Gentamicina intratimpánica comparado con placebo para la enfermedad de Ménière / Intratympanic gentamicin compared with placebo for Ménière's disease

INTRODUCCION La enfermedad de Ménière es una anomalía del oído interno de etiología multifactorial, caracterizada por episodios de vértigo espontáneo y recurrente, hipoacusia fluctuante y tinnitus. La terapia con gentamicina intratimpánica para la enfermedad de Ménière ha sido utilizada buscando reducir la intensidad y frecuencia de las crisis, pero se ha asociado a pérdida auditiva, por lo que existe controversia respecto a su eficacia y seguridad. MÉTODOS Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos 13 revisiones sistemáticas que en conjunto incluyeron 80 estudios primarios, de los cuales tres corresponden a ensayos aleatorizados. Concluimos que la gentamicina intratimpánica podría reducir el control del vértigo y resultar en poca o nula diferencia sobre el tinnitus, pero la certeza de evidencia es baja. Además, no es posible establecer con claridad si el uso de gentamicina intratimpánica disminuye la audición o la frecuencia de los ataques de vértigo porque la certeza de la evidencia existente ha sido evaluada como muy baja.

INTRODUCTION Ménière's disease is a multifactorial disorder affecting the inner ear, characterized by episodes of spontaneous and recurrent vertigo, fluctuating hearing loss and tinnitus. Intratympanic gentamicin therapy has been used to reduce the intensity and frequency of attacks in intractable Ménière's disease, but it is associated with hearing loss. There is controversy regarding its efficacy and safety. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified 13 systematic reviews that included 80 primary studies overall, of which three correspond to randomized trials. We concluded that intratympanic gentamicin may improve the control of vertigo, and result in little or no difference to tinnitus, but the certainty of the evidence is low. Furthermore, we are uncertain whether intratympanic gentamicin reduces hearing or the frequency of vertigo attacks as the certainty of the evidence has been assessed as very low.

Uso de gentamicina transtimpánica: experiencia del Hospital Clínico de la Universidad de Chile / Transtympanic gentamicin: experience in Hospital Clínico Universidad de Chile

RESUMEN Introducción: La gentamicina transtimpánica se utiliza en el manejo de pacientes con vértigo crónico refractario al manejo médico. Objetivo: Describir y analizar las características clínicas, epidemiológicas, y resultados de pacientes sometidos a tratamiento con gentamicina transtimpánica en el Hospital Clínico de la Universidad de Chile. Material y método: Estudio retrospectivo, descriptivo, incluyendo los pacientes con patología otorrinolaringológica que hayan recibido gentamicina transtimpánica entre los años 2008 y 2018. Se analizaron variables epidemiológicas, clínicas, y función vestibular. Resultados: La serie está constituida por diez pacientes, con una edad promedio de 52,4 años; siete mujeres y tres hombres. El diagnóstico fue en su mayoría enfermedad de Ménière (7 pacientes). El número promedio de inyecciones de gentamicina fue de 2,8. En el período de seguimiento (rango 1-96 meses), se logró mejoría del vértigo en la mayoría de los pacientes (8 de 10). Conclusión: El tratamiento con inyecciones de gentamicina transtimpánica es una opción importante para aliviar la sintomatología de pacientes con vértigo crónico intratable. Debe indicarse en casos seleccionados, y siempre realizar un estudio auditivo y vestibular completo antes y después del tratamiento con gentamicina.

ABSTRACT Introduction: Transtympanic gentamicin is used for treatment of patients with chronic vertigo refractory to medical management. Aim: To describe and analyze the clinical outcome of patients whom underwent treatment with transtympanic gentamicin at the Clinical Hospital Universidad de Chile. Material and method: Retrospective and descriptive study including patients with otolaryngologist disease whom underwent treatment with transtympanic gentamicin between 2008 and 2018. Epidemiological, clinical variables and vestibular function were analyzed. Results: The serie consists of ten patients, 7 men and 3 women, with an average age of 52,4 years. The most frequent diagnosis was Ménière disease (7 patients). The average number of gentamicin injections was 2,8. The follow up varies from 1 to 96 months, presenting improvement of vertigo in the majority of the cases (8 of 10 patients). Conclusion: The treatment with transtympanic injections of gentamicin is a relevant option to decrease symptoms in patients with chronic intractable vertigo. It should be indicated in selected patients. Prior and posterior the treatment, patients must be studied with a complete evaluation of the auditory and vestibular function.

