Benign paroksismal pozisyonel vertigo tanılı olgularda tedavi öncesi ve sonrası vestibüler uyarılmış potansiyellerin değerlendirilmesi
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Dosyalar
Tarih
2019
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Benign paroksismal pozisyonel vertigo (BPPV), dönmesinin en sık nedenidir. Hastalığın tanısında pozisyonel manevralar en değerli tanı araçlarıdır. Bu tezde hastalığın patogenezinin değerlendirilmesinde objektif bir test olan vestibüler evoked myojenik potansiyeller (VEMP) kayıtlamalarının tedavi öncesi ve sonrası yanıtlarının ortaya konması amaçlanmıştır. Gereç ve Yöntem : Çalışmamız Ege Üniversitesi Tıp Fakültesi Hastanesi (EÜTFH) Nöroloji kliniğinde nörosensöryel birimimizde yapıldı. Servikal VEMP testi incelemesi Synergy Elektromyografi (EMG) (Medelec; Viasys Healthcare UK Ltd 2009) kullanılarak yapıldı. Test sırasında her 2 kulaktan ayrı ayrı 110 desibel (dB) klik şeklinde ses uyaranı verildi. Bu uyarılar 100 milisaniye aralıklarla kayıtlanarak 250 kez averajlama yapıldı. Ölçümler için 3 elektrod (aktif, referans ve toprak) kullanıldı. Aktif elektrod ipsilateral sternokleidomastoid (SKM) kasının orta 1/3 noktasına, yapıştırıldı. Sağlam ve hasta grubun kayıtlamaları ile P13, N23 latansları ve düzeltilmiş amplitüd değerleri kaydedildi. İstatistiksel analizleri yapıldı. Bulgular: Tedavi edilmeden önce yapılan kayıtlamada P13 latansı 13.51 ± 1.99 milisaniye (msn) , N23 latans değeri ise 22.44 ± 2.22 ve düzeltilmiş amplitüd değeri 6.44 ± 3.49 olarak kaydedildi. Kontrol grubu ile kıyaslandığında P13 ve N23 latanslarında uzama görüldü. Tedavi sonrası P13 latansı 12.87 ± 1.65, N23 latans 121.97 ± 1.95 düzeltilmiş ampltiüd ise 5.75 ± 2.5 görüldü. Tedavi sonrası yanıtlarda ise sadece P13 latansında düzelme olduğu , N23 ve amplitüd de değerinde ise tedavi öncesi ve sonrası farklılık olmadığı görüldü. Sonuç: BPPV hasta grubunda VEMP testi noninvaziv, düşük maliyetli ve pratik bir test olup otolit organları ile efektör kaslar arasında beyin sapı boyunca seyreden vestibule-oküler ve vestibule-spinal yolların değerlendirilmesine imkan sağladığını düşünmekteyiz.
Aim: Benign paroxysmal positional vertigo (BPPV) is the most frequent cause of vertigo. Making the correct diagnosis as well as treatment depends mainly on the patient history and the positional nystagmus evoked during positional maneuvers. Objective neuro-otological tests need to be developed to understand the underlying exact pathogenetic mechanism. Vestibular evoked myogenic potentials (VEMPs) can make contributions to the understanding of the pathophysiological mechanisms underlying BPPV. They may also help to determine the therapeutic efficacy of the maneuvers. Methods: Our study was performed in our neurosensorial unit at the Neurology Clinic of Ege University Medical Faculty Hospital (EUTFH). Cervical VEMP test was performed using Synergy EMG (Medelec; Viasys Healthcare UK Ltd 2009). During the test, 110 decibels sound stimuli were given separately from each of the two ears. These response stimuli were recorded at intervals of 100 milliseconds and averaged 250 times. 3 electrodes (active, reference and ground) were used for the measurements. The active electrode was recorded to middle of the ipsilateral sternocleidomastoid muscle. P13, N23 latencies and corrected amplitude values of the healthy and patient groups were recorded. Statistical analyzes were performed. Results: Before the treatment, P13 latency was recorded as 13.51 ± 1.99 milliseconds (msn), the N23 latency values were 22.44 ± 2.22 and the corrected amplitude value was 6.44 ± 3.49. The P13 and N23 latencies were prolonged compared to the control group. After the treatment, P13 latency was 12.87 ± 1.65, N23 latency 121.97 ± 1.95 corrected amplitude was 5.75 ± 2.5. In the post-treatment responses, only P13 latency improved, and N23 and amplitude values did not different before and after treatment. Conclusion: We think that the VEMP test is a noninvasive, cost-effective and practical test that allows the evaluation of vestibular-ocular and vestibule-spinal pathways at the brain stem between otolithic organs and effector muscles in BPPV patients.
Aim: Benign paroxysmal positional vertigo (BPPV) is the most frequent cause of vertigo. Making the correct diagnosis as well as treatment depends mainly on the patient history and the positional nystagmus evoked during positional maneuvers. Objective neuro-otological tests need to be developed to understand the underlying exact pathogenetic mechanism. Vestibular evoked myogenic potentials (VEMPs) can make contributions to the understanding of the pathophysiological mechanisms underlying BPPV. They may also help to determine the therapeutic efficacy of the maneuvers. Methods: Our study was performed in our neurosensorial unit at the Neurology Clinic of Ege University Medical Faculty Hospital (EUTFH). Cervical VEMP test was performed using Synergy EMG (Medelec; Viasys Healthcare UK Ltd 2009). During the test, 110 decibels sound stimuli were given separately from each of the two ears. These response stimuli were recorded at intervals of 100 milliseconds and averaged 250 times. 3 electrodes (active, reference and ground) were used for the measurements. The active electrode was recorded to middle of the ipsilateral sternocleidomastoid muscle. P13, N23 latencies and corrected amplitude values of the healthy and patient groups were recorded. Statistical analyzes were performed. Results: Before the treatment, P13 latency was recorded as 13.51 ± 1.99 milliseconds (msn), the N23 latency values were 22.44 ± 2.22 and the corrected amplitude value was 6.44 ± 3.49. The P13 and N23 latencies were prolonged compared to the control group. After the treatment, P13 latency was 12.87 ± 1.65, N23 latency 121.97 ± 1.95 corrected amplitude was 5.75 ± 2.5. In the post-treatment responses, only P13 latency improved, and N23 and amplitude values did not different before and after treatment. Conclusion: We think that the VEMP test is a noninvasive, cost-effective and practical test that allows the evaluation of vestibular-ocular and vestibule-spinal pathways at the brain stem between otolithic organs and effector muscles in BPPV patients.
Açıklama
Anahtar Kelimeler
Benign Pozisyonel Paroksismal Vertigo, Vestibülokollik Refleks, Nörootoloji, Servikal Vestibuler Uyarılmış Myojenik Potansiyel, Benign Paroxysmal Positional Vertigo, Vestibulocollic Reflex, Neurotology, Cervikal Vestibular Evoked Myogenic Potentials
