SemontPlus maneuver more effective than Epley maneuver for vertigo

Key takeaways:

• Participants received three physician-administered SemontPlus or Epley maneuvers, then performed a series of self-maneuvers at home.
• The EM group had a mean recovery of 3.34 days vs. 1.96 in the SM+ group.

BOSTON — The SemontPlus maneuver led to quicker recovery than the Epley maneuver in patients with posterior canal benign paroxysmal positional vertigo, according to research presented at the American Academy of Neurology annual meeting.

Michael Strupp, MD, DO, FAAN, from the department of neurology at the University of Munich, and colleagues have previously studied and demonstrated that the SemontPlus maneuver (SM+) is superior to regular Semont. They hypothesized that SM+ — which is characterized by an overextension of the head/body by at least 60 degrees during the second step — would also be more effective than the Epley maneuver (EM) for treatment of posterior canal benign paroxysmal positional vertigo (pc-BPPV).

Strupp noted that the Epley maneuver is the most commonly used in the U.S., which made the next study a logical path.

In a prospective, multinational randomized trial, 195 patients with pc-BPPV canalithiasis were randomized to receive three physician-administered SM+ (n = 98) or EM (n = 97). Patients were then instructed on how to do self-maneuvers, which they performed three times in the morning, noon and night for a total of nine times per day. The primary endpoint was how long it took to recover.

Strupp noted the EM group took far longer (mean, 3.34 days; median, 2 days) vs. the SM+ group (mean, 1.96 days; median, 1 day; P = .012).

“The SemontPlus is evidently more effective than the regular Semont and the Epley maneuver,” Strupp said.

Strupp recommends patients perform the SM+ maneuver on their bed, keep each position for 60 seconds, keep the canal at 45 degrees — “otherwise the crystals will not move” —and support their body with their arm. He also suggested audience members review the JAMA Neurology 2023 paper that includes a video of the maneuver.

Additionally, Strupp’s daughter created the Positional Vertigo App to assist patients in learning the SM+ maneuver.

Editor’s note: This article was updated April 25, 2023, to include information on the Positional Vertigo App.