AUTHOR=Strupp Michael , Goldschagg Nicolina , Vinck Anne-Sophie , Bayer Otmar , Vandenbroeck Sebastian , Salerni Lorenzo , Hennig Anita , Obrist Dominik , Mandalà Marco 

TITLE=BPPV: Comparison of the SémontPLUS With the Sémont Maneuver: A Prospective Randomized Trial

JOURNAL=Frontiers in Neurology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.652573

DOI=10.3389/fneur.2021.652573

ISSN=1664-2295

ABSTRACT=<p><bold>Objective:</bold> To compare the efficacy of the Sémont maneuver (SM) with the new “SémontPLUS maneuver” (SM+) in patients with posterior canal BPPV canalolithiasis (pcBPPVcan).</p><p><bold>Methods and Patients:</bold> In a prospective trinational (Germany, Italy, and Belgium) randomized trial, patients with pcBPPVcan were randomly assigned to SM or SM+; SM+ means overextension of the head by 60+° below earth horizontal line during the movement of the patient toward the affected side. The first maneuver was done by the physician, and the subsequent maneuvers by the patients 9 times/day on their own. Each morning the patient documented whether vertigo could be induced. The primary endpoints were: “How long (in days) does it take until no attacks can be induced?” and “What is the efficacy of a single SM/SM+?”</p><p><bold>Results:</bold> In the 194 patients analyzed (96 SM, 98 SM+), it took 2 days (median, range 1–21 days, mean 3.6 days) for recovery with SM and 1 day (median, range 1-8 days, mean 1.8 days) with SM+ (<italic>p</italic> = 0.001, Mann-Whitney <italic>U</italic>-test). There was no difference in the second primary endpoint (chi<sup>2</sup>-test, <italic>p</italic> = 0.39).</p><p><bold>Interpretation:</bold> This prospective trial shows that SM+ is more effective than SM when repeated therapeutic maneuvers are performed but not when a single maneuver is performed. It also supports the hypothesis of the biophysical model: overextension of the head during step 2 brings the clot of otoconia beyond the vertex of the canal, which increases the effectivity.</p><p><bold>Classification of Evidence:</bold> This study provides Class I evidence that SM+ is superior to SM for multiple treatment maneuvers of pcBPPVcan.</p>