Study On Diagnosis Classification Of Vestibular Disorders In Neurology Department And Sleep Physiological Mechanism Of Vestibular Disorders

PART Ⅰ DIAGNOSTIC CLASSIFICATION OF VESTIBULAR DISORDERS IN NEUROLOGY DEPARTMENTObjective:We aimed to epidemiological characteristics of vestibular disorders oriented neurology,clear diagnostic classification,in order to provide a reference for diagnosis and treatment of patients with vestibular disorders.Method:Retrospective analysis were carried out with clinical data of patients in our department of vertigo and dizziness oriented neurology,From June 1,2016 to May 31,2017.The target group under study was diagnosed based on the uniform diagnostic criteria.Collect demographic characteristics and detailed case information.Analyzed the age,sex and etiological factor of the patients.Result:1.A total of 3174 patients with a chief complaint of vertigo or dizziness were included.The ratio of male to female was 1:1.89,t ranged from 18 to 89 years with the mean of 57.28±12.56 years.The percentage of patients in the age groups of 18 years and 89 years,18～29 years,30～39 years,40～49 years,50～59 years,60～69 years,70～79 years,80～89 years were 2.33%,6.46%,16.48%,29.33%,28.04%,15.03%and 15.03%.2.Diagnose classification:Peripheral vestibular disease,Central vestibulardisease,Persistent postural-perceptual dizziness,Systemic disease-related dizziness.①The vestibular peripheral accounted for 48.27%:BPPV(29.49%),VN(8.63%),VP(3.09%),MD(2.93%),BVP(2.80%),Sudden sensorineural hearing loss(1.13%),Labyrinthitis(0.16%),Acoustic neuroma(0.03%)②The central vestibular disease accounted for 23.47%:Disorders of brainstem/cerebellum(15.72%),VM(6.64%),Dementia(1.20%),Syringomyelia(0.06%),Epileptic vertigo(0.03%);③The persistent postural-perceptual dizziness accounted for 18.81%;④The systemic disease-related dizziness accounted for 1.32%:Drug-induced vertigo(0.98%),Carbon monoxide poisoning(0.16%),Cardiogenic vertigo(0.01%),Obstructive sleep apnea hypopnea syndrome(0.01%)。3.Among the patient of vestibular disorders,the number of women is far more than men,this gender difference in the PPPD more significant(χ2=124.8,p =0.00),stratified by gender,and the difference was statistically significant.Disorders of brainstem/cerebellum,VP,Dementia and Drug-induced vertigo are more common in male,Other diseases in this study are more common in female.4.Vestibular disorders of different ages constitute a certain distinction.BPPV remained to be the first cause in the age group of 18-69 years,PPPD remained to be the second cause in the age group of 18-59 years.Disorders of brainstem/cerebellum remained to be the first cause in the age group of 70-89 years.The highest suffers of BPPV,PPPD,VM,VN were reported in the age group of 50-59years.The majority of VP patients are concentrated in 60-79 years.Disorders of brainstem/cerebellum,VP and Dementia were significantly older than the other groups.5.In this study,3174 patients with vestibular disorders were associated with insomnia(40.36%),snoring(18.62%),daytime sleepiness(16.01%),awakening after sleep(15.85%),OSAHS(12.00%),dreaminess(5.26%),related sports symptoms(0.82%),abnormal sleep behavior(0.60%).Conclusion:1.Diagnosis classification of vestibular disorders in neurology department:The peripheral vertigo is more common,with BPPV being the most common.The central vestibular disease appears to gradually increase along with age.PPPD is very common in clinical,so clinicians needs to be highly aware of PPPD.It is also important not to overlook t the low incidence of vestibular disorders.There are still certain proportion of patients who visited our vertigo and dizziness oriented neurology undetermined.2.Vestibular disorders occurred in the high incidence of 50 to 69 years old.In general,Women are more likely than men to suffer from vertigo or dizziness.3.Patients with vestibular disorders have multiple sleep disorders.PART Ⅱ RESEARCH ON MECHANISM OF SLEEP PHYSIOLOGY IN VESTIBULAR DISORDERSObjective:The study and compare the characteristics of nocturnal sleep physiological parameters of BPPV and VM.To explore the possible pathogenesis of VM from the perspective of sleep physiology.Objective to explore the value of sleep disorders in diagnosis,treatment and prognosis of vestibular disorders.Method:Based on clinical epidemiology investigation and according to the inclusion and exclusion criterions,VM and BPPV patients were respectively recruited.To evaluate PSG,DHI,PSQI.Analyze and compare the nocturnal sleep parameters of two constitutional types,which include sleep stages,respiratory state and morement situation.Result:1.The DHI total scores DHI total scores the two groups and The DHI scores of P and F were statistically different,That is to say,the scores of VM and BPPV groups are as follows:The total score of vertigo disorder caused by VM group is low,and the functional disability caused by vertigo is light;VM group Physical Activity Restriction due to Vertigo(P),Social