Preview

Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Optimal duration of therapy in the recovery period of vestibular diseases

https://doi.org/10.14412/2074-2711-2014-3-10-16

Full Text:

Abstract

Dizziness is a common symptom in neurological and general medical practice. In most cases it is caused by diseases of the central or peripheral vestibular system. The most common vestibular system diseases include benign paroxysmal postural vertigo, dizziness, Meniere's disease, vestibular neuronitis, and cerebrovascular diseases. One of the main treatments for the diseases accompanied by dizziness is vestibular rehabilitation that is a complex of exercises, the goal of which is to stimulate vestibular compensation. Adequate vestibular compensation allows a patient to get rid of dizziness and unsteadiness even though vestibular system injury is irreversible. Some medications are able to enhance the efficiency of vestibular rehabilitation. At the same time, the optimal duration of treatment for the most common vestibular disorders has not been
adequately explored. The paper gives the results of an observational program, whose purpose was to determine the optimal duration of vestibular rehabilitation in combination with the use of tanakan in patients with non-progressive unilateral peripheral vestibular disorder.

Patients and methods. Data on 46 patients aged 19 to 70 years who underwent vestibular rehabilitation and took tanakan for vertigo caused by vestibular neuronitis (n = 44), labyrinthitis (n =1), or Ramsay Hunt syndrome (n = 1) were analyzed. All the patients were examined four times. The symptoms were recorded and the histories of disease were considered. The degree of vestibular disorders, including vertigo, was assessed when collecting complaints. The symptoms of vertigo were objectivized using its vertigo rating scale and five-point subjective rating scale for vertigo. All the patients underwent standard somatic and neurological examinations and videonystagmography. During the first visit after diagnosis, vestibular exercises were chosen for the patients and tanakan was used in a dose of 40 mg thrice daily to accelerate vestibular
compensation. During visits 2, 3, and 4, the symptoms of the disease were recorded in the patients and the time course of treatment-induced changes in their status was estimated.

Results. The optimal duration of treatment was established to be at least 2 months. Vestibular exercises in combination with the intake of tanakan resulted in a reduction in the symptoms of vestibular dysfunction and in emotional improvement in the patients.

About the Authors

M. V. Zamergrad
A.Ya. Kozhevnikov Clinic of Nervous System Diseases, I.M. Sechenov First Moscow State Medical University Ministry of Health of Russia
Russian Federation

Moscow, Russia 8, Trubetskaya St., Build. 2, Moscow 119991



V. A. Parfenov
A.Ya. Kozhevnikov Clinic of Nervous System Diseases, I.M. Sechenov First Moscow State Medical University Ministry of Health of Russia
Russian Federation
Moscow, Russia 8, Trubetskaya St., Build. 2, Moscow 119991


N. N. Yakhno
A.Ya. Kozhevnikov Clinic of Nervous System Diseases, I.M. Sechenov First Moscow State Medical University Ministry of Health of Russia
Russian Federation
Moscow, Russia 8, Trubetskaya St., Build. 2, Moscow 119991


References

1. Neuhauser HK. Epidemiology of vestibular vertigo. Neurology. 2005;65:898–904. DOI: http://dx.doi.org/10.1212/01.wnl. 0000175987.59991.3d.

2. Замерград МВ, Парфенов ВА, Яхно НН и др. Диагностика системного головокружения в амбулаторной практике. Неврологический журнал. 2014;19(2):23–9. [Zamergrad MV, Parfenov VA, Yakhno NN, et al. The diagnosis of systemic vertigo in out-patient practice. Nevrologicheskii zhurnal. 2014;19(2):23–9. (In Russ.)]

3. Balci BD, Akdal G, Yaka E, Angin S. Vestibular rehabilitation in acute central vestibulopathy: a randomized controlled trial. J Vestib Res. 2013;23(4–5):259–67.

4. Hillier SL, Hollohan V. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2007;17: CD005397.

5. Han BI, Song HS, Kim JS. Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises. J Clin Neurol. 2011 Dec;7(4):184–96. DOI: http://dx.doi.org/10.3988/jcn.2011.7.4.184.

6. Shepard NT, Telian SA. Programmatic vestibular rehabilitation. Otolaryngol Head Neck Surg. 1995;112:173–82. DOI: http://dx.doi.org/10.1016/S0194- 5998(95)70317-9.

7. Denise P, Bustany P. The effect of extract of Ginkgo biloba (EGb 761) on central compensation of a total unilateral peripheral vestibular deficite in the rat. In: Vestibular compensation: facts, theories and clinical perspectives. Lacour M, Toupet M, Denise P, Chirsten Y, editors. Paris: Elsevier; 1989. P. 201–8.