Intratympanic Gentamicin for Intractable Ménière's Disease - A Review and Analysis of Audiovestibular Impact

Abstract Introduction Intratympanic gentamicin regulates the symptoms in most patients with incapacitating Ménière's disease. The treatment protocols have changed over the years from medical labyrinthectomy to preservation of vestibular function. Objectives This study aims to review the audiovestibular response related to the effect of the drug in controlling vertigo. Data Synthesis Articles were identified by means of a search in the PubMed database using the key words Meniere and intratympanic or transtympanic gentamicin. Total 144 articles were reviewed after excluding those that were technical reports, those based on experimental animal studies, those that focused on outcomes other than vertigo (tinnitus or aural fullness), those with delivery methods other than tympanic membrane injection, and those with bilateral cases. If there was more than one article by the same author(s) or institution, only the most recent one matching the aforementioned criteria and those that were not overlapping were included. Conclusion Titration methods or multiple injections on a daily basis can be preferred if the patients have profound or non-serviceable hearing, since these methods have significant incidence of hearing loss. Treatment protocols with a frequency of injection not shorter than once a week, or those with injections on a monthly basis as "needed" provide the same level of vertigo control with better preservation of hearing. Caloric testing is not an ideal tool to analyze the correlation between vertigo control and the effect of gentamicin as compared with gain asymmetry of the vestibulo-ocular reflex. Vestibular-evoked myogenic potentials and the head thrust test are more reliable than other vestibular tests for the follow-up of patients undergoing gentamicin treatment.

¿Son efectivos los diuréticos en la enfermedad de Ménière? / Are diuretics effective for Ménière`s disease?

INTRODUCCIÓN: La enfermedad de Ménière es una anomalía del oído interno caracterizada por episodios de vértigo espontáneo, hipoacusia fluctuante y tinnitus. Los diuréticos han sido ampliamente utilizados para el tratamiento de las crisis de esta enfermedad, pero existe controversia respecto a su eficacia. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos tres revisiones sistemáticas que en conjunto incluyen diecinueve estudios primarios, de los cuales, cuatro son ensayos aleatorizados. Concluimos que no está claro si el uso de diuréticos lleva a una mejoría sintomática del vértigo o a una disminución objetiva de la hipoacusia en pacientes con enfermedad de Ménière, porque la certeza de la evidencia es muy baja.

INTRODUCTION: Ménière`s disease is an inner ear disorder characterized by episodes of spontaneous vertigo, fluctuating hearing loss and tinnitus. Diuretics have been widely used for the treatment of attacks, but there is controversy about their effectiveness. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified three systematic reviews including nineteen studies overall, of which four were randomized trials. We concluded it is not clear whether diuretics lead to a symptomatic improvement of vertigo or an objective decrease in hearing loss in patients with Ménière`s disease, because the certainty of the evidence is very low.

Paroxismia vestibular: reporte de un caso / Vestibular paroxysmia: case report

Presentamos el caso de un paciente joven quien presenta 4 a 5 crisis diarias de vértigo espontáneo de segundos de duración, todos o casi todos los días desde hace 9 meses. Estas crisis no tienen gatillo posicional, y hay completa ausencia de sintomatologia entre crisis. Como discutimos en el artículo, este cuadro coíncide con los recientemente publicados criterios para una paroxismia vestibular, entidad supuestamente secundaria a la compresión neurovascular del nervio vestibular. El paciente respondió de forma inmediata y completa a carbamazepina a dosis bajas, el tratamiento de elección en la paroxismia vestibular.

We present the case of a young patient, with a 9-month long history of 4 to 5 daily spells of spontaneous vertigo, each lasting only seconds. There is no positional trigger, and there is a complete lack of symptoms between attacks. As is discussed in the article, this matches the recently published criteria for Vestibular Paroxysmia, an entity allegedly secondary to neurovascular compression of the vestibular nerve. The patient responded immediately and completely to carbamazepine at low dosage, the preferred treatment for vestibular paroxysmia.

