Benign paroxysmal positioning vertigo (BPPV) is the most frequent peripheral vestibular disorder. Most often the posterior canal is affected: pcBPPV. For its treatment, there is Level 1 evidence that the Semont maneuver (SM) and the Epley maneuver (EM) are effective. However, a meta-analysis concluded that many patients suffer longer and are more impaired than previously assumed. A biophysical model and computer simulations showed that during the rotation of the labyrinth the crystals move about 25° less than the rotation of the canal [1]. Based on these findings, the Semont-Plus (SM+) was developed: the patient’s body is moved towards the affected side 60°+ below earth horizontal. In this way, the otoconia move 60°+ further in the direction of the utricle, which should theoretically increase the effectivity. In two prospective randomized tri-national studies, it was demonstrated that the SM+ is superior to (A) the regular SM: in the 194 patients analyzed, it took 2 days (median, mean: 3.6 days) for recovery with SM and 1 day (median, mean: 1.8 days) with SM+ (p=.001, 2-sided Mann-Whitney-U-test [2]; and
(B) the EM: in the 195 patients analyzed, it took 1 day (median, mean: 1.96 days) in the SM+ group and 2 days (median, mean: 3.34 days, p=.012) in the EM group [3].
Based on these three studies, the SM+ maneuver can be recommended for the treatment pcBPPV in clinical practice.
Key Points:
- For the treatment of the common condition posterior canal BPPV (pcBPPV) canalolithiasis, it was shown that the Semont maneuver (SM) and the Epley maneuver (EM) are effective.
- In a biophysical model and computer simulations, it was demonstrated that during the rotation of the labyrinth the crystals move about 25° less than the rotation of the canal, i.e. they are not beyond the vertex of the canal when the patient moves towards the non-affected side.
- The new Semont-Plus maneuver (SM+) overcomes this limitation because the patient is moved 60°+ below earth horizontal so that the otoconia are beyond the vertex of the canal.
- Two randomized multinational prospective trials showed that the time until recovery is significantly reduced by SM+ in comparison to the regular SM and the EM; therefore the SM+ can be recommended for your clinical practice
References:
- Obrist D, Nienhaus A, Zamaro E, Kalla R, Mantokoudis G, Strupp M (2016) Determinants for a Successful Semont Maneuver: An In vitro Study with a Semicircular Canal Model. Front Neurol 7:150
- Strupp M, Goldschagg N, Vinck AS, Bayer O, Vandenbroeck S, Salerni L, Hennig A, Obrist D, Mandala M (2021) BPPV: Comparison of the SemontPLUS With the Semont Maneuver: A Prospective Randomized Trial. Front Neurol 12:652573
- Strupp M, Mandala M, Vinck AS, van Breda L, Salerni L, Gerb J, Bayer O, Mavrodiev V, Goldschagg N (2023) The Semont-plus maneuver or the Epley maneuver in posterior canal BPPV: a randomized prospective study. JAMA Neurology (in press)
Publish on behalf of the Scientific Panel on Neuro-ophthalmology and -otology