{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T02:30:04Z","timestamp":1791772204202,"version":"4.3.4"},"reference-count":24,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"published-print":{"date-parts":[[2023,8,1]]},"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>Questions remain concerning treatment efficacy for the common condition of benign paroxysmal positional vertigo (BPPV).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare the effectiveness of the Semont-plus maneuver (SM-plus) and the Epley maneuver (EM) for treatment of posterior canal benign paroxysmal positional vertigo (pcBPPV) canalolithiasis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This prospective randomized clinical trial was performed at 3 national referral centers (in Munich, Germany; Siena, Italy; and Bruges, Belgium) over 2 years, with a follow-up to 4 weeks after the initial examination. Recruitment took place from June 1, 2020, until March 10, 2022. Patients were selected randomly during routine outpatient care after being referred to 1 of the 3 centers. Two hundred fifty-three patients were assessed for eligibility. After consideration of the exclusion criteria as well as informed consent, 56 patients were excluded and 2 declined to participate, with 195 participants included in the final analysis. The analysis was prespecified and per-protocol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>After being randomized to the SM-plus or the EM group, patients received 1 initial maneuver from a physician, then subsequently performed self-maneuvers at home 3 times in the morning, 3 times at noon, and 3 times in the evening.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome and Measures<\/jats:title><jats:p>Patients had to document whether they could provoke positional vertigo every morning. The primary end point was the number of days until no positional vertigo could be induced on 3 consecutive mornings. The secondary end point was the effect of the single maneuver performed by the physician.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 195 participants included in the analysis, the mean (SD) age was 62.6 (13.9) years, and 125 (64.1%) were women. The mean (SD) time until no positional vertigo attacks could be induced in the SM-plus group was 2.0\u2009(1.6) days (median, 1 [range, 1-8] day; 95% CI,\u20091.64-2.28 days); in the EM group, 3.3\u2009(3.6) days (median, 2 [range, 1-20] days; 95% CI,\u20092.62-4.06 days) (<jats:italic>P<\/jats:italic>\u2009=\u2009.01; \u03b1\u2009=\u2009.05, 2-tailed Mann-Whitney test). For the secondary end point (effect of a single maneuver), no significant difference was detected (67 of 98 [68.4%] vs 61 of 97 [62.9%]; <jats:italic>P<\/jats:italic>\u2009=\u2009.42; \u03b1\u2009=\u2009.05). No serious adverse event was detected with both maneuvers. Nineteen patients (19.6%) in the EM group and 24 (24.5%) in the SM-plus group experienced relevant nausea.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The SM-plus self-maneuver is superior to the EM self-maneuver in terms of the number of days until recovery in pcBPPV.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT05853328?cond=bppv&amp;amp;amp;draw=2&amp;amp;amp;rank=2\">NCT05853328<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaneurol.2023.1408","type":"journal-article","created":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T15:32:52Z","timestamp":1687793572000},"page":"798","source":"Crossref","is-referenced-by-count":44,"title":["The Semont-Plus Maneuver or the Epley Maneuver in Posterior Canal Benign 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Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Salerni","sequence":"additional","affiliation":[{"name":"Department of ENT (Ear, Nose, and Throat), University of Siena, Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Gerb","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ludwig Maximilian University, Munich, Germany"},{"name":"German Center for Vertigo and Balance Disorders, Ludwig Maximilian University, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Otmar","family":"Bayer","sequence":"additional","affiliation":[{"name":"German Center for Vertigo and Balance Disorders, Ludwig Maximilian University, Munich, Germany"},{"name":"ReliaTec GmbH, Garching, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vergil","family":"Mavrodiev","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ludwig 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