Clinical characteristics of patients with persistent postural-perceptual dizziness / Caracterização clínica dos pacientes com tontura postural-perceptual persistente (TPPP)

INTRODUCTION: Persistent postural-perceptual dizziness is the dizziness that lasts for over three months with no clinical explanation for its persistence. The patient's motor response pattern presents changes and most patients manifest significant anxiety. OBJECTIVE: To evaluate the clinical characteristics of patients with persistent postural and perceptual dizziness. METHODS: statistical analysis of clinical aspects of patients with persistent postural-perceptual dizziness. RESULTS: 81 patients, average age: 50.06 ± 12.16 years; female/male ratio: 5.7/1; main reasons for dizziness: visual stimuli (74%), body movements (52%), and sleep deprivation (38%). The most prevalent comorbidities were hypercholesterolemia (31%), migraine headaches (26%), carbohydrate metabolism disorders (22%) and cervical syndrome (21%). DHI, State-Trait Anxiety Inventory - Trait, Beck Depression Inventory, and Hospital Anxiety and Depression Scale questionnaires were statistically different (p < 0.05) when compared to controls. 68% demonstrated clinical improvement after treatment with serotonin reuptake inhibitors. CONCLUSION: Persistent postural-perceptual dizziness affects more women than men, with a high associated prevalence of metabolic disorders and migraine. Questionnaires help to identify the predisposition to persistent postural-perceptual dizziness. The prognosis is good with adequate treatment. .

INTRODUÇÃO: A denominação tontura postural-perceptual persistente (TPPP) é atribuida à tontura que se mantém por mais de 3 meses em pacientes, sem que exista justificativa clínica para a sua persistência. A maioria dos pacientes possui perfil ansioso ou experimenta alto grau de ansiedade no início dos sintomas. O padrão de resposta motora apresenta-se alterado, com hipervigilância e hipersensibilidade a estímulos visuais e de movimento. OBJETIVO: Avaliar as características clínicas de pacientes com diagnóstico de TPPP. MÉTODO: Análise dos aspectos clínicos de pacientes do ambulatório de TPPP e quantificação do perfil ansioso ou depressivo. RESULTADOS: Foram avaliados 81 pacientes, com média de idade de 50,06 ± 12,16 anos; relação mulher/homem de 5,7/1; principais gatilhos para tontura: estímulos visuais (74%), movimentos corporais (52%) e privação de sono (38%). As comorbidades mais prevalentes foram hipercolesterolemia (31%), migrânea (26%), distúrbios do metabolismo do açúcar (22%) e síndrome cervical (21%). Os questionários DHI, STAI-Traço, Beck para depressão e HADS foram estatisticamente diferentes (P < 0,05) entre pacientes e controles. 68% de melhora clínica com o uso de inibidores da recaptação da serotonina. CONCLUSÃO: TPPP acomete principalmente as mulheres, sendo alta a associação com distúrbios metabólicos e migrânea. Os questionários auxiliam na identificação da predisposição à TPPP. Há bom prognóstico com o tratamento adequado. .

Fatores prognósticos em perda auditiva neurossensorial súbita: estudo retrospectivo usando efeitos de interação / Prognostic factors in sudden sensorineural hearing loss: a retrospective study using interaction effects

O significado prognóstico de vertigem em pacientes com perda auditiva neurossensorial súbita idiopática (PANSI) continua a ser uma questão controversa. OBJETIVO: Este trabalho tem como objetivo verificar a diferença entre um grupo com vertigem e um grupo sem vertigem e analisar a validação da vertigem como fator prognóstico em pacientes com PANSI. MÉTODO:Este estudo envolveu 183 pacientes com PANSI. O teste t foi utilizado para comparar o grupo A (PANSI com vertigem, n = 31) e o grupo B (PANSI sem vertigem, n = 152). Também queremos verificar os efeitos de interação entre vertigem e outros fatores prognósticos por meio de análise de regressão múltipla. RESULTADOS: Houve uma diferença significativa entre o grupo A e o grupo B: o nível auditivo inicial do grupo A foi menor do que no grupo B, e seu início de tratamento também foi menor. Além disso, a vertigem em si não afetou a melhora da audição, mas a variável de interação entre vertigem e nível de audição inicial afetou significativamente a melhora da audição. CONCLUSÃO: As características clínicas dos pacientes com vertigem não afetaram diretamente a melhora da audição de pacientes com PANSI; no entanto, vertigem teve uma influência sobre a PANSI por meio de sua interação com os níveis iniciais de audição.

