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Pharmacotherapy of vestibular disorders and nystagmus.
Semin Neurol. 2013 Jul; 33(3):286-96.SN

Abstract

Vertigo and dizziness are with a life-time prevalence of ~30% among the most common symptoms and are often associated with nystagmus or other oculomotor disorders. The prerequisite for a successful treatment is a precise diagnosis of the underlying disorder. In this overview, the current pharmacological treatment options for peripheral and central vestibular, cerebellar, and oculomotor disorders including nystagmus are described. There are basically seven groups of drugs that can be used (the "7 As"): antiemetics; anti-inflammatory, anti-Menière's, and antimigraine medications; antidepressants, anticonvulsants, and aminopyridines. In acute vestibular neuritis, recovery of the peripheral vestibular function can be improved by treatment with oral corticosteroids. In Menière's disease, a long-term high-dose treatment with betahistine-dihydrochloride (at least 48 mg three times daily) had a significant effect on the frequency of the attacks; the underlying mode of action is evidently an increase in inner-ear blood flow. The use of aminopyridines is a well-established therapeutic principle in the treatment of downbeat and upbeat nystagmus as well as episodic ataxia type 2 and cerebellar gait disorders. As was shown in animal experiments, these potassium channel blockers increase the activity and excitability and normalize irregular firing of cerebellar Purkinje cells. They evidently augment the inhibitory influence of these cells on vestibular and deep cerebellar nuclei. A few studies showed that baclofen improves periodic alternating nystagmus; gabapentin and memantine improve pendular and infantile nystagmus. However, many other eye-movement disorders such as ocular flutter, opsoclonus, central positioning, and see-saw nystagmus are still difficult to treat. Although substantial progress has been made, further state-of-the-art trials must still be performed on many vestibular and oculomotor disorders, namely Menière's disease, vestibular paroxysmia, vestibular migraine, and many forms of central eye-movement disorders.

Authors+Show Affiliations

Department of Neurology, German Center for Vertigo and Balance Disorders.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

24057832

Citation

Strupp, Michael, et al. "Pharmacotherapy of Vestibular Disorders and Nystagmus." Seminars in Neurology, vol. 33, no. 3, 2013, pp. 286-96.
Strupp M, Kremmyda O, Brandt T. Pharmacotherapy of vestibular disorders and nystagmus. Semin Neurol. 2013;33(3):286-96.
Strupp, M., Kremmyda, O., & Brandt, T. (2013). Pharmacotherapy of vestibular disorders and nystagmus. Seminars in Neurology, 33(3), 286-96. https://doi.org/10.1055/s-0033-1354594
Strupp M, Kremmyda O, Brandt T. Pharmacotherapy of Vestibular Disorders and Nystagmus. Semin Neurol. 2013;33(3):286-96. PubMed PMID: 24057832.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pharmacotherapy of vestibular disorders and nystagmus. AU - Strupp,Michael, AU - Kremmyda,Olympia, AU - Brandt,Thomas, Y1 - 2013/09/21/ PY - 2013/9/24/entrez PY - 2013/9/24/pubmed PY - 2014/5/3/medline SP - 286 EP - 96 JF - Seminars in neurology JO - Semin Neurol VL - 33 IS - 3 N2 - Vertigo and dizziness are with a life-time prevalence of ~30% among the most common symptoms and are often associated with nystagmus or other oculomotor disorders. The prerequisite for a successful treatment is a precise diagnosis of the underlying disorder. In this overview, the current pharmacological treatment options for peripheral and central vestibular, cerebellar, and oculomotor disorders including nystagmus are described. There are basically seven groups of drugs that can be used (the "7 As"): antiemetics; anti-inflammatory, anti-Menière's, and antimigraine medications; antidepressants, anticonvulsants, and aminopyridines. In acute vestibular neuritis, recovery of the peripheral vestibular function can be improved by treatment with oral corticosteroids. In Menière's disease, a long-term high-dose treatment with betahistine-dihydrochloride (at least 48 mg three times daily) had a significant effect on the frequency of the attacks; the underlying mode of action is evidently an increase in inner-ear blood flow. The use of aminopyridines is a well-established therapeutic principle in the treatment of downbeat and upbeat nystagmus as well as episodic ataxia type 2 and cerebellar gait disorders. As was shown in animal experiments, these potassium channel blockers increase the activity and excitability and normalize irregular firing of cerebellar Purkinje cells. They evidently augment the inhibitory influence of these cells on vestibular and deep cerebellar nuclei. A few studies showed that baclofen improves periodic alternating nystagmus; gabapentin and memantine improve pendular and infantile nystagmus. However, many other eye-movement disorders such as ocular flutter, opsoclonus, central positioning, and see-saw nystagmus are still difficult to treat. Although substantial progress has been made, further state-of-the-art trials must still be performed on many vestibular and oculomotor disorders, namely Menière's disease, vestibular paroxysmia, vestibular migraine, and many forms of central eye-movement disorders. SN - 1098-9021 UR - https://www.unboundmedicine.com/medline/citation/24057832/Pharmacotherapy_of_vestibular_disorders_and_nystagmus_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0033-1354594 DB - PRIME DP - Unbound Medicine ER -