Event:

Pharmacotherapy of vertigo, dizziness and nystagmus

The various forms of vertigo and dizziness are treated with pharmacological therapy, physical therapy, psychotherapeutic measures and, rarely, surgery. For pharmacotherapy there are basically eight groups of drugs that can be used (the “8 ‘A’s”): antiemetics; anti-inflammatory, anti-menières, and anti-migraineous medications; anti-depressants, anti-convulsants, aminopyridines and acetyl-DL-leucine.
Peripheral vestibular disorders: Acute vestibular neuritis. A prospective randomized placebo-controlled study showed that methylprednisolone alone significantly improves the recovery of peripheral vestibular function in patients with vestibular neuritis, whereas valacyclovir does not. The combination of methylprednisolone and valacyclovir was not superior to steroid monotherapy. Menière’s disease (MD). In an open, non-masked trial, in which patients with MD received either a low dosage of betahistine-dihydrochloride (16 or 24 mg tid) or a higher dosage of 48 mg tid for at least 12 months it was demonstrated that the higher dosage is more efficient. Vestibular paroxysmia. In an open trial it was demonstrated that carbamazepine in a dosage of 400 to 600 mg per day significantly reduces the number of attacks of vestibular paroxysmia.
Central vestibular, ocular and cerebellar disorders: Downbeat and upbeat nystagmus, episodic ataxia type 2 and other cerebellar disorders. Recent trials showed that the potassium channel blocker and 4-aminopyridine is effective for the treatment of downbeat nystagmus and upbeat nystagmus as well as episodic ataxia type 2 (EA 2) Finally, it was demonstrated that the modified amino acid acetyl-DL-leucine improves cerebellar ataxia.
Perspectives: There are currently eight on-going placebo-controlled clinical trials at the German Center for Vertigo and Balance Disorders (all funded by the Federal Ministry Research (BMBF)) on the following vestibular and cerebellar disorders (agents in parentheses),: BPPV (vitamin D), vestibular paroxysmia (carbamazepine), vestibular migraine (metoprolol), acute vestibular neuritis (betahistine), Menière’s disease (high dose betahistine), episodic ataxia type 2 (Fampiridine and acetazolamide), cerebellar gait ataxia (Fampiridine) and cerebellar ataxia (acetyl-DL-leucine).