The prognostic significance of vertigo in patients with idiopathic sudden sensorineural hearing loss (SSNHL) remains a matter of debate. OBJECTIVE: This paper aims to verify the difference between a group with vertigo and a group without vertigo, and to analyze vertigo's validation as a prognostic factor in patients with SSNHL. METHOD: This study involved 183 patients with SSNHL. A t-test was used to compare group A (SSNHL with vertigo, n = 31) and group B (SSNHL without vertigo, n = 152). Also we want to verify the interaction effects between vertigo and other prognostic factors using multiple regression analysis. RESULTS: There was a significant difference between group A and group B: the initial hearing level of group A was lower than group B, and their treatment onset was also shorter. In addition, vertigo itself didn't affect hearing improvement, but the interaction variable between vertigo and initial hearing level did affect hearing improvement significantly. CONCLUSION: The clinical characteristics of patients with vertigo did not directly affect hearing improvement with SSNHL; however, vertigo had an influence on SSNHL though its interaction with the initial hearing levels.

Vértigo con nistagmo vertical por administración de morfina intratecal y reversión con naloxona / Vertigo and vertical nystagmus associated with intrathecal morphine administration and resolution by naloxone

La anestesia regional combinada es utilizada frecuentemente como herramienta para el tratamiento del dolor postoperatorio. Los efectos secundarios de los opioides utilizados por esta vía son similares a los que se presentan luego de la administración sistémica. La aparición de vértigo con nistagmo vertical es un efecto adverso muy pocas veces descripto con el uso de morfina por vía intratecal, epidural o endovenosa. Comunicamos el caso de un paciente que presentó esta complicación en el postoperatorio de una nefrectomía parcial, luego de la administración de morfina intratecal, con resolución completa mediante el uso de naloxona endovenosa.

Combined regional anesthesia is frequently used as a tool for management of postoperative pain. The profile of side effects of the opioids used via this route is similar to those occurring after systemic administration. The onset of vertigo with vertical nystagmus is an adverse effect rarely described after the use of intrathecal, epidural or intravenous morphine. We report the case of a patient who presented this complication in the postoperative period of a partial nephrectomy, after the administration of intrathecal morphine, with complete resolution by intravenous naloxone.

Low dose transtympanic gentamicin treatment for intractable Meniere's disease: a prospective study.

OBJECTIVE: To evaluate the effectiveness of low dose transtympanic gentamicin treatment in Meniere's disease. MATERIAL AND METHOD: Prospective study of 20 disable Meniere's patients in Ramathibodi Hospital who received transtympanic gentamicin treatment for Meniere's disease by fixed dose regimen of 12 injections during a period of 4 days. The study took place from March 1999 to December 2004. The hearing and equilibrium guidelines for reporting treatment results in Meniere's disease of the American Academy of Otolaryngology and Head & Neck Surgery (1995) were used. The outcomes of treatment were evaluated at the 6th month. The multivariate repeated measures ANOVA was used for statistical comparisons. RESULTS: During the 5-year period, there were 20 patients, 9 men, and 11 women. The six-month outcomes of vertigo control, the functional level scale and tinnitus score were significantly improved by the treatment. Whereas, the mid frequency pure tone threshold average and the speech discrimination score were not significantly affected. CONCLUSION: Fixed low dose transtympanic gentamicin treatment was found to be an effective treatment option for patients with disabling or intractable Meniere's disease, with a low incidence of hearing deterioration. The use of this method appears to be practical and has been set as the standard protocol replacing the vestibular surgery in Ramathibodi Hospital.

