良性発作性頭位めまい症100例からみた頭位変換療法の効果と問題点

Efficacy and Problems of the Canalith Repositioning Procedure for Treatment of Benign Paroxysmal Positional Vertigo―Review of 100 Cases

I．はじめに

　良性発作性頭位めまい症（以下，BPPV）は従来自然治癒傾向の強い疾患とされ，1990年代前半以前は本邦では積極的な理学的療法が行われることは稀であった。しかし，米国ではEpley^1）の努力により，その原因と推測される半規管内の耳石片を卵形囊へ戻す頭位変換療法（canalith repositioning procedure：CRP）が第1選択の治療法となっている。

　本邦でも1990年代半ばより，CRPによる治療成績の報告がみられるようになってきた^2～12）。諸家の報告で安定した成績の得られることが認められており^1～15），既に多くの施設で治療の第1選択となっていると思われる。

　われわれの治療してきた100例のBPPV症例を振り返って，CRPの効果と問題点を検討した。

　The efficacy and problems of the canalith repositioning procedure（CRP） in 100 cases of benign paroxysmal positional vertigo（BPPV） were discussed. The efficacy of CRP only once at the first consultation for both the posterior canal type BPPV（p-BPPV） and the lateral canal type BPPV（l-BPPV） were about 70％.

　The recurrence was found 6 of 69 cases（8.7％） in the p-BPPV group,6 of 31 cases（19.4％） in the l-BPPV group. The recurrence over three times were found in 3 cases in the l-BPPV group. The l-BPPV had the tendency of repetition if once the recurrence had occurred.

　The complications of the CRP were as follows. Two cases were the change of canal type,the posterior to the lateral after Parnes' maneuver and the lateral to the posterior after head tilt and rotation maneuver.

　The change of the nystagmus of the l-BPPV,canalithiasis to cupulolithiasis,after modified Lempert maneuver was also found.

　To increase the efficacy of the CRP of the first consultation,it is important not to neglect the change of the direction of the nystagmus during the procedure. If the change of the direction of the nystagmus was not satisfactory,it should be better to repeat the CRP until the proper change is observed on the same day.

　It is desirable to know the several maneuvers of CRPs for one type of BPPV as another CRP may show some effect if one CRP has no effect.