New guideline for the treatment of vertigo

A new guideline developed by the American Academy of Neurology found that the best treatment for vertigo is the easiest and quickest one. The guideline on benign paroxysmal positional vertigo (BPPV), an inner ear disorder that is a common cause of dizziness, is published in the May 27, 2008, issue of Neurology, the medical journal of the American Academy of Neurology.

The disorder causes a feeling of spinning or whirling when the head is moved in certain ways, such as looking up or bending. The feeling lasts a short time but can be severe.

The guideline determined that in many cases the vertigo can be treated with simple maneuvers-a series of head and body movements performed by a doctor or therapist while the patient sits on a bed or table.

"The good news is that this type of vertigo is easily treated," said guideline author Terry D. Fife, MD, of the University of Arizona College of Medicine and Barrow Neurological Institute. Fife is also a Fellow of the American Academy of Neurology. "Instead of telling patients to 'wait it out' or having them take drugs, we can perform a safe and quick treatment that is immediate and effective."

Several maneuvers are in use for vertigo. The guideline found that canalith repositioning procedure, also called the Epley maneuver, is safe and effective for people of all ages. The Semont maneuver is possibly an effective treatment. To develop the guideline, the authors analyzed all available scientific studies on the topic.

The disorder is believed to be caused by loose calcium carbonate crystals that move in the sensing tubes of the inner ear. The maneuvers move the calcium crystals out of the sensing tube and into another inner chamber of the ear, from which they can be absorbed.

The guideline also evaluated whether restrictions on activity are needed after the maneuvers are performed. "There is no clear evidence to support these restrictions, which include sleeping upright and wearing a cervical collar," Fife said.

The guideline also reviewed whether patients can perform the maneuvers safely and effectively at home. "Having patients treat themselves using home exercises seems to pose little risk, but there is not sufficient evidence that this is as effective as maneuvers done by a doctor or therapist," Fife said.

The American Academy of Neurology, an association of more than 21,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as epilepsy, dystonia, migraine, Huntington's disease, and dementia.

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