Akutno liječenje bolesnika s vestibularnim neuronitisom

Adamec, Ivan (2014) Akutno liječenje bolesnika s vestibularnim neuronitisom. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Background: Aim of this study was to determine the efficacy of intravenous dexamethasone in acute management of VN patients and to determine the usefulness of VEMP in assessment of vestibular nerve damage in VN. ----- Patients and methods: Patients with acute VN were included in the study and were randomised into two groups. Patients in group A received intravenous dexamethasone and patients in group B received placebo. Both groups of patients received symptomatic therapy as well. Before and 120 minutes after therapy the following parameters were recorded: degree of nystagmus, Fukuda test, number of vomiting, visual-analogue scale of nausea, European Evaluation of Vertigo questionnaire. All patients who gave consent underwent VEMP during seven days time from presentation. ----- Results: A total of 100 patients were enrolled in the study, 52 (52%) males and 48 (48%) females. 51 (51%) patients were randomized to receive dexamethasone and 49 (49%) to receive placebo. In group A statistically significant smaller number of patients had III degree nystagmus after therapy compared with group B. After therapy, significantly more patients had I degree nystagmus in both gropus, which was more pronounced in group A. There was a statistically significant greater difference in European Evaluation of Vertigo questionnaire in group A compared with group B after therapy administration. Regarding the VEMP part of the study amplitudes on the affected side were significantly smaller than amplitudes on the healthy side. Conduction block on oVEMP was significantly more often present on the affected side than on the healthy side. The accuracy of AR was 71% for oVEMP, meaning that it accurately detected 60 out of 84 affected sides. Of those 60 detected sides, 41 (68%) had lower AR for cVEMP, meaning that the inferior branch was affected as well. ----- Conclusion: Intravenous dexamethasone leads to a better recovery of nystagmus when compared to placebo and it has an ameliorating effect on symptoms as measured by European Evaluation of Vertigo questionnaire. VEMP analysis has been demonstrated to be useful for vestibular nerve damage detection in VN patients.

Abstract in Croatian

Uvod: Cilj ovog istraživanja bio je procijeniti učinak intravenskog deksametazona u akutnom zbrinjavanju bolesnika s VN-om te ispitati ulogu VEMP-a u procjeni oštećenja vestibularnog živca u VN-u. ----- Ispitanici i metode: U istraživanje su bili uključeni bolesnici s akutnim VN-om koji su bili randomizirani u dvije skupine. Bolesnici skupine A primili su intravenski deksametazon, a bolesnici skupine B placebo. Obje skupine su primile i simptomatsku terapiju. Prije i 120 minuta nakon primanja terapije procijenjeni su slijedeći parametri: stupanj nistagmusa, Fukuda test, broj povraćanja, vizualno-analogna skala mučnine, European Evaluation of Vertigo upitnik. Svim bolesnicima koji su dali pristanak učinjen je VEMP unutar tjedan dana od javljanja u hitnu službu. ----- Rezultati: Ukupno je uključeno 100 bolesnika, 52 (52%) muškarca i 48 (48%) žena. Na temelju randomizacije deksametazon je primio 51 (51%) bolesnik (skupina A) dok ih je 49 (49%) primilo placebo (skupina B). U skupini A statistički značajno manje bolesnika imalo je nistagmus III stupnja nakon terapijske intervencije dok u skupini B ta razlika nije dostigla statističku značajnost. Također, nakon terapijske intervencije nistagmus I stupnja imalo je statistički značajno više bolesnika u obje skupine, izraženije u skupini A u odnosu na skupinu B. Nađena je statistički značajno veća razlika u rezultatima upitnika European Evaluation of Vertigo u skupini A u odnosu na skupinu B nakon terapije. U VEMP dijelu istraživanja amplitude na zahvaćenoj strani bile su statistički značajno manje u usporedbi s amplitudama na zdravoj strani. Blok provođenja u oVEMP-u statistički značajno češće bio je prisutan na strani vestibularnog oštećenja u odnosu na zdravu stranu. Točnost kojom se detektirao snižen AR za oVEMP je 71%, odnosno točno je detektirano 60 strana od ukupno 84. Od tih 60 bolesnika 41 (68%) je imao snižen AR i za cVEMP, odnosno zahvaćenost obje grane vestibularnog živca. ----- Zaključak: Intravenski deksametazon dovodi do boljeg oporavka nistagmusa u usporedbi s placebo skupinom te ima povoljan učinak na simptome VN-a izražene European Evaluation of Vertigo upitnikom. Rezultati analiza VEMP varijabli pružaju dokaze o VEMP-u kao korisnoj metodi za ispitivanje oštećenja pojedinih grana vestibularnog živca u VN-u.

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