Treatment

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• Botulinum Toxin for Neurological Disorders
• Vagal Nerve Stimulator Management
• Electromyogram (EMG) and Nerve Conduction Study (NCS)
• Electroencephalogram
• 24 Hour Ambulatory
• Epley Maneuvers
• Evoked Potential Testing
• Video Electronystagmography (ENG)

Epley Maneuver

The Epley Maneuver is a treatment for benign paroxysmal positional vertigo (BPPV). It works by allowing free floating particles from the affected ear canal to be relocated, therefore, relieving the patient of bothersome vertigo. It has a reported success rate of between 90-95%.

What to expect

1. The patient begins in an upright sitting posture, with the legs fully extended and the head rotated 45 degrees towards the affected side.
2. The patient is then quickly and passively forced down backwards by the clinician performing the treatment into a supine position with the head held approximately in a 30 degree neck extension where the affected ear faces the ground.
3. The patient remains in this position for approximately 1-2 minutes.
4. The patient’s head is then turned 90 degrees to the opposite direction so that the unaffected ear faces the ground, all while maintaining the 30 degree neck extension.
5. The patient remains in this position for approximately 1-2 minutes.
6. Keeping the head and neck in a fixed position relative to the body, the individual rolls onto their shoulder, rotating the head another 90 degrees in the direction that they are facing. The patient is now looking downwards at a 45 degree angle.
7. The patient remains in this position for approximately 1-2 minutes.
8. Finally, the patient is slowly brought up to an upright sitting posture, while maintaining the 45 degree rotation of the head.
9. The patient holds sitting position for up to 30 seconds.

The entire procedure may be repeated two more times, for a total of three times. During every step of this procedure the patient may experience some dizziness.

Post-treatment

Following the treatment, the clinician may provide the patient with a soft collar, often worn for the next 48 hours. The patient may be instructed to be cautious of bending over, lying backwards, moving the head up and down, or tilting the head to either side.