Biomedical subjects

Shlomo Flechter

Publications and source records attributed to Shlomo Flechter.

4 recordsLinked to original sources

PubMed2005

Approach to benign paroxysmal positional vertigo in old age.

BACKGROUND: Benign paroxysmal positional vertigo is a common and treatable vestibular disorder characterized by attacks of positional vertigo. Although elderly patients often complain about unsteadiness, the symptom of positional vertigo is seldom reported. Several studies on BPPV in the elderly reveal a low success rate in the treatment of this entity. OBJECTIVES: To assess the clinical characteristics and treatment outcome of BPPV in elderly patients and to compare them with those of the general population treated at our dizziness clinic. METHODS: We reviewed the medical records of 23 patients above age 75 who were treated at our dizziness clinic for BPPV during the years 1998-2004. Their clinical data, BPPV characteristics and treatment outcome were compared with the data of 30 consecutive BPPV patients who represented the general population. RESULTS: No differences in gender distribution, duration of BPPV, treatment responsiveness or recurrence rate were found between elderly patients as compared to the general population. The duration of the last attack of positional vertigo was found to be longer in the elderly, probably due to the delay in recognition of symptoms and accessibility of a dizziness clinic. CONCLUSIONS: Our study shows that BPPV characteristics and treatment effectiveness, as measured by negative Dix-Hallpike maneuver, are not age-dependent and there is no need for a special approach or cautiousness in prognosis prediction. It is important to search actively for this condition since treatment leads to amelioration of unsteadiness and improved well-being in these patients.

Adult↗

PubMed2003

Phobic postural vertigo: a new proposed entity.

BACKGROUND: Dizziness and vertigo can be a complaint in various psychiatric conditions where it usually constitutes only one of the features of the syndrome. Lately, a somatoform disorder characterized by almost mono-symptomatic dizziness and unsteadiness has been described. Since phobic postural vertigo usually presents without anxiety or other psychological symptomatology, patients with this condition seek help at neurologic and otolaryngologic clinics where they are often misdiagnosed as suffering from organic vertigo. OBJECTIVES: To present the clinical features of 55 consecutive patients diagnosed with phobic postural vertigo at our clinic during 1998-2002. METHODS: We conducted a retrospective review of patients' medical records and report two typical cases for illustration. RESULTS: The patients presented with complaints of unsteadiness with or without dizziness, and attacks of sudden veering that caused them to grasp for support. Accompanying anxiety was admitted by only 5% and vegetative symptoms were reported in 18%. In 16% the symptoms resulted in avoidance behavior. A stressful life event or an unrelated somatic disease triggered the onset of PPV in 35% of patients, whereas a vestibular insult preceded the symptoms in 13%. The mean duration of symptoms was 26.7 +/- 39.1 months (range 0.5-20 years). In 72% of patients the symptoms resolved after the psychological mechanism of their symptoms was explained to them; 24% improved with antidepressant treatment (selective serotonin reuptake inhibitors or tricyclic antidepressants), and only in 4% did the symptoms persist. CONCLUSIONS: Since PPV is a frequently encountered diagnosis at some specialized dizziness clinics, familiarity with this entity resulting in early diagnosis can avoid unnecessary examinations and lead to effective treatment.

Adolescent↗

PubMedDate not supplied

Approach to bilateral benign paroxysmal positioning vertigo.

BACKGROUND: Bilateral benign paroxysmal positioning vertigo (bBPPV) is rather rare, accounting for up to 10% in the reported benign paroxysmal positioning vertigo (BPPV) series. Inappropriate head positioning during testing in unilateral BPPV causes the otolith debris in the uppermost ear to move toward the cupula, resulting in an inhibitory nystagmus and mimicking bBPPV. PURPOSE: We analyzed the clinical data of patients with bilaterally positive Dix-Hallpike maneuver and compared them with the characteristics of patients with unilateral BPPV. We further tried to propose a simple schematic approach to the treatment of patients with bilaterally positive Dix-Hallpike maneuver. MATERIALS AND METHODS: Medical records of 232 patients treated for BPPV at our dizziness clinic during 1999 to 2003 were reviewed. An algorithm used for the treatment of patients with bilaterally positive BPPV is discussed. RESULTS: Twenty-eight patients with bilaterally positive Dix-Hallpike test were found. Sixteen were diagnosed with bBPPV, and 12 were diagnosed with unilateral mimicking bBPPV. Thirty patients with unilateral posterior canal BPPV served as control subjects. No difference in age, sex distribution, duration of symptoms, number of treatments per ear, and recurrence was found between bBPPV and unilateral BPPV. The female sex appeared to be predisposed for more treatments. The total duration of BPPV symptoms obtained by history was found to correlate with the number of recurrences after treatment. CONCLUSIONS: We conclude that bBPPV can be readily distinguished from unilateral mimicking bBPPV. Patients with bBPPV do not differ from patients with unilateral BPPV in clinical characteristics. The mechanism of otolith debris dislodgment appears to be the main cause of bilaterality, trauma being a more common trigger than other known causes of BPPV.

Adult↗

PubMedDate not supplied

Copolymer 1 (glatiramer acetate) in relapsing forms of multiple sclerosis: open multicenter study of alternate-day administration.

Daily 20-mg doses of Copolymer 1 have been shown to significantly decrease the relapse rate in patients with multiple sclerosis (MS). In the present open-label study, patients with relapsing MS were treated with the same dose of Copolymer 1 administered on alternate days. Sixty-eight patients were recruited: fifty-one and forty-one patients completed 1 and 2 years of treatment respectively. The relapse rate during the 2 years of treatment decreased by 80.8% compared with the 2 years before treatment (means, 0.56 +/- 1.02 versus 2.91 +/- 1.10, respectively; p < 0.0001). This lower rate is comparable with that obtained with daily open-label administration previously reported by the authors. The score on the Expanded Disability Status Scale did not differ from that at baseline after the first year of treatment, although it increased somewhat at the end of the second year (baseline = 2.72 +/- 1.55, 1 year = 2.71 +/- 1.59, 2 years = 2.97 +/- 1.80; p < 0.008). The drug was very well tolerated. This preliminary open-label study suggests that alternate-day therapy has beneficial effects and is well tolerated, comparing favorably with the effects of daily injections of Copolymer 1 in patients with relapsing MS. These results should be confirmed by randomized double-blind examinations.

Adult↗