Preview

Meditsinskiy sovet = Medical Council

Advanced search

Drug and non-drug treatments of vertigo

https://doi.org/10.21518/2079-701X-2021-2-39-44

Abstract

Patients with complaints of “dizziness” often make an odyssey of visits to physicians belonging to various specialties. The prevalence of vertigo in the population is 17–30%. In most cases, disorders of various areas of the vestibular analyzer form the pathogenetic basis of vertigo and unsteadiness, while the most common cause of these complaints is the pathology of the peripheral area of the vestibular system: benign paroxysmal positional vertigo, vestibular neuronitis, Meniere’s disease. The cerebral vessel disease caused by hypertensive cerebral microangiopathy and cerebral atherosclerosis can also manifest by vertigo and unsteadiness. They can be represented by acute cerebrovascular disorders in the vertebrobasilar arterial system, transient ischemic attacks, as well as manifestations of chronic cerebrovascular disease (chronic cerebral ischemia, discirculatory encephalopathy). Episodes of recurrent spontaneous vestibular vertigo can be caused by vestibular migraine, which is rarely diagnosed in our country. The variety of reasons