Diagnostics of dizziness and balance disorders after whiplash and craniocerebral injury and their specific therapy by local blockade of the proprioceptors of the neck muscles

Status:

completed 11/2009

Aims:

Evaluation of objective parameters and therapeutic options for patients with whiplash or craniocerebral injury QTF II°, who have symptoms longer than six months. Affected patients complain about symptoms like dizziness, nausea, headache, neck pain, disorders of sensibility and tinnitus. In the otorhinolaryngology we need certain methods of diagnostics for whiplash associated disorders. We wanted to confirm the gained knowledge with an other prospective double-blind study: intramuscular drug therapy of the neck muscles by CT-controlled injection of local anaesthetics (botulinum toxin, lidocaine, placebo).

Activities/Methods:

The concept of therapeutic local anaesthetics shall be applied to patients with whiplash associated disorders. It should be proven if a better therapeutic result can be achieved.

Results:

Under cervicotonic derivation conditions, as well as in the pre-post 3D HDT comparison, we were able to detect primarily an upbeat nystagmus in students in flexed trunk provocation. In the case of cervically deficient patient suffering from dizziness, upbeat nystagmus is a significant distinguishing characteristic between the groups. This sensible parameter of investigation was also confirmed in the pilot study. We found the vertical nystagmus to be again a sensible distinguishing characteristic between the respective treatment groups and the placebo group. A success in subjective contentment with the therapy is revealed when comparing both medicinally treated groups combined (botulinum toxin plus lidocaine) versus the placebo group.

We have found an upbeat nystagmus under cervicotonic investigation conditions. This "cervicotonic provocation nystagmus" can be understood to be an expression of a vestibular activation over the cervicoocular pathways. Possibly, in further studies, cervically induced disorders in the head-trunk coordination can be defined better therewith and thus, not least, the discriminatory power versus whiplash associated symptoms can be augmented.

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