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01-06-2013 | Original Communication

Natural course of positional down-beating nystagmus of peripheral origin

Authors: Jacopo Cambi, Serena Astore, Marco Mandalà, Franco Trabalzini, Daniele Nuti

Published in: Journal of Neurology | Issue 6/2013

Abstract

The aim of this study was to assess the natural course of positional down-beating nystagmus (pDBN) and vertigo in patients with no evidence of central nervous system involvement and of presumed peripheral origin. Fifty-three patients with pDBN had a complete otoneurological examination. All subjects, apart from three (excluded from the study), showed no additional neurological signs and normal brain imaging. Patients were randomly assigned to two groups: with or without treatment with exercise. Patients were seen again after 24 h, and then weekly for up to 6 months. Forty-seven patients (94 %) showed pDBN in the straight head-hanging position and in a Dix–Hallpike position. A torsional component was detected in 17 patients (34 %). The mean latency and duration of pDBN was 4.7 ± 5 s and 40.1 ± 22 s, respectively. After 2 weeks, only 12 patients (24 %) still had pDBN and all but one patient had recovered by 1 month. Twenty patients (40 %) were diagnosed with a typical posterior canal benign paroxysmal positional vertigo (PC BPPV) before or after pDBN. This study assessed for the first time the natural course of presumed peripheral pDBN, which was characterized by a spontaneous remission in 24 patients in the first week and in 49 patients within 4 weeks. pDBN is much more common than previously suggested, with about the same frequency as lateral canal BPPV. Furthermore, the clinical characteristics of pDBN have been highlighted, as well as its possible relationship to PC BPPV.

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Title: Natural course of positional down-beating nystagmus of peripheral origin
Authors: Jacopo Cambi
Serena Astore
Marco Mandalà
Franco Trabalzini
Daniele Nuti
Publication date: 01-06-2013
Publisher: Springer-Verlag
Published in: Journal of Neurology / Issue 6/2013
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-012-6815-9

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Natural course of positional down-beating nystagmus of peripheral origin

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