Benign paroxysmal positional vertigo (BPPV) usually has a favorable course, although it is possible to observe BPPV with a high recurrence rate. Previous studies suggested that vitamin D deficiency might affect BPPV recurrences, and oxidative stress might play a complementary role in BPPV pathogenesis. This multicentric trial aimed to evaluate the effectiveness of oral nutritional supplementation with a compound of alpha-lipoic acid, Carnosine, and Zinc (LICA^® (Difass International, Coriano (RN), Italy)), vitamins of group B and vitamin D in preventing BPPV recurrences. A total of 128 patients with high recurrence-BPPV were randomized in three arms: Arm 1 consisted of subjects with “insufficient” or “deficient” vitamin D blood levels, treated with daily oral supplementation of LICA^®, vitamins of group B and vitamin D3 (800 UI), Arm 2 included BPPV subjects with “sufficient” vitamin D who did not receive any nutritional support, and Arm 3 included subjects with a “sufficient” serum concentration of vitamin D who received supplementation with a compound of LICA^® and Curcumin. After six months of follow-up, a significant reduction of BPPV relapses compared to the baseline was found only in Arm 1 (−2.32, 95% CI: 3.41–1.62, p-value < 0.0001). Study results suggested that oral nutritional supplementation with vitamin D3 plus antioxidants can prevent relapses in patients suffering from high recurrence-BPPV.

L’obiettivo è stato valutare bed side l’intensità e la direzione del nistagmo (NID) nelle due differenti posizioni del “bow and lean test” (BLT) per differenziare la forma geotropa dalla forma apogeotropa e determinare il lato affetto in caso di vertigine parossistica da posizionamento benigna idiopatica da litiasi a carico del canale semicircolare laterale (LSC-BPPV), prima ancora di utilizzare le classiche manovre diagnostiche. Sono stati esaminati 32 soggetti affetti da LSC-BPPV, in ognuno dei quali sono state valutate l’intensità e la direzione del nistagmo nelle due posizioni del BLT. L’intensità del nistagmo consente di differenziare la forma geotropa della forma apogeotropa mentre la direzione del nistagmo consente di indentificare il lato affetto. Per le noti legge che governano la fisiopatologia del CSL, un nistagmo più intenso in flessione del capo (bow) rispetto all’estensione (lean) indica un flusso ampullipeto e quindi la presenza di materiale flottante nel braccio non ampollare, tipico della forma geotropa. In tal caso, se il nistagmo in flessione (bow) è diretto a sinistra, il materiale flottante deve necessariamente occupare il braccio non ampollare del CSL sinistro; viceversa se il nistagmo in flessione è diretto a destra. D’altro canto, un nistagmo più intenso in estensione del capo (lean) rispetto alla flessione (bow) indica un flusso ampullifugo e quindi la presenza di materiale aderente alla cupola (cupololitiasi) o flottante nel braccio ampollare (canalolitiasi), tipico della forma apogeotropa. In tal caso, se il nistagmo in estensione (lean) è diretto a sinistra, il materiale flottante deve necessariamente occupare il braccio ampollare del CSL sinistro; viceversa se il nistagmo in estensione è diretto a destra. Come regola generale, in entrambe le forme la direzione del nistagmo con maggiore intensità indica il lato affetto. Il “NID-BLT” è risultato efficace nell’identificare la forma ed il lato affetto in ventidue soggetti su ventotto (79% del campione). In caso di LSC-BPPV, la corretta esecuzione ed interpretazione del “NID-BLT” fornisce un importante aiuto nello stabilire la forma (geotropa versus apogeotropa) e la sede (destra versus sinistra) nella maggior parte dei pazienti, prima ancora di utilizzare le classiche manovre diagnostiche. A differenza del test di Choung, che richiede di conoscere a priori se il paziente ha una forma geotropa o apogeotropa, il nostro test consente di formulare direttamente la diagnosi o di fornire elementi indispensabili nei casi in cui la diagnosi di lato è dubbia, mentre il paziente è ancora in posizione seduta.

Downbeat nystagmus (DBN) is a neuro-otological finding frequently encountered by clinicians dealing with patients with vertigo. Since DBN is a finding that should be understood because of central vestibular dysfunction, it is necessary to know how to frame it promptly to suggest the correct diagnostic-therapeutic pathway to the patient. As knowledge of its pathophysiology has progressed, the importance of this clinical sign has been increasingly understood. At the same time, clinical diagnostic knowledge has increased, and it has been recognized that this sign may occur sporadically or in association with others within defined clinical syndromes. Thus, in many cases, different therapeutic solutions have become possible. In our work, we have attempted to systematize current knowledge about the origin of this finding, the clinical presentation and current treatment options, to provide an overview that can be used at different levels, from the general practitioner to the specialist neurologist or neurotologist.

Aim: The aim of this article is to explore the progression of neurological, neuro-otological and cochlear features in benign paroxysmal vertigo (BPV) in children over time and its relation with migraine, neuro-otological and cochlear disorders in adulthood. Methods: From January 2002 to December 2002, 15 children with BPV were prospectively recruited and then evaluated during a 10-year observational follow-up. All patients underwent detailed neurological, neuro-otological and cochlear examinations during interictal phases. Six children were also studied during ictal periods. Results: At first assessment, four children reported migraine with aura (MwA) and six children reported migraine without aura (MwoA). Neuro-otological examinations were abnormal in two of 15 children. Cochlear examinations were normal in all patients. During the 10-year follow-up, recurrent vestibular symptoms and/or MwA and/or MwoA have been observed in the children. Neuro-otological examinations were abnormal in three of 15 individuals during the interictal period, and abnormal in four out of six patients who were studied during the ictal period. Two patients developed cochlear signs and/or symptoms. Conclusions: During the 10-year follow-up, a phenotype variability in BPV patients has been observed. Specifically, de novo cochlear signs and/or symptoms developed in children with BPV, suggesting that cochlear symptoms should be properly investigated in these patients over time.