慢性头晕:考虑到并发症的现代治疗方法

E. N. Zastenskaia, L. M. Antonenko
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All patients were examined twice: at the beginning and after completion of treatment, which lasted an average of 1 month. Treatment included antidepressants (serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors), anti-anxiety medications, vestibular exercises, an educational program, and cognitive behavioral therapy. Arlevert (a combination of cinnarizine 20 mg + dimenhydrinate 40 mg) was used as a drug therapy for the treatment of vestibular dizziness in 28 patients. A clinical otoneurological evaluation and videonystagmography were performed to assess vestibular disorders; the severity of dizziness was assessed using an otoneurological questionnaire and the Dizziness Handicap Inventory (DHI); the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Spielberger Anxiety Inventory (STAI) were used to assess anxiety and depressive disorders.Results. None of the 60 patients had previously been diagnosed with PPPD. They were observed with a misdiagnosis of cerebrovascular disease and/or cervical spine pathology and received ineffective treatment. Anxiety and depressive disorders were detected in 32 (53.33%) patients, migraine – in 20 (33.33%) and previous peripheral vestibular disorders – in 8 (13.33%) patients. After one month of treatment in patients with PPPD and comorbid conditions, the severity of dizziness according to DHI decreased from 45.59±15.47 to 29.9±12.56 points (p<0.001), the severity of anxiety according to BAI from 27.50±6.38 to 15.66±4.07 points (p<0.001), the severity of depression according to BDI from 11.91±6.24 to 7.06±4.12 points (p<0.001), the severity of anxiety according to HADS from 13.47±4.16 to 8.60±2.86 points (p<0.001), the severity of depression according to HADS from 6.34±3.72 to 4.31±2.82 points (p<0.001), situational anxiety according to STAI from 50.69±7.13 to 41.26±6.24 points (p<0.001), personal anxiety according to STAI from 54.66±8.21 to 43.78±6.75 points (p<0.001).Conclusion. It was found that PPPD is rarely diagnosed, and anxiety disorders, migraine and peripheral vestibular disorders are very common in PPPD patients. 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Arlevert (a combination of cinnarizine 20 mg + dimenhydrinate 40 mg) was used as a drug therapy for the treatment of vestibular dizziness in 28 patients. A clinical otoneurological evaluation and videonystagmography were performed to assess vestibular disorders; the severity of dizziness was assessed using an otoneurological questionnaire and the Dizziness Handicap Inventory (DHI); the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Spielberger Anxiety Inventory (STAI) were used to assess anxiety and depressive disorders.Results. None of the 60 patients had previously been diagnosed with PPPD. They were observed with a misdiagnosis of cerebrovascular disease and/or cervical spine pathology and received ineffective treatment. Anxiety and depressive disorders were detected in 32 (53.33%) patients, migraine – in 20 (33.33%) and previous peripheral vestibular disorders – in 8 (13.33%) patients. 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引用次数: 0

摘要

大多数情况下,慢性头晕是持续性姿势性知觉性头晕(PPPD),它往往合并有前庭系统的其他疾病和焦虑症。在现实的临床实践中,PPPD和合并症很少被诊断出来,有效的治疗方法也很少被开出,因此,开发现代方法来管理合并症的PPPD患者非常重要。目的:分析典型的管理方法,评估复合疗法对PPPD和合并症患者的疗效。我们对 60 名确诊为 PPPD(根据巴拉尼学会的诊断标准)和合并疾病的患者(平均年龄 - 42.5±13.8 岁)进行了检查。所有患者都接受了两次检查:治疗开始时和治疗结束后,治疗平均持续 1 个月。治疗包括抗抑郁药物(5-羟色胺再摄取抑制剂/5-羟色胺-去甲肾上腺素再摄取抑制剂)、抗焦虑药物、前庭运动、教育计划和认知行为疗法。阿乐维(辛那利嗪 20 毫克+地美肼 40 毫克的复方制剂)作为药物疗法用于治疗 28 名患者的前庭性眩晕。临床耳神经学评估和视频震颤成像用于评估前庭障碍;头晕的严重程度通过耳神经学问卷和头晕障碍量表(DHI)进行评估;医院焦虑和抑郁量表(HADS)、贝克抑郁量表(BDI)、贝克焦虑量表(BAI)和斯皮尔伯格焦虑量表(STAI)用于评估焦虑和抑郁障碍。60 名患者中没有人曾被诊断为 PPPD。他们被误诊为脑血管疾病和/或颈椎病,接受的治疗效果不佳。32(53.33%)名患者被诊断出患有焦虑症和抑郁症,20(33.33%)名患者被诊断出患有偏头痛,8(13.33%)名患者曾患有外周前庭疾病。经过一个月的治疗,PPPD 和合并症患者的头晕严重程度根据 DHI 从(45.59±15.47)分下降到(29.9±12.56)分(p<0.001),焦虑严重程度根据 BAI 从(27.50±6.38)分下降到(15.66±4.07)分(p<0.001),抑郁严重程度根据 BDI 从(11.91±6.24)分下降到(7.06±4.12)分(p<0.001),根据 HADS 的焦虑严重程度从(13.47±4.16)分降至(8.60±2.86)分(P<0.001),根据 HADS 的抑郁严重程度从(6.34±3.72)分降至(4.31±2.82)分(P<0.001),STAI的情景焦虑从50.69±7.13分降至41.26±6.24分(P<0.001),STAI的个人焦虑从54.66±8.21分降至43.78±6.75分(P<0.001)。研究发现,PPPD 很少被确诊,焦虑症、偏头痛和外周前庭疾病在 PPPD 患者中非常常见。在治疗 PPPG 患者的过程中,考虑到并发症的综合治疗方法已被证明具有很高的疗效。
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Chronic dizziness: modern treatment methods taking into account comorbidity
In most cases, chronic dizziness is persistent postural perceptual dizziness (PPPD), which is often combined with other diseases of the vestibular system and anxiety disorders. In real-life clinical practice, PPPD and comorbid disorders are rarely diagnosed and effective treatments are rarely prescribed, so the development of modern methods for managing patients with PPPD with comorbid diseases is important.Objective: to analyze the typical management practices and evaluate the effectiveness of complex therapy in patients with PPPD and comorbid disorders.Material and methods. We examined 60 patients (mean age – 42.5±13.8 years) with diagnosis of PPPD (according to the diagnostic criteria of the Barany Society) and comorbid diseases. All patients were examined twice: at the beginning and after completion of treatment, which lasted an average of 1 month. Treatment included antidepressants (serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors), anti-anxiety medications, vestibular exercises, an educational program, and cognitive behavioral therapy. Arlevert (a combination of cinnarizine 20 mg + dimenhydrinate 40 mg) was used as a drug therapy for the treatment of vestibular dizziness in 28 patients. A clinical otoneurological evaluation and videonystagmography were performed to assess vestibular disorders; the severity of dizziness was assessed using an otoneurological questionnaire and the Dizziness Handicap Inventory (DHI); the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Spielberger Anxiety Inventory (STAI) were used to assess anxiety and depressive disorders.Results. None of the 60 patients had previously been diagnosed with PPPD. They were observed with a misdiagnosis of cerebrovascular disease and/or cervical spine pathology and received ineffective treatment. Anxiety and depressive disorders were detected in 32 (53.33%) patients, migraine – in 20 (33.33%) and previous peripheral vestibular disorders – in 8 (13.33%) patients. After one month of treatment in patients with PPPD and comorbid conditions, the severity of dizziness according to DHI decreased from 45.59±15.47 to 29.9±12.56 points (p<0.001), the severity of anxiety according to BAI from 27.50±6.38 to 15.66±4.07 points (p<0.001), the severity of depression according to BDI from 11.91±6.24 to 7.06±4.12 points (p<0.001), the severity of anxiety according to HADS from 13.47±4.16 to 8.60±2.86 points (p<0.001), the severity of depression according to HADS from 6.34±3.72 to 4.31±2.82 points (p<0.001), situational anxiety according to STAI from 50.69±7.13 to 41.26±6.24 points (p<0.001), personal anxiety according to STAI from 54.66±8.21 to 43.78±6.75 points (p<0.001).Conclusion. It was found that PPPD is rarely diagnosed, and anxiety disorders, migraine and peripheral vestibular disorders are very common in PPPD patients. The integrated approach in the treatment of patients with PPPG, taking into account concomitant disorders, has demonstrated high efficacy.
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