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Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus.
J Neurol. 2011 Jul; 258(7):1207-22.JN

Abstract

We review current pharmacological treatments for peripheral and central vestibular disorders, and ocular motor disorders that impair vision, especially pathological nystagmus. The prerequisites for successful pharmacotherapy of vertigo, dizziness, and abnormal eye movements are the "4 D's": correct diagnosis, correct drug, appropriate dosage, and sufficient duration. There are seven groups of drugs (the "7 A's") that can be used: antiemetics; anti-inflammatory, anti-Ménière's, and anti-migrainous medications; anti-depressants, anti-convulsants, and aminopyridines. A recovery from acute vestibular neuritis can be promoted by treatment with oral corticosteroids. Betahistine may reduce the frequency of attacks of Ménière's disease. The aminopyridines constitute a novel treatment approach for downbeat and upbeat nystagmus, as well as episodic ataxia type 2 (EA 2); these drugs may restore normal "pacemaker" activity to the Purkinje cells that govern vestibular and cerebellar nuclei. A limited number of trials indicate that baclofen improves periodic alternating nystagmus, and that gabapentin and memantine improve acquired pendular and infantile (congenital) nystagmus. Preliminary reports suggest suppression of square-wave saccadic intrusions by memantine, and ocular flutter by beta-blockers. Thus, although progress has been made in the treatment of vestibular neuritis, some forms of pathological nystagmus, and EA 2, controlled, masked trials are still needed to evaluate treatments for many vestibular and ocular motor disorders, including betahistine for Ménière's disease, oxcarbazepine for vestibular paroxysmia, or metoprolol for vestibular migraine.

Authors+Show Affiliations

Department of Neurology, University of Munich, Munich, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Review

Language

eng

PubMed ID

21461686

Citation

Strupp, Michael, et al. "Pharmacotherapy of Vestibular and Ocular Motor Disorders, Including Nystagmus." Journal of Neurology, vol. 258, no. 7, 2011, pp. 1207-22.
Strupp M, Thurtell MJ, Shaikh AG, et al. Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus. J Neurol. 2011;258(7):1207-22.
Strupp, M., Thurtell, M. J., Shaikh, A. G., Brandt, T., Zee, D. S., & Leigh, R. J. (2011). Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus. Journal of Neurology, 258(7), 1207-22. https://doi.org/10.1007/s00415-011-5999-8
Strupp M, et al. Pharmacotherapy of Vestibular and Ocular Motor Disorders, Including Nystagmus. J Neurol. 2011;258(7):1207-22. PubMed PMID: 21461686.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus. AU - Strupp,Michael, AU - Thurtell,Matthew J, AU - Shaikh,Aasef G, AU - Brandt,Thomas, AU - Zee,David S, AU - Leigh,R John, Y1 - 2011/04/02/ PY - 2010/12/29/received PY - 2011/03/04/accepted PY - 2011/03/01/revised PY - 2011/4/5/entrez PY - 2011/4/5/pubmed PY - 2011/11/16/medline SP - 1207 EP - 22 JF - Journal of neurology JO - J Neurol VL - 258 IS - 7 N2 - We review current pharmacological treatments for peripheral and central vestibular disorders, and ocular motor disorders that impair vision, especially pathological nystagmus. The prerequisites for successful pharmacotherapy of vertigo, dizziness, and abnormal eye movements are the "4 D's": correct diagnosis, correct drug, appropriate dosage, and sufficient duration. There are seven groups of drugs (the "7 A's") that can be used: antiemetics; anti-inflammatory, anti-Ménière's, and anti-migrainous medications; anti-depressants, anti-convulsants, and aminopyridines. A recovery from acute vestibular neuritis can be promoted by treatment with oral corticosteroids. Betahistine may reduce the frequency of attacks of Ménière's disease. The aminopyridines constitute a novel treatment approach for downbeat and upbeat nystagmus, as well as episodic ataxia type 2 (EA 2); these drugs may restore normal "pacemaker" activity to the Purkinje cells that govern vestibular and cerebellar nuclei. A limited number of trials indicate that baclofen improves periodic alternating nystagmus, and that gabapentin and memantine improve acquired pendular and infantile (congenital) nystagmus. Preliminary reports suggest suppression of square-wave saccadic intrusions by memantine, and ocular flutter by beta-blockers. Thus, although progress has been made in the treatment of vestibular neuritis, some forms of pathological nystagmus, and EA 2, controlled, masked trials are still needed to evaluate treatments for many vestibular and ocular motor disorders, including betahistine for Ménière's disease, oxcarbazepine for vestibular paroxysmia, or metoprolol for vestibular migraine. SN - 1432-1459 UR - https://www.unboundmedicine.com/medline/citation/21461686/Pharmacotherapy_of_vestibular_and_ocular_motor_disorders_including_nystagmus_ L2 - https://dx.doi.org/10.1007/s00415-011-5999-8 DB - PRIME DP - Unbound Medicine ER -