背景:良性复发性眩晕(BRV),梅尼埃病(MD),和前庭性偏头痛(VM)在眩晕发作的过程和临床特征方面显示出许多相似之处。在本文中,我们通过探索BRV患者眩晕发作的持续时间和触发因素的变化来阐述我们小组先前研究中观察到的眩晕发作频率的降低,MD,或VM。
方法:在我们的三级转诊中心进行的为期3年的前瞻性队列研究中,我们招募了确诊为BRV的患者,MD,或VM在我们中心的神经科医生和耳鼻喉科医生在2015-2016年。研究特定的问卷用于评估眩晕发作的通常持续时间及其每6个月的潜在诱因。主要结局指标是持续发作患者亚组眩晕发作的持续时间和触发因素的变化,使用重复测量逻辑回归模型进行分析。
结果:纳入了121例患者(BRV:n=44;MD:n=43;VM:n=34),其中117例完成了3年的随访期,57例(48.7%)继续报告眩晕发作。与基线相比,在随后的年度随访测量中,诊断组均未显示出发作持续时间的统计学显着缩短。在基线,压力和疲劳被报告为攻击的触发因素在三组之间存在显着差异(压力:BRV40.9%,MD62.8%,VM76.5%,p=0.005;疲劳:BRV31.0%,MD48.8%,VM68.8%,p=0.003)。在VM组中,在24和30个月的随访测量之前,观察到作为触发因素的压力和疲劳的持续减少,分别,比值比(OR)范围为0.15至0.33(所有P<0.05)。在MD组中,从24个月测量开始,观察到作为触发因素的头部运动持续减少(ORs范围为0.07~0.11,所有p<0.05).
结论:我们的研究表明,BRV患者的眩晕发作持续时间随着时间的推移没有减少,MD,和VM谁仍然有眩晕发作。在持续眩晕发作的VM和MD患者中,疲劳和头部运动成为眩晕发作的主要诱因。
BACKGROUND: Benign recurrent vertigo (BRV), Menière\'s disease (MD), and vestibular migraine (VM) show many similarities with regard to the course of vertigo attacks and clinical features. In this paper, we elaborate on the decreasing frequency of vertigo attacks observed in a previous study from our group by exploring changes in the duration and trigger factors of vertigo attacks in patients with BRV, MD, or VM.
METHODS: For this 3-year prospective cohort study in our tertiary referral center we recruited patients with a confirmed diagnosis of BRV, MD, or VM by a neurologist and otorhinolaryngologist in our center in 2015-2016. A study-specific questionnaire was used to assess the usual duration of vertigo attacks and their potential triggers every 6 months. Main outcome measures were changes in duration and trigger factors of vertigo attacks in the subgroups of patients with persisting attacks, which were analyzed using repeated measures logistic regression models.
RESULTS: 121 patients were included (BRV: n = 44; MD: n = 43; VM: n = 34) of whom 117 completed the 3-year follow-up period and 57 (48.7%) kept reporting vertigo attacks at one more follow-up measurements. None of the diagnosis groups showed statistically significant shortening of attack duration at the subsequent annual follow-up measurements compared to baseline. At baseline, stress and fatigue being reported as triggers for attacks differed significantly between the three groups (stress: BRV 40.9%, MD 62.8%, VM 76.5%, p = 0.005; fatigue: BRV 31.0%, MD 48.8%, VM 68.8%, p = 0.003). In the VM group, a consistent reduction of stress and fatigue as triggers was observed up until the 24- and the 30-month follow-up measurements, respectively, with odds ratios (ORs) ranging from 0.15 to 0.33 (all p < 0.05). In the MD group, a consistent reduction of head movements as trigger was observed from the 24-month measurement onward (ORs ranging from 0.07 to 0.11, all p < 0.05).
CONCLUSIONS: Our study showed no reduction in vertigo attack duration over time in patients with BRV, MD, and VM who remain to have vertigo attacks. In VM and MD patients with persisting vertigo attacks stress, fatigue and head movements became less predominant triggers for vertigo attacks.