had 21.4% more nystagmus-free patients following only one session (CI95% [7.7% -35.1%]). Conclusion: Repeated Epley's maneuvers in less sessions rendered more positional nystagmus-free patients when compared to those submitted to more sessions of single maneuvers.

Benign Paroxysmal Positional Vertigo: comparison of two recent international guidelines

“…Korn et al 25 and Dorigueto et al 26 studied the number of maneuvers which must be used to treat BPPV and concluded that repeated maneuvers in the same session seem to be more efficient, and even more necessary when one is dealing with cupulolithiasis. It was only in one of the studies 19 hereby analyzed, that it was not possible to identify a specific number or a protocol for such, and the CR repetition must be determined by symptom severity, if persistent, by the professional's evaluation and its successful treatment with the maneuver.…”

“…Based on two class i studies, three class ii, four metanalysis and one systematic review, Fife et al 18 classified the maneuver as "Level A recommendation", in other words, treatment is effective and safe, and it should be offered to the patients of all ages with posterior canal BppV. korn et al 25 and dorigueto et al 26 studied the number of maneuvers which must be used to treat BppV and concluded that repeated maneuvers in the same session seem to be more efficient, and even more necessary when one is dealing with cupulolithiasis. it was only in one of the studies 19 hereby analyzed, that it was not possible to identify a specific number or a protocol for such, and the Cr repetition must be determined by symptom severity, if persistent, by the professional's evaluation and its successful treatment with the maneuver.…”