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No Improvement With Betahistine And Physiotherapy For Benign Paroxysmal Positional Vertigo, What Is The Permanent Cure?

Posted on Tue, 21 Jan 2014

Question: Sir, As you adviced to use some medicine which i used in my past medical history but there is no use with that. Please assist me in curing my problem. It is good to note that your MRI brain was normal, which excludes a brain disease.In this scenario, the most likely diagnosis is BPPV. BPPV suggests a problem with the semicircular canal, where some particles accumulate in the fluid. This is not a serious problem, however, it is a disabling problem.The initial treatment is with betahistine tablets. If you were my patient, I would treat you with a dose of 16 mg three times daily for 2-4 weeks.In addition, physiotherapy with vestibular rehabilitation or adaptation exercises would be useful.With the above treatment, we expect permanent improvement in 4-6 weeks.I hope it helps.

Answered by Dr. Sudhir Kumar (5 hours later)

Brief Answer: My reply is below. Detailed Answer: Thank you for getting back. It is unfortunate that you have not improved with the treatment so far. If you were my patient, I would start TAB. PIRACETAM 800 mg two times daily and use for four weeks. In addition, TAB. METHYCOBAL (vitamin B12) tablets once a day can be used. You would also benefit from EPLEY's maneuver, after consulting an ENT surgeon. I hope my reply has helped you. I would be pleased to answer, if you have any follow up queries or if you require any further information. Best wishes, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar My blog: http://bestneurodoctor.blogspot.com/

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (6 minutes later)

I am unable to understand what the line says ''You would also benefit from EPLEY's maneuver, after consulting an ENT surgeon". If you don't mind please explain me in detail about the above line. Because i already consulted ENT Two months back only. And he told that the problem is because of Sinusities and prescribed some medicine. But it is not useful to me after using the medicine also.

Answered by Dr. Sudhir Kumar (21 minutes later)

Brief Answer: My reply is below. Detailed Answer: Possibly, you need to change the ENT doctor, as Epley's maneuver is done by ENT doctor, who knows about BPPV. It is a simple procedure, which is done to cure BPPV. It can be done by making you lie down in OPD and turning the head in a certain direction, after doing a clinical examination. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (16 hours later)

Thank you for responding and advicing me the treatments. actually i dont know to whom i have to consult for ENT in banglore.. Please refer one ENT doctor in bangalore who will take care of my problem.

Answered by Dr. Sudhir Kumar (7 hours later)

Brief Answer: Thank you for getting back. Detailed Answer: I do not know anyone in specific. However, Manipal and Apollo Hospitals, are good hospitals in Bangalore. You can consult an ENT doctor there and specifically discuss about BPPV and Epley's maneuver when you meet them. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (7 minutes later)

Thank you for your Valuable suggestions. I have taken the tablets today and i will start using it from tomorrow for four weeks as you said in the part of the treatment. And i have one doubt whether to consult the ENT doctor nowitself or after completing the course of medicine which you prescribed.

Answered by Dr. Sudhir Kumar (2 minutes later)

Brief Answer: You can consult ENT after using the tablets. Detailed Answer: Thank you for getting back. You can consult ENT doctor after four weeks (after completing the medicines). Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (2 minutes later)

Thank you once again. I will get in touch with you after completing the course of medicine which you prescribed.

Answered by Dr. Sudhir Kumar (1 minute later)

Brief Answer: Thank you. Detailed Answer: I would be pleased to be of help to you in future too. Thank you and best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar