Combination of head-up sleep and vertical recognition training may cure intractable motion-evoked dizziness with unknown origin

Abstract

Background: It has been reported that head-up sleep (HUS) prevents free-floating otoliths from entering canals and that vertical recognition training (VRT) promotes vestibular compensation.

Aims/objectives: We would like to assess HUS and VRT for intractable motion-evoked dizziness, including possible benign paroxysmal positional vertigo (BPPV).

Materials and methods: 162 patients diagnosed with intractable motion-evoked dizziness of unknown origin were enrolled and randomly divided into the following four groups: HUS−/VRT−, HUS+/VRT−, HUS−/VRT+, and HUS+/VRT+. The at-home interventions comprised HUS with an upper head position of 45° when lying down and VRT with a right down-left down 30° head inclination while watching the vertical index.

Results: At the post-treatment 6th month, visual analogue scale (VAS) scores for vertiginous sensation were significantly lower in the HUS+/VRT + group than in the HUS+/VRT − and HUS−/VRT + groups, which were in turn significantly lower than those in the HUS−/VRT − group. VAS scores in the HUS−/VRT + group of patients with abnormal subjective visual vertical (SVV) were significantly lower than those in the HUS+/VRT − group, while those in the HUS+/VRT − group of patients with normal SVV were significantly lower than those in the HUS−/VRT + group.

Conclusions: HUS and/or VRT is a good initial treatment for patients with intractable undiagnosed motion-evoked dizziness, including possible BPPV.

Chinese abstract

背景：据报道, 头高位睡眠（HUS）可防止游离耳石进入耳道, 垂直识别训练（VRT）可促进前庭代偿。

目的：我们希望能评估HUS和VRT对难治性运动性眩晕（包括可能的良性阵发性位置性眩晕（BPPV））的疗效。

材料与方法：将162例不明原因顽固性运动性眩晕患者随机分为4组：HUS-/VRT-、HUS+/VRT-、HUS-/VRT+、HUS-/VRT+和HUS+/VRT+。居家干预包括躺下时头上部位置为45°的HUS和观察垂直指数时右下左下30°的VRT。

结果：治疗6个月后, HUS+/VRT+组眩晕感觉视觉模拟量表（VAS）评分显著低于HUS+/VRT-组和HUS-/VRT+组, 后者又显著低于HUS-/VRT-组。HUS-/VRT+组主观垂直视觉异常（SVV）患者的VAS评分显著低于HUS-/VRT+组, 而HUS-/VRT+组SVV正常患者的VAS评分显著低于HUS-/VRT+组。

结论：HUS和/或VRT是治疗难治性未确诊运动诱发性眩晕（包括可能的BPPV）的良好初始治疗方法.

Keywords:

• Unknown origin
• undiagnosed
• possible BPPV
• no obvious nystagmus
• subjective visual vertical
• head-up sleep
• vertical recognition training

Acknowledgements

The authors wish to thank Dr. Masashi Choubi, a registered statistician (certificate number: 622017) for helpful advice on statistical analyses and Dr. Adam Phillips from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

Author contributions

Tadashi Kitahara and Akira Horinaka: study design, data interpretation, and writing. Tomoyuki Shiozaki and Taeko Ito: data collection and analysis. Yoshiro Wada, Toshiaki Yamanaka, and Kazuhiko Nario: data interpretation.

Table 1. Patients demographics and test results for Groups I–IV.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported in part by JSPS KAKENHI Grant [2017–2019], AMED under Grant Number 18dk0310092h000a and Health and Labour Sciences Research Grant for Research on Rare and Intractable Diseases [H29-Nanchito (Nan)-Ippan-031] from the Ministry of Health, Labour and Welfare of Japan.