目的:调查依从性,特点,以及在家中首次捕获眼震的临床经验,可以进行,以补充有偶发性前庭症状的患者的诊断过程。
方法:在三级转诊中心招募患者,以防捕获眼震可能有助于诊断过程(例如,检测或排除BPPV)。他们被要求在家里用自己的智能手机捕获ictal眼球震颤,使用基于智能手机的适配器(Nystagmocatcher,Balansdiagnos,斯德哥尔摩,瑞典)。所有录音均由最后作者(RvdB)分析,和坚持,特点,并对首次临床经验进行了评估。
结果:有前庭症状的70例患者被要求参加本研究。62人(89%)同意参加。参与的中位数为86天。51名患者在研究期间经历了发作。最终,其中51%提供了足以进行分析的眼球运动记录。观察到不同类型的眼球震颤:位置性眼球震颤与BPPV有关,位置性眼震与BPPV无关,功能性眼球运动,没有眼球震颤或功能性眼球运动。捕获眼震可以在几个方面有助于诊断过程,包括检测或排除BPPV,为了检测或排除前庭症状的起源,为了确定受影响的一方,远程医疗,监控攻击频率,并检测恶意行为。此外,严格的病人指导是必要的,这可能很耗时。
结论:捕获眼震可以在几个方面有助于诊断过程,这促使人们重新思考当前前庭医学的临床工作流程。然而,严格的指导是必要的,并不是所有的患者都提供ictal记录.在门诊,建议使用Ital眼球震颤记录,以补充诊断过程。
OBJECTIVE: To investigate adherence, characteristics, and first clinical experiences of capturing ictal nystagmus at home, which can be performed to complement the diagnostic process in patients with episodic vestibular symptoms.
METHODS: Patients were recruited at a tertiary referral center in case capturing ictal nystagmus could contribute to the diagnostic process (e.g., to detect or rule out BPPV). They were asked to capture ictal nystagmus with their own smartphone at home, using a smartphone-based adapter (Nystagmocatcher, Balansdiagnos, Stockholm, Sweden). All recordings were analyzed by the last author (RvdB), and the adherence, characteristics, and first clinical experiences were evaluated.
RESULTS: Seventy patients with vestibular symptoms were asked to participate in this study. Sixty-two (89%) agreed to participate. The median period of participation was 86 days. Fifty-one patients experienced attacks during the study period. Eventually, 51% of them provided eye movement recordings sufficient for analysis. Different types of nystagmus were observed: positional nystagmus related to BPPV, positional nystagmus not related to BPPV, functional eye movements, and the absence of nystagmus or functional eye movements. Capturing ictal nystagmus could contribute to the diagnostic process in several ways, including to detect or rule out BPPV, to detect or rule out vestibular origin of symptoms, to determine the affected side, telemedicine, to monitor attack frequency, and to detect malingering. Furthermore, strict guidance of patients was necessary, which could be time-consuming.
CONCLUSIONS: Capturing ictal nystagmus can contribute to the diagnostic process in several ways, which motivates to rethink current clinical workflow in vestibular medicine. However, strict guidance is necessary and not all patients provide ictal recordings. In an outpatient setting, it would be advised to use ictal nystagmus recordings on indication, to complement the diagnostic process.