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Predicting a successful treatment in posterior canal benign paroxysmal positional vertigo

From the MTV (Migraine, Tinnitus, and Vertigo) Clinic (H.J.O., B.I.H.), Oh Neurology Center, Daegu, and Department of Neurology (J.S.K), College of Medicine, Seoul National University, and Department of Neurology (J.G.L.), Keimyung University School of Medicine, Daegu, Korea.

Address correspondence and reprint requests to Dr Han, MTV (Migraine, Tinnitus, and Vertigo) Clinic, Oh Neurology Center, 200-13, Icheon-dong, Nam-gu, Daegu 705 - 836, South Korea; e-mail: byung_in{at}hotmail.com

Objective: To elucidate the characteristics and prognostic value of positioning nystagmus during the second position of the Epley maneuver (90° contralateral head turn from the initial Hallpike maneuver).

Method: The Epley maneuver was performed in 126 patients with confirmed posterior canal benign paroxysmal positional vertigo (PC-BPPV). The characteristics of positioning nystagmus were investigated using video Frenzel goggles.

Results: During the second position, 99 patients developed torsional upbeating nystagmus, which was in the same direction (orthotropic nystagmus) as during the first position (Hallpike maneuver), whereas 15 patients showed a reversed pattern. In 12 patents, nystagmus was not induced during the second position. All 99 patients with orthotropic nystagmus had resolution of BPPV after the first or second trial of the Epley maneuver. In contrast, 12 of the 15 patients with reversed nystagmus and 8 of the 12 patients without nystagmus failed to resolve.

Conclusion: During the second position of the Epley maneuver, an orthotropic pattern of nystagmus predicts a successful repositioning, whereas reversed nystagmus or no nystagmus is suggestive of poor response to repositioning.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the April 10 issue to find the title link for this article.

*Hui Jong Oh and Ji Soo Kim contributed equally to this study.

Disclosure: The authors report no conflicts of interest.

Received September 26, 2006. Accepted in final form December 10, 2006.