Update on benign paroxysmal positional vertigo
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NEUROLOGICAL UPDATE
Update on benign paroxysmal positional vertigo Hyo‑Jung Kim1 · JaeHan Park2 · Ji‑Soo Kim3,4 Received: 15 October 2020 / Revised: 4 November 2020 / Accepted: 8 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo worldwide. This review considers recent advances in the diagnosis and management of BPPV including the use of web-based technology and artificial intelligence as well as the evidence supporting the use of vitamin D supplements for patients with BPPV and subnormal serum vitamin D. Keywords Dizziness · Vertigo · Benign paroxysmal positional vertigo
Introduction Benign paroxysmal positional vertigo (BPPV) is characterized by paroxysms of vertigo triggered by head position changes in the direction of gravity [1]. BPPV is explained by migration of degenerated otoconia into the semicircular canals, rendering them sensitive to head motion [2]. BPPV is the most common cause of dizziness/vertigo worldwide with a lifetime prevalence of 2.4%, a 1-year prevalence of 1.6%, and 1-year incidence of 0.6% [3]. BPPV accounts for 24.1% of all hospital visits due to dizziness/vertigo [4]. BPPV is most common in elderly women with a peak incidence in their sixties and a women-to-men ratio of 2.4:1 [4]. Recurrences of BPPV are frequent [5, 6] with an annual recurrence rate of 15–20% [7, 8]. Even though benign in nature, patients with BPPV are markedly limited in their daily activities [10, 11]. The Hyo-Jung Kim and JaeHan Park equally contributed to this study. * Ji‑Soo Kim [email protected] 1
Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
2
Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
3
Department of Neurology, Seoul National University College of Medicine, 300 Gumi‑dong, Bundang‑gu, Seongnam‑si, Gyeonggi‑do 463‑707, South Korea
4
Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
medical costs for diagnosis of BPPV have been estimated at 2,000 US$ in the USA [12], 364 Euros (~ 450 US$) in Spain [13], RMB 4165.2 Yuan (~ 600 US$) in China [14], and 180 US$ in South Korea [9]. Therefore, the healthcare burden due to BPPV totals around 2 billion US$ in the USA per year [15] and is likely to increase as the population ages. According to data from South Korea, the number of hospital visits per 100,000 of general population due to dizziness and vertigo was around 3974 in 2019 and could increase to 6057 by 2050, which corresponds to an increase of 52% [4].
Pathophysiology The cause of BPPV is mostly unknown although cases may be associated with head trauma, a prolonged recumbent position, or various disorders involving the inner ear [16]. Other risk factors for BPPV may include female gender, age under 65 years, a high income, living in a metropolis, osteoporosis, hypertension,
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