Function(F)Disturbance Mild,Moderate,Severe Stratification for Comparison of the Total DHI Scores in the Two Patients:High Ratio of Mild to Severe in BPPV Patients The proportion of moderate to high VM patients.2.PSQI:The proportions of patients who were had poor sleep quality were:BPPV(54.39%),VM(79.16%).The incidence of sleep disorders in both groups was higher in the VM group than in the normal population.The VM group had a higher proportion of sleep quality,sleep time,and sleep disorders than the BPPV group.PSQI sub-items:Sleep time was shorter and sleep efficiency was worse in the VM group than in the BPPV group.PSQI abnormalities in each item:The VM group had a higher rate of sleep quality,sleep time,and sleep time than the BPPV group.3.PSG:①The two groups of patients were compared with the normal sleep parameter range:The total sleep time and sleep efficiency of both groups were lower than the normal range;Sleep latency is in the normal range;Wake after sleep onset was higher than the normal range;N1%is higher than the normal range;N2%:The BPPV group was in the normal range,and the VM group was higher than the normal range;N3%:The BPPV group was in the normal range,and the VM group was lower than the normal range;REM%:The BPPV group was in the normal range and the VM group was lower than the normal range.② Comparison of sleep physiological parameters between the two groups:The VM group had worse sleep efficiency,longer wake after sleep onset,lower N1%,higher N2%,lower N3%,and lower REM%than the BPPV.③Abnormal activities during sleep:AHI:The proportion of obstructive sleep apnea hypopnea syndrome was higher than that of the normal population.Two groups of patients with mild,moderate,severe stratification of OSAHS were compared:The proportion of patients with severe OSAHS in the VM group was significantly higher than that in the BPPV group.PLMS index:The proportion of VMs with periodic leg movement during sleep is higher than that of BPPV.Conclusion:1.Attention should be paid to the comorbidity of sleep disorders in the diagnosis and treatment of VM and BPPV.The VM group was lighter than the functional disability due to vertigo in the BPPV group,but the score of the Vertigo Disability Scale could not be used as an indicator for the presence of sleep disorders.2.Patients with BPPV and VM have a higher proportion of sleep disorders than normal people.However,the VM group had poor sleep quality,long sleep time,short sleep time,and poor sleep efficiency.Deep sleep time was lower than the normal range.The proportion of PLMS VM during sleep was higher than that of the normal population and BPPV group.Therefore,in the process of diagnosis and treatment of VM patients,more attention should be paid to the appeal.This result may be related to the pathogenesis of VM,suggesting that the pathogenesis of VM patients is more involved.3.Patients with BPPV and VM had a higher proportion of OSA than the normal population.It suggests that sleep apnea may have a certain correlation with the occurrence,development,and outcome of the disease.4.In the treatment of vestibular disorders,we should take into account the treatment of sleep disorders.PART Ⅲ RANDOMIZED TRIAL OF BETAHISTINE MESILATE TABLETS AS AUGMENTATION FOR OXCARBAZEPINE AND CARBAMAZEPINE IN TREATING VESTIBULAR PAROXYSMIABackground:Vestibular paroxysmia(VP)is a rare episodic peripheral vestibular disorder.This study was conducted to compare the efficacy and acceptability of carbamazepine(CBZ)plus betahistine mesilate tablets(BMT)(CBZ+BMT)and oxcarbazepine(OXC)plus BMT(OXC+BMT)in treating VP,and investigated whether the synergistic effect could be increased along with the increased dose of BMT.Methods:VP patients were recruited and randomly assigned to receive CBZ+BMT or OXC+BMT.The doses of CBZ and OXC were set to 200 and 300 mg/time,twice daily,respec-tively.The doses of BMT were set to 12 and 18 mg/time,twice daily.Half of the patients in each group received BMT 12 mg/time and the other half received BMT 18 mg/time.The treatment was continued for 12 weeks.The vertigo frequency,vertigo score,vertigo duration,response rate,and drug-related side effects were analyzedResults:In total,92 patients in the CBZ+BMT group and 93 patients in the OXC+BMT group completed this trial.After 12 weeks of treatment,the two groups had similar average vertigo frequency,average vertigo score,average vertigo duration,and response rate.But the incidence of side effects was significantly higher in the CBZ+BMT group than in the OXC+BMT group(p=0.04).Subgroup analysis found that patients receiving BMT(18 mg)had greater reductions in average vertigo frequency,average vertigo duration,and average vertigo score,and higher response rates than patients receiving BMT(12 mg).Conclusion:These results demonstrated that OXC+BMT may be suitable as an alternative method in VP patients with CBZ hypersensitivity,and the synergistic effect could be increased along with the increased dose of BMT.