BPPV: Comparison of the SémontPLUS With the Sémont Maneuver: A Prospective Randomized Trial

• Published in: Frontiers in neurology 2021-04, Vol.12, p.652573-652573
• Main Authors: Strupp, Michael, Goldschagg, Nicolina, Vinck, Anne-Sophie, Bayer, Otmar, Vandenbroeck, Sebastian, Salerni, Lorenzo, Hennig, Anita, Obrist, Dominik, Mandalà, Marco
• Format: Article
• Language: English
• Subjects: BPPV [2,182]; dizziness [35,838]; Epley maneuver; Neurology; Sémont maneuver; vertigo [18,284]
• ISSN: 1664-2295; 1664-2295
• DOI: 10.3389/fneur.2021.652573

To compare the efficacy of the Sémont maneuver (SM) with the new "SémontPLUS maneuver" (SM+) in patients with posterior canal BPPV canalolithiasis (pcBPPVcan). In a prospective trinational (Germany, Italy, and Belgium) randomized trial, patients with pcBPPVcan were randomly assigned to SM or SM+; SM+ means overextension of the head by 60+° below earth horizontal line during the movement of the patient toward the affected side. The first maneuver was done by the physician, and the subsequent maneuvers by the patients 9 times/day on their own. Each morning the patient documented whether vertigo could be induced. The primary endpoints were: "How long (in days) does it take until no attacks can be induced?" and "What is the efficacy of a single SM/SM+?" In the 194 patients analyzed (96 SM, 98 SM+), it took 2 days (median, range 1-21 days, mean 3.6 days) for recovery with SM and 1 day (median, range 1-8 days, mean 1.8 days) with SM+ ( = 0.001, Mann-Whitney -test). There was no difference in the second primary endpoint (chi -test, = 0.39). This prospective trial shows that SM+ is more effective than SM when repeated therapeutic maneuvers are performed but not when a single maneuver is performed. It also supports the hypothesis of the biophysical model: overextension of the head during step 2 brings the clot of otoconia beyond the vertex of the canal, which increases the effectivity. This study provides Class I evidence that SM+ is superior to SM for multiple treatment maneuvers of pcBPPVcan.