Vestibular rehabilitation in benign paroxysmal positional vertigo: Reality or fiction?

Abstract

The objective of this article is to systematically review the evidence on the effectiveness of vestibular rehabilitation (VR) in patients with benign paroxysmal positional vertigo (BPPV). Relevant published studies about VR in BPPV were searched in PubMed, Google Scholar and Ovid using various keywords. We included trials that were available in the English language and did not apply publication year or publication status restrictions. Studies based on the VR in other peripheral and/or central balance disorders are excluded. Primary outcome was the effect on vertigo attacks and balance. Of 42 identified trials, only 12 trials fulfilled our inclusion criteria and were included in this review. Three of them investigated the role of VR in patients with BPPV comparing with no treatment, two of them evaluated the efficacy of VR versus medications, seven of them have highlighted the benefits of the VR alone or in combination with canalith repositioning procedure (CRP) compared to CRP alone. The studies differed in type of intervention, type of outcome and follow-up time. VR improves balance control, promoting visual stabilization with head movements, improving vestibular–visual interaction during head movement and expanding static and dynamic posture stability. CRP and VR seem to have a synergic effect in patients with BPPV, especially in elderly patients. VR does not reduce the recurrence rate, but it seems to reduce the unpleasantness. So VR can substitute CRP when spine comorbidities contraindicate CRP and can reduce the uptake of anti-vertigo drugs post CRP. Further studies are needed to confirm these encouraging results.

Indicaciones de la rehabilitación vestibular

“…Aunque en la actualidad se acepta que el tratamiento gold standard del VPPB son las maniobras de reposición canalicular, algunos pacientes manifiestan en las semanas posteriores a su recuperación con este tratamiento, síntomas de mareo e inestabilidad persistente sin nistagmo ni sensación vertiginosa en posiciones estáticas o dinámicas posiblemente en relación con la alteración de la información propioceptiva y visual [28,29]. La aparición de este cuadro se ha relacionado con factores tales como la edad, el tiempo de evolución del cuadro de VPPB [30,31] o con un componente de ansiedad.…”

“…Aunque la inestabilidad en la edad avanzada puede ser atribuida a múltiples causas, se estima que cerca de la mitad de los casos presenta una alteración vestibular [28]. En la búsqueda de factores que determinen cuáles de estos pacientes son subsidiarios de rehabilitación vestibular, Rossi y cols (2009) [32] encuentran un factor pronóstico de buena respuesta en aquellos pacientes con los límites de estabilidad alterados y peor en aquellos con la prueba Up and go alargado.…”

The Efficacy of the Half Somersault Maneuver in Comparison to the Epley Maneuver in Patients with Benign Paroxysmal Positional Vertigo

“…The best practice in treating BPPV is the Canalith Repositioning Procedure (CRP), and depending on the affected canals, different maneuvers have been described. 5 Almost 85% to 95% of cases of BPPV arise in the posterior semicircular canal (PC-BPPV). 6 To treat PC-BPPV, the Epley and Semont maneuvers are commonly used, with nearly similar success rates.…”

Effects of vestibular rehabilitation, with or without betahistine, on managing residual dizziness after successful repositioning manoeuvres in patients with benign paroxysmal positional vertigo: a protocol for a randomised controlled trial

“…This review supports the contention that the primary intervention for BPPV should be CRP that directly treat the condition, but movement/habituation-based VR will further aid and benefit long-term functional recovery. A more recent review by Bressi et al 31 proposed that a hierarchy of interventions should be offered to patients with BPPV, starting with CRP and followed by post-treatment exercises. The findings also indicated that CRP and VR seem to have a synergic effect in patients with BPPV 31…”

“…A more recent review by Bressi et al 31 proposed that a hierarchy of interventions should be offered to patients with BPPV, starting with CRP and followed by post-treatment exercises. The findings also indicated that CRP and VR seem to have a synergic effect in patients with BPPV 31…”