Benign Paroxysmal Positional Vertigo (BPPV)

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Benign Paroxysmal Positional Vertigo (BPPV)

What is benign paroxysmal positional vertigo (BPPV)?

Benign paroxysmal positional vertigo (BPPV) is an inner ear problem that causes short periods of vertigo when your head is moved in certain positions. It occurs most commonly when lying down, turning over in bed and looking up. Even though you are still, you may feel like you are moving, or that the room is moving around you. You may also experience nausea, vomiting, sweating, and abnormal eye movements. If the vertigo is accompanied by double vision, difficulty speaking, change in alertness, arm / leg weakness or an inability to walk, you should immediately contact your doctor.

What causes BPPV?

BPPV occurs when small crystals of calcium carbonate, commonly referred to as rocks, in the inner ear break loose and fall into another area within the balance canals. The crystals may break loose for many reasons following an inner ear infection, fever, concussion or whiplash injury. BPPV can also occur along with other diseases of the inner ear such as Meniere's disease, migraines or as a 'normal' aging process.

How is BPPV treated?

About 85% people recover from specific neck manoeuvres, performed by their physician or physical therapist which are designed to move the crystals back into place. Research shows that the repositioning manoeuvre works on the first effort, 80-90% of the time. After the treatment is complete, you may feel nauseous, dizzy or have more trouble balancing than before. This can last for several hours. Avoid dangerous activity and follow the instructions given by the physician.

    What else should I do after treatment?

    For several hours, you should not turn your head quickly or tilt your head far up (as if looking to the sky) or far back, such as when lying on your back, looking down at your shoes or picking something up from the floor. You can sleep that night in whatever position you choose. Starting the next day, you should continue your normal activity and move your head as normally as possible.

    Can dizziness come back?

    Since we do not know the exact cause of BPPV, it is also not possible to know how to prevent it. Unfortunately, medication has not been proven effective but rather can cause more harm than good. If your BPPV does return, you should contact your physical therapist. The crystals may be in a different place, so your treatment may be different than before. You should never try to put the crystals back on your own unless instructed by your healthcare provider. Remember, BPPV is treatable and the manoeuvres can greatly reduce your vertigo and other symptoms associated with BPPV.

    It is likely that your neurologist will perform several tests, including:

    • Electroencephalography (EEG), which records brain wave patterns
    • Magnetic resonance imaging (MRI) of the brain
    • Blood tests

    What are the treatment options?

    The most common treatment to prevent seizures is the daily use of medications. Nearly 70% of people with epilepsy can have good control of their seizures using medications. Most people whose seizures are controlled with drugs have few restrictions on their activities. Many medications are available. Some of them work better for one type of epilepsy than another. Talk to your neurologist about the choice of medication, how often it is taken and any side effects. Side effects may vary from one drug to another and from one person to another. Your neurologist will make sure that the prescribed drug is the best medication for you.

    In some cases, medication does not work. Then surgery or vagus nerve stimulation may be an option. In vagus nerve stimulation, a device similar to a pacemaker is implanted under the skin on the chest. It reduces seizures by delivering electrical signals to the brain via the vagus nerve in the neck. Epilepsy surgery usually involves identifying and removing the seizure focus. It can be very effective and even curative for some people, even when medications have failed. It is not a 'last resort'. Talk to your neurologist about the best treatment for your seizures.

    Living with epilepsy

    Epilepsy is different for everyone. Some people have seizures that are easily controlled; their epilepsy doesn’t have much effect on their daily lives. Others may find that their seizures will have a bigger impact on their lives; they may affect the way they work, socialise or complete daily activities.

    • Diet: Do not fast or skip meals. Eat solids.
    • Rest: Adequate rest is essential
    • Exercise: is a must but do not overdo
    • Stress: should be avoided

    Controlling seizures

    To help control your seizures:

    • Take your medication as prescribed.
    • Maintain regular sleep patterns.
    • Avoid excessive alcohol use or use of illegal drugs.
    • Work to reduce and manage stress.
    • Talk to your neurologist about any changes in symptoms or new symptoms.
    • Exercise to maintain your overall health.

    Driving and safety

    • Driving should be avoided.
    • Talk to your neurologist about this issue and your overall safety.
    • People with epilepsy also need to avoid sports or activities that could be hazardous if they were to lose consciousness or become unable to control their movements.
    • Working at a height should also be avoided, along with swimming alone.

    Women and epilepsy

    • Women with epilepsy should talk to their neurologist before becoming pregnant.
    • Most pregnancies in women with epilepsy have a happy outcome and a healthy baby.
    • But both seizures and the drugs that treat seizures can be harmful to the developing baby.
    • Women need to be under close medical care to make sure the epilepsy is under the best control possible.

    Partnering with your neurologist

    • Inform the neurologist about all symptoms and medical history.
    • In a diary, you record the dates, frequency, and severity of your seizures.

    Epileptic seizure first aid

    When a person is having a seizure:

    • Stay calm and remain with the person.
    • If there is food or fluid in the mouth, roll him / her onto the side immediately.
    • Keep the person safe and protect them from injury.
    • Place something soft under their head and loosen any tight clothing.
    • Do not restrain while having fits.
    • Reassure the person until they recover.
    • Time the seizure, if you can.