前庭阵发症的临床特点及疗效观察

Clinical Features and Therapeutic Effects of Vestibular Paroxysmia

赵梓博;孙淑萍;范凯慧;卢伟;

1:郑州大学第一附属医院耳科

摘要

目的探讨前庭阵发症(vestibular paroxysmia,VP)的临床特点,观察其药物治疗效果。方法回顾性分析32例诊断为VP患者的临床资料,分析其眩晕发作特点、纯音听阈(pure-tone audiometry PTA)、听性脑干反应(ABR)、头颅磁共振(MRI)及前庭功能等检查结果。给予卡马西平或奥卡西平治疗3个月后评估其疗效。结果32例VP患者均以反复发作的短暂性眩晕为主要临床表现,24例(75.0%)患者在转头或转身时诱发眩晕发作,24例(75.0%)患者伴平衡障碍或自身感觉的不平衡感;11例(34.38%)患者PTA阈值上升;所有患者的颅脑MRI均显示前庭蜗神经存在神经血管交互压迫(neurovascular cross-compression,NVCC)现象;行ABR检测的30例患者中有24例(80.00%)异常,其中I-III波间期延长(>2.2ms)者19例(63.33%),其病程较I-III波间期正常者长,但差异无统计学意义(P=0.231)。所有患者经抗癫痫药物治疗1个月,失访1例,症状无改善者4例,其余27例患者均继续治疗3个月,停药6个月后与治疗前比较,其眩晕发作频率明显减少(P<0.05),眩晕的严重程度亦明显减轻(P<0.05)。结论 VP以反复发作的短暂性眩晕为主要临床表现,常见诱发因素有头位或体位变动;MRI均提示有NVCC现象,多数患者ABR I-III波间期延长,部分患者PTA阈值上升;卡马西平或奥卡西平能有效控制眩晕症状,在试验性治疗中有重要意义。

关键词

前庭阵发症;听性脑干反应;磁共振成像;卡马西平

基金项目(Foundation):

人力资源和社会保障部留学归国人员科技活动择优资助项目(国人社厅2008-86号);; 河南省医学科技攻关计划(200903044、201303049)联合资助

作者

赵梓博;孙淑萍;范凯慧;卢伟;

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