Modified Epley maneuver bests traditional approach for treating PC-benign paroxysmal positional vertigo

A modified Epley maneuver for posterior semicircular canal BPPV treatment, involving extended time in the healthy side-lying position and final bowing, achieved an impressive 85% success rate after the first attempt, compared to the traditional Epley maneuvre's success rate of 63%," the researchers reported in Frontiers in Neurology.

" After two attempts, the experimental group reached 100% repositioning success, while the control group required three attempts for an 86% success rate."

Benign paroxysmal positional vertigo is a prevalent cause of vertigo, accounting for 17–42% of reported cases. Manifesting as brief episodes of nystagmus and vertigo, BPPV is triggered by alterations in head position relative to gravity, such as turning over, lying down, or standing up. BPPV is further divided based on the involved semicircular canal, with posterior canal BPPV (PC-BPPV) being the most prevalent, accounting for 80% of cases.

Xiaosu Chen, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People’s Hospital, Wenzhou, China, and colleagues compared the repositioning effect of the modified Epley maneuver and the traditional Epley maneuver for posterior semicircular canal benign paroxysmal positional vertigo.

The study included sixty-five patients with unilateral PC-BPPV. They were randomly divided into two groups: the experimental group received the modified Epley maneuver, which prolonged the time in the healthy side-lying position and the final bowing position and the control group received the traditional Epley maneuver.

The researchers recorded and compared the number of successful repositions after one, two, and three attempts and the total number of successful repositions between the two groups. A BPPV virtual simulation model was used to analyze the mechanism of the modified Epley maneuver.

The study revealed the following findings:

• The first repositioning success rate of the experimental group was significantly higher than that of the control group (85% versus 63%).
• The experimental group achieved a 100% repositioning success rate after two attempts, while the control group needed three attempts to reach an 86% repositioning success rate.
• Four cases in the control group experienced canal switching during the repositioning process, while none in the experimental group did.
• The BPPV virtual simulation model showed that the modified Epley maneuver could facilitate the passage of otoliths through the posterior arm of the posterior semicircular canal, especially through the location of the obstruction.

"Our study contributes a novel treatment approach for posterior canal BPPV patients, particularly those with refractory cases, offering a promising therapeutic option," the researchers concluded.

Reference:

Chen, X., Mao, J., Ye, H., Fan, L., Tong, Q., Zhang, H., Wu, C., & Yang, X. (2023). The effectiveness of the modified Epley maneuver for the treatment of posterior semicircular canal benign paroxysmal positional vertigo. Frontiers in Neurology, 14, 1328896. https://doi.org/10.3389/fneur.2023.1328896