Semont-plus maneuver led to faster positional vertigo recovery than Epley maneuver in trial
Patients randomized to the Semont-plus maneuver averaged two days until recovery from posterior canal benign paroxysmal positional vertigo canalolithiasis compared with more than three days among those who underwent the Epley maneuver.
The Semont-plus maneuver was more effective than the Epley maneuver in terms of days until vertigo recovery, a recent trial found.
Researchers conducted the prospective randomized clinical trial at three national referral centers in Germany, Italy, and Belgium over two years, with follow-up until four weeks after the initial examination. They randomized adult patients to the Semont-plus maneuver (SM-plus) or the Epley maneuver for treatment of posterior canal benign paroxysmal positional vertigo canalolithiasis. Participants received one initial maneuver from a physician, then subsequently performed self-maneuvers at home three times in the morning, three times at noon, and three times in the evening. Every morning, they documented whether they could provoke positional vertigo. The primary end point was the number of days until no positional vertigo could be induced on three consecutive mornings. Results were published June 26 by JAMA Neurology.
A total of 195 participants (mean age, 62.6 years; 64.1% women) were included in the per-protocol analysis, 97 in the Epley maneuver group and 98 in the SM-plus group. The mean time until no positional vertigo attacks could be induced in the SM-plus group was 2.0 days (median, 1 d; 95% CI, 1.64 to 2.28 d), with a range of 1 to 8 days, compared to 3.3 days (median, 2 d; 95% CI, 2.62 to 4.06 d) in the Epley maneuver group, with a range of 1 to 20 days (P=0.01). There was no difference between groups for the secondary end point of the effect of a single maneuver performed by a physician. No serious adverse events were detected in either group; however, 24 patients (24.5%) in the SM-plus group and 19 patients (19.6%) in the Epley maneuver group experienced relevant nausea.
The authors noted that they had no control over how well patients performed self-maneuvers at home. They added that the primary end point was ascertained by patient self-report, among other limitations, and concluded that the SM-plus maneuver can be recommended in clinical practice.