VPPB - Tratamento com manobras ou medicamentoso?

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VPPB - Tratamento com manobras ou medicamentoso?

Mensagem  Armanda Resende em Ter Dez 17, 2013 12:45 pm

  • A prior history of migraine suggests that this may be the etiology of vertigo.

A family history of vertigo may suggest a rare hereditary channelopath

The efficacy of the Epley maneuver has been demonstrated in studies comparing it with a sham maneuver [45-47]. In one report, analysis one month after treatment found that patients who had the particle repositioning maneuver had significantly more negative responses on the Dix-Hallpike maneuver than the placebo group (89 versus 27 percent) [45]. In a second report, significantly more patients reported resolution of symptoms at 10 days after the particle repositioning compared with sham maneuver (50 versus 19 percent) [46]. In the short term, repositioning maneuvers may be even more efficacious [47,48]; 24 hours after treatment, patients receiving the Epley maneuver were more likely to be free of vertigo and nystagmus compared with patients in the sham group (80 versus 10 percent) [47]. The success of the procedure can be predicted by inspection of nystagmus during the second position of the Epley's procedure; reversed nystagmus direction or no nystagmus observed at this point suggests that the procedure will not be efficacious.

Systematic reviews have concluded that particle repositioning maneuvers are safe and effective for the treatment of posterior canal BPPV. Treated subjects are 37 times more likely to recover than subjects undergoing sham treatments [50-54]. The Semont and Epley maneuvers appear to be equally effective , although the Semont is less well studied. The maneuver can be repeated in patients who do not respond to or relapse after the first attempt.
Medications — Drugs are not useful for the brief episodes of vertigo associated with BPPV, except when the frequency of spells is very high . However, vestibular suppressants can be used as premedication with liberatory maneuvers, and may help patients who would not otherwise tolerate these maneuvers because of discomfort and nausea. In a randomized trialpatients given betahistine(24 mg twice daily for one week) along with the Epley maneuver had reduced dizziness symptoms compared to those treated with the maneuver alone.

Armanda Resende

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Data de inscrição : 06/12/2013

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