8. Lacour M, Ez-Zaher L, Raymond J. Plasticity mechanisms in vestibular compensation in the cat are improved by an extract of Ginkgo biloba (EGb 761). Pharmacol Biochem Behav. 1991 Oct;40(2):367–79. DOI: http://dx.doi.org/10.1016/0091-3057(91)90568-M.

9. Yabe T, Chat M, Malherbe E, Vidal PP. Effects of Ginkgo biloba extract (EGb 761) on the guinea pig vestibular system. Pharmacol Biochem Behav. 1992;42(4):595–604. DOI: http://dx.doi.org/10.1016/0091-3057(92)90004-Y.

10. Maclennan K, Smith PF, Darlington CL. The effects of ginkgolide B (BN52021) on guinea pig vestibular nucleus neurons in vitro: importance of controlling for effects of dimethylsulphoxide (DMSO) vehicles. Neurosci Res. 1996;26(4):395–9. DOI: http://dx.doi.org/10.1016/S0168- 0102(96)01118-2.

11. Hamann KF. Physical treatment of vertigo of peripheral origin in combination with standargized ginkgo biloba extract (EGb 761). Therapiewoche. 1985;33:4586–90.

12. Hamann KF. Special ginkgo extract in cases of vertigo: a systematic review of randomised, double-blind, placebo controlled clinical examinations. HNO. 2007;55(4):258–63. DOI: http://dx.doi.org/10.1007/s00106-006-1440-5.

13. Haguenauer JP, Cantenot F, Koskas H, Pierart H. Treatment of equilibrium disorders with Ginkgo biloba extract. A multicenter double- blind drug vs. placebo study. Presse Med. 1986;15(31):1569–72.

14. Claussen CF, Kirtane MV. Randomisierte doppelblindstudie zur wirkung von extractum Ginkgo biloba bei Schwindel und Gangunsicherheit des alteren Menschen. In: Presyvertigo, Presbyataxie, Presbytinnitus. Claussen CF, editor. Berlin: Springer; 1985. P. 103–15. DOI: http://dx.doi.org/10.1007/978-3-642-70035-4_4.

15. Jacobson GP, Newman CW. The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg.1990;116:424–7. DOI: http://dx.doi.org/10.1001/archotol. 1990.01870040046011.

16. Arbusow V, Schulz P, Strupp M, et al. Distribution of herpes simplex virus type I in human geniculate and vestibular ganglia: implications for vestibular neuritis. Ann Neurol. 1999;46:416–19. DOI: http://dx.doi.org/10.1002/1531- 8249(199909)46:3%3C416::AIDANA20% 3E3.0.CO;2-W.

17. Okinaka Y, Sekitani T, Okazaki H, et al Progress of caloric response of vestibular neuronitis. Acta Otolaryngol. 1993;503:18–22. DOI: http://dx.doi.org/10.3109/ 00016489309128064.

18. Woelk H, Arnoldt KH, Kieser M, Hoerr R. Ginkgo biloba special extract EGb 761 in generalized anxiety disorder and adjustment disorder with anxious mood: a randomized, doubleblind, placebo-controlled trial. J Psychiatr Res. 2007;41(6):472–80. DOI: http://dx.doi.org/10.1016/j.jpschires. 2006.05.004.

19. Yang YL, Su YW, Ng MC, et al. Extract of Ginkgo biloba EGb761 facilitates extinction of conditioned fear measured by fear-potentiated tartle. Neuropsychopharmacology. 2007;32(2):332–42. DOI: http://dx.doi.org/10.1038/sj.npp.1301060.

20. Zheng Y, Goddard M, Darlington CL, Smith PF. Effects of bilateral vestibular deafferentation on anxiety-related behaviours in Wistar rats. Behav Brain Res. 2008;193(1):55–62. DOI: http://dx.doi.org/10.1016/j.bbr.2008.04.018.

21. Staab JP. Chronic dizziness: the interface between psychiatry and neuro-otology. Curr Opin Neurol. 2006;19(1):41–8. DOI: http://dx.doi.org/10.1097/01.wco.0000198102.95294.1f.

22. Staab JP, Ruckenstein MJ. Which comes first? Psychogenic dizziness versus otogenic anxiety. Laryngoscope. 2003;113(10):1714–8. DOI: http://dx.doi.org/10.1097/00005537- 200310000-00010.


For citation:


Zamergrad M.V., Parfenov V.A., Yakhno N.N. Optimal duration of therapy in the recovery period of vestibular diseases. Neurology, Neuropsychiatry, Psychosomatics. 2014;6(3):10-16. (In Russ.) https://doi.org/10.14412/2074-2711-2014-3-10-16

Views: 738


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)