OBJECTIVE: To explore the clinical value of different positioning tests for different benign paroxysmal positional vertigo (BPPV). METHOD: This research applies Dix-Hallpike test and Side-lying test for PC-BPPV, Roll test and WRW test for HC-BPPV, Dix-Hallpike test, Side-lying test and Rahko T maneuvers for SC-BPPV. Six hundred and thirteen cases, who were tested with different positioning tests in the sequence of firstly PC-BPPV then HC-BPPV and finally SC-BPPV, were randomly divided into 2 groups. The order of positioning tests for PC-BPPV and HC-BPPV in the two groups was reversed. RESULT: There's no significant difference between the detection rate of Dix-Hallpike test and Side-lying test for PC-BPPV (P > 0.05). Similarly, there's no difference in statistics between the detection rate of Roll test and WRW test for HC-BPPV (P > 0.05). However, the detection rate of Rahko T maneuver was higher than the other two tests for SC-BPPV and the differences were statistically significant (P < 0.05). The detection rates of different positioning tests for PC-BPPV and HC-BPPV between the two groups were not different in statistics (P > 0.05), which implies that the different order had no effect on the sensitivity of each positioning test. CONCLUSION Dix-Hallpike test is recommended as the first choice for PC-BPPV for its more efficient stimulus to the posterior semicircular canal, and Side-lying test is recommended as a prior choice to the patients with suspected PC-BPPV but unable to receive Dix-Hallpike test because of its similar sensitivity and more convenient manipulation. The detection rate of Both Roll test and WRW test were higher than 90% and there's no significant difference between the two tests. In addition, Roll test is easier to perform and helpful for the therapy, so its considered as the preferred test for HC-BPPV with WRW test as the supplement test. Nevertheless, for SC-BPPV the sensitivity of Rahko T maneuver was higher than that of the other two tests, so it can be used to confirm the suspected SC-BPPV patients detected or missed diagnosed by the two other tests. To avoid misdiagnosis or missed diagnosis, the judgment of affected semicircular canal is determined not only by positioning test but also by the feature of nystagmus.
Adolescent ; Adult ; Aged ; Benign Paroxysmal Positional Vertigo ; Female ; Humans ; Male ; Middle Aged ; Patient Positioning ; Retrospective Studies ; Vertigo ; diagnosis ; Young Adult

Objective:To report 2 young infants of sodium channel related epilepsy with SCN2A gene mutation, and to discuss the clinical characteristics of the disease and the efficacy and safety of lacosamide combined with the literature.Methods:Corresponding information of 2 children hospitalized in the Department of Neurology of Hunan Children′s Hospital in July 2021 and October 2021 was collected, including the symptoms, comprehensive physical examination, blood, cerebrospinal fluid, imaging, electrophysiological examination, diagnosis and treatment process, response to treatment and other clinical data, as well as the sequencing results of the whole exome of the children. The efficacy and safety of lacosamide were analyzed, and the related literatures of the Biomedical Literature Database, Wanfang Data Knowledge Service Platform and Chinese Knowledge Infrastructure Database were searched and reviewed.Results:Both of the 2 cases were girl. Their onset age was within 3 months. The initial symptoms were frequent convulsions and backward development. There was no structural abnormality in the head image. The convulsions could not be controlled according to conventional multidrug treatment. The seizures were quickly controlled with lacosamide. Now they have been followed up for 6 months. No obvious adverse reactions were found. Case 1 gene test results showed the SCN2A gene (chr2:166152333-166246334) heterozygous deletion, SCN1A gene (chr2:166847754-16693013) heterozygous deletion, the deletion size being about 5.72 Mb. Case 2 gene test results showed new missense mutation of SCN2A (c.1285G>A, p.Glu429Lys). There were dozens of seizures every day. They were treated with valproic acid, oxcarbazepine and levetiracetam successively. The seizures could not be controlled. Three focal seizures originated in the left temporal region were detected by electroencephalogram. There was no recurrence on the third day after adding lacosamide, and there was no attack after 5 months of follow-up. No obvious adverse reactions were found during follow-up.Conclusions:Sodium channel related epileptic encephalopathy often starts early, has frequent seizures, and can be accompanied by backward psychomotor development at the same time. The slow sodium channel blocker lacosamide has good efficacy and safety in the treatment of sodium channel-related epilepsy with SCN2A gene mutation or combined SCN1A gene mutation.