前庭阵发症的临床特点及疗效观察  

Clinical Features and Therapeutic Effects of Vestibular Paroxysmia

作　　者：赵梓博[1] 孙淑萍[1] 范凯慧[1] 卢伟[1] 

机构地区：[1]郑州大学第一附属医院耳科,郑州450052

出　　处：《听力学及言语疾病杂志》2016年第3期231-235,共5页Journal of Audiology and Speech Pathology

基　　金：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

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。Objective To investigate the clinical features and the therapeutic effects in patients with vestibular paroxysmia（VP）. Methods A total of 32 patients with VP were analyzed retrospectively through pure--tone audiometry （PTA）, auditory brainstem response（ABR）, magnetic resonance imaging （MRI）, and vestibular function. The effects were assessed after 3 months treatment of carbamazepine （CBZ） or oxearbazepine （OXA）. Results The main clinical symptom of 32 patients was a brief spell of vertigo, and 75% of patient＇s attacks were regularly precipitated by certain head positions or position changes. The most common accompanying symptom was unsteadiness of stance or gait （75.00%）. The PTA thresholds were elevated in 11 patients （34.38%） . MRI in all patients showed neurovascular cross--compression（NVCC） . Among 30 patients who performed ABR tests, 24 （80.00%） were abnormal and 19 patients （63.33%）were found that the interpeak latency （IPL） of wave I-III（ IPL I-III） prolonged more than 2.2 ms. The course of the patients with IPL I--III prolonged was relatively longer （P=0. 231）, but there was no significantly difference. All patients received carbamazepine （CBZ） or oxcarbazepine （OXA） for one month. One case was lost to follow--up, 4 had no symptom improvement and 27 had a significant reduction in the attack frequency and intensity respectively after treatment of one month, two months, three months and 6 months of the drug withdrawal, compared with the previous （P〈0.05）. The level of vertigo was significantly improved（P〈 0.05）. Conclusion Episodic spells of vertigo are the main clinical symptom of VP, regularly caused by certain head positions or position changes. The NVCC can be found by MRI in all patients. The IPL I--III in ABR was pro- longed in most patients, some of them have hearing loss. CBZ and OXA are effective with VP and also significant in the experimental treatment of diagnosis.

关 键 词：前庭阵发症 听性脑干反应 磁共振成像 卡马西平 

分 类 号：R764.34[医药卫生—耳鼻咽喉科]