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Pharmacotherapy of vestibular and cerebellar disorders and downbeat nystagmus: translational and back-translational research.
Ann N Y Acad Sci. 2015 Apr; 1343:27-36.AN

Abstract

There are currently eight groups of drugs for the pharmacotherapy of vertigo, nystagmus, and cerebellar disorders: antiemetics; anti-inflammatories, antimenieres, and antimigraineous medications; antidepressants, anticonvulsants, aminopyridines, and acetyl-DL-leucine ("the eight A's"). In acute unilateral vestibulopathy, corticosteroids improve the recovery of peripheral vestibular function, but there is not sufficient current evidence for a general recommendation. There is also insufficient evidence that 48 or 144 mg/day betahistine has an effect in Ménière's disease. Therefore, higher dosages are currently recommended; in animal studies, it was shown that betahistine increases cochlear blood flow. In vestibular paroxysmia, oxcarbazepine was effective (one yet not randomized controlled trial (RCT)). Aminopyridines are recommended for the treatment of downbeat nystagmus (two RCTs) and episodic ataxia type 2 (EA2, one RCT). There are so far no RCTs on vestibular migraine, so currently no treatment can be recommended. Acetyl-dl-leucine improves cerebellar ataxia (three observational studies); it also accelerates central compensation in an animal model of acute unilateral lesion, but RCTs were negative. There are ongoing RCTs on vestibular paroxysmia with carbamazepine (VESPA), acute unilateral vestibulopathy with betahistine (BETAVEST), vestibular migraine with metoprolol (PROVEMIG), benign paroxysmal positional vertigo with vitamin D (VitD@BPPV), EA2 with 4-aminopyridine versus acetazolamide (EAT-2-TREAT), and cerebellar ataxias with acetyl-DL-leucine (ALCAT).

Authors+Show Affiliations

Department of Neurology, German Center for Vertigo and Balance Disorders and Institute for Clinical Neurosciences, University Hospital Munich, Campus Grosshadern, Munich, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

25903394

Citation

Strupp, Michael, et al. "Pharmacotherapy of Vestibular and Cerebellar Disorders and Downbeat Nystagmus: Translational and Back-translational Research." Annals of the New York Academy of Sciences, vol. 1343, 2015, pp. 27-36.
Strupp M, Zwergal A, Feil K, et al. Pharmacotherapy of vestibular and cerebellar disorders and downbeat nystagmus: translational and back-translational research. Ann N Y Acad Sci. 2015;1343:27-36.
Strupp, M., Zwergal, A., Feil, K., Bremova, T., & Brandt, T. (2015). Pharmacotherapy of vestibular and cerebellar disorders and downbeat nystagmus: translational and back-translational research. Annals of the New York Academy of Sciences, 1343, 27-36. https://doi.org/10.1111/nyas.12774
Strupp M, et al. Pharmacotherapy of Vestibular and Cerebellar Disorders and Downbeat Nystagmus: Translational and Back-translational Research. Ann N Y Acad Sci. 2015;1343:27-36. PubMed PMID: 25903394.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pharmacotherapy of vestibular and cerebellar disorders and downbeat nystagmus: translational and back-translational research. AU - Strupp,Michael, AU - Zwergal,Andreas, AU - Feil,Katharina, AU - Bremova,Tatiana, AU - Brandt,Thomas, PY - 2015/4/24/entrez PY - 2015/4/24/pubmed PY - 2015/6/25/medline KW - Ménière's disease KW - acute unilateral vestibulopathy KW - aminopyridines KW - central vestibular disorders KW - cerebellar ataxias KW - downbeat nystagmus KW - episodic ataxia type 2 KW - vestibular migraine KW - vestibular paroxysmia SP - 27 EP - 36 JF - Annals of the New York Academy of Sciences JO - Ann N Y Acad Sci VL - 1343 N2 - There are currently eight groups of drugs for the pharmacotherapy of vertigo, nystagmus, and cerebellar disorders: antiemetics; anti-inflammatories, antimenieres, and antimigraineous medications; antidepressants, anticonvulsants, aminopyridines, and acetyl-DL-leucine ("the eight A's"). In acute unilateral vestibulopathy, corticosteroids improve the recovery of peripheral vestibular function, but there is not sufficient current evidence for a general recommendation. There is also insufficient evidence that 48 or 144 mg/day betahistine has an effect in Ménière's disease. Therefore, higher dosages are currently recommended; in animal studies, it was shown that betahistine increases cochlear blood flow. In vestibular paroxysmia, oxcarbazepine was effective (one yet not randomized controlled trial (RCT)). Aminopyridines are recommended for the treatment of downbeat nystagmus (two RCTs) and episodic ataxia type 2 (EA2, one RCT). There are so far no RCTs on vestibular migraine, so currently no treatment can be recommended. Acetyl-dl-leucine improves cerebellar ataxia (three observational studies); it also accelerates central compensation in an animal model of acute unilateral lesion, but RCTs were negative. There are ongoing RCTs on vestibular paroxysmia with carbamazepine (VESPA), acute unilateral vestibulopathy with betahistine (BETAVEST), vestibular migraine with metoprolol (PROVEMIG), benign paroxysmal positional vertigo with vitamin D (VitD@BPPV), EA2 with 4-aminopyridine versus acetazolamide (EAT-2-TREAT), and cerebellar ataxias with acetyl-DL-leucine (ALCAT). SN - 1749-6632 UR - https://www.unboundmedicine.com/medline/citation/25903394/Pharmacotherapy_of_vestibular_and_cerebellar_disorders_and_downbeat_nystagmus:_translational_and_back_translational_research_ L2 - https://doi.org/10.1111/nyas.12774 DB - PRIME DP - Unbound Medicine ER -