Manobras para o tratamento da vertigem posicional paroxística benigna: revisão sistemática da literatura / Maneuvers for the treatment of benign positional paroxysmal vertigo: a systematic review

A Vertigem Posicional Paroxística Benigna (VPPB) é uma das mais freqüentes patologias do sistema vestibular e é caracterizada por episódios de vertigens recorrentes desencadeados por movimentos da cabeça ou mudanças posturais. Há várias opções para o seu tratamento, porém as efetividades terapêuticas das mesmas permanecem controversas. OBJETIVO: Avaliar a efetividade terapêutica das manobras específicas disponíveis para o tratamento da VPPB. METODOLOGIA: Realizou-se uma busca eletrônica nas principais bases de dados, selecionando-se estudos clínicos randomizados envolvendo adultos com diagnóstico de VPPB confirmado com o teste de Dix-Hallpike e tratamento com manobras específicas (Epley ou Semont, por exemplo). Considerou-se como desfecho clínico a negativação do teste de Dix-Hallpike e a melhora das queixas subjetivas. Agruparam-se em metanálise os estudos com Escala de Jadad igual ou superior a três. RESULTADOS: Cinco estudos clínicos preencheram os critérios de inclusão, ou seja, ensaios randomizados de fase I comparando a manobra de Epley com placebos e controles. A metanálise mostra evidência dos efeitos benéficos da manobra de Epley para o tratamento do canal semicircular posterior (magnitude do efeito de 0,11 [IC 95 por cento 0.05, 0.26] de melhora objetiva (Dix-Halpike) após uma semana, 0.24 [IC 95 por cento 0.13, 0.45] após um mês e 0.16 [IC 95 por cento 0.08, 0.33] de melhora referida pelos pacientes após a primeira semana). CONCLUSÃO: Evidencia-se boa eficácia clínica da manobra de Epley para o tratamento da VPPB do canal semicircular posterior. Contrariamente, trabalhos com a manobra de Semont e as propostas de manejo dos demais canais semicirculares não obtiveram qualidade metodológica satisfatória, não sendo possível demonstrar a efetividade dos mesmos

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most frequent diseases of the vestibular system and it is characterized by episodes of recurrent vertigo triggered by head movements or position changes. There are several approaches for treatment, but efficacy is still being discussed. AIM: To asses the effectiveness of the specific maneuvers available to the treatment of BPPV. METHODOLOGY: An electronic search at the main databases, including MEDLINE, LILACS, PEDro, Cochrane Collaborations Database was performed, and we selected only randomized clinical trials studying adults with diagnosis of BPPV confirmed by the Dix-Hallpike test. The trials should have included physical maneuvers such as Epley and Semont. The main outcome was Dix-Hallpike negative test and the changes to subjective complaints. The trials were assessed using Jadad's scale and only studies with quality scores equal or above 3 were pooled on a meta-analyses to assess their effectiveness. RESULTS: We found five controlled clinical trials phase I comparing the Epley's maneuver with controls or placebo. The meta-analysis showed positive evidence of Epley's maneuver to the posterior semicircular canal (effect size = 0.11 [CI 95 percent 0.05, 0.26] of objective improvement [Dix-Halpike] within one week, 0.24 [CI 95 percent 0.13, 0.45] within one month and 0.16 [CI 95 percent 0.08, 0.33] of improvement reported by the patients within one week. There are no studies about the efficacy of Semont's maneuver. CONCLUSION: There is scientific evidence showing good efficacy of Epley's maneuver in the treatment.

Síndrome de Cogan: relato de caso / Cogan's Syndrome: case report

Ceratite intersticial não luética, surdez e vertigem caracterizam a síndrome de Cogan. Os achados oculares mais comuns no início da síndrome são opacidades corneanas numulares periféricas bilaterais. O tratamento desta rara doença utiliza imunossupressão sistêmica com agentes citotóxicos e corticosteróides. O relato de caso apresenta uma paciente com a evolução da forma clássica da síndrome de Cogan.

Experiencia en el tratamiento de la enfermedad de Ménière con terapia transtimpánica / Experience in the treatment of Ménière disease with trans-tympanic therapy

El tratamiento de la enfermedad de Ménière continúa siendo controversial. Existen muchos tratamientos disponibles con diferentes efectividades. La terapia transtimpánica es una novedosa arma terapéutica que se está introduciendo gradualmente en el campo de la otología. Este estudio pretende: 1) Evaluar la utilidad de la terapia transtimpánica en el tratamiento de la enfermedad de Ménière. 2) Dar a conocer la experiencia de nuestro centro al respecto. Para ello se evaluó retrospectivamente, por medio de una encuesta telefónica, la respuesta clínica de los pacientes con enfermedad de Ménière que recibieron terapia transtimpánica (corticoides y/o gentamicina) entre los años 2002 y 2004. Se estudió a 34 pacientes, con un promedio de edad de 53 años. El 79,4 por ciento (n=27) presentó una respuesta favorable en relación a su sintomatología vestibular (p=0,02) y un 55,9 por ciento (n=19) refirió mejoría total de ella. Cuatro pacientes que no respondieron a corticoides transtimpánicos recibieron gentamicina intratimpánica, llegando a la parálisis vestibular total y mejoría de su sintomatología vestibular. Se concluye que los corticoides transtimpánicos son efectivos en el tratamiento de la sintomatología vestibular en la enfermedad de Ménière. La gentamicina intratimpanica es una alternativa eficaz para los pacientes que no responden a corticoides transtimpánicos.

Paroxismia vestibular: estudo clínico e tratamento de oito pacientes / Vestibular paroxysmia: clinical study and treatment of eight patients

A paroxismia vestibular é uma síndrome de compressão do VIII nervo craniano e foi denominada inicialmente por Janetta "vertigem posicional incapacitante". Esta síndrome é caracterizada por episódios curtos de vertigem, zumbido, déficit vestibular e auditivo. A RM pode mostrar compressão do VIII nervo por vasos da fossa posterior, como a artéria basilar, artéria vertebral, artéria cerebelar inferior anterior, artéria cerebelar inferior posterior. A paroxismia vestibular pode ser tratada com terapia medicamentosa tais como carbamazepina, fenitoína ou gabapentina, ou com descompressão microvascular do VIII nervo. Este estudo descreve oito pacientes com paroxismia vestibular. Quatro deles mostraram também sinais clínicos sugerindo compressão do V e/ou VII nervos. Sete pacientes tratados com carbamazepina tiveram melhora significativa da vertigem e zumbido.

Treatment of memory impairment, vertigo and tinnitus in the elderly with piribedil in an Indian general practice setting.

Age-related dopamine decline leads to memory impairment, vertigo or tinnitus leading to a reduced quality of life in the elderly. This study demonstrates the efficacy and acceptability of piribedil, a dopamine agonist, in improving these conditions. Of the 515 patients included in the study, there was complete resolution of memory impairment, vertigo and tinnitus in 103 patients (20%), improvement in 374 cases (72.6%), with 38 cases (7.4%) showing no change after one month's treatment with piribedil. The treatment was well accepted with a low frequency of side-effects and full compliance with daily medication.

Pre and post betahistine therapy 99m Tc - HMPAO brain spect studies in patients with vertigo.

Vertebro basilar insufficiency (VBI) is a well known cause of vertigo. Brain Single Photon Emission Computed Tomography (SPECT) is an important diagnostic tool to detect and to quantitate the perfusion abnormalities in different areas of the brain. Effect of an antivertigo drug Betahistine on improving the hypoperfusion in different areas of the brain in vertigo patients was studied using brain SPECT. Betahistine at a dose of 16 mg three times daily was shown to improve perfusion in the hypoperfused areas of the brain resulting in relief from symptoms of vertigo. The cerebellar region, which is the most important area involved in vertigo patients with vascular pathology, showed almost complete normalisation of perfusion following Betahistine therapy.

Revisión de los medicamentos antivertiginosos / a review of antivertigo medication

Objetivo. Valorar la información existente sobre los efectos de las sustancias antivertiginosas, basados en la bibliografía asequible. Información. Se localizaron artículos pertinentes en Medline y en revistas obtenidas en la ciudad de México. Selección del material. Los artículos se seleccionaron en base a su aparente consistencia interna y su relación con el propósito de la revisión. Conclusión. Se evaluaron 22 substancias pertenecientes a 8 grupos farmacológicos (colinérgicos, antihistamínicos, GABAérgicos, bloqueadores de canales de calcio, serotoninérgicos, hemorreológicos, antiagregantes plaquetarios y diuréticos) útiles en diversos padecimientos vertiginosos. Se advirtió la necesidad de un método objetivo y cuantitativo para valorar resultados de ensayos clínicos en humanos. Mientra esto no ocurra, tendremos que usar los medicamentos en base de una información veraz, confiable y basada sólidamente en la farmacología estudiada en experimentos con animales y en la valoración cuidadosa de los efectos -buenos y malos- observados en nuestros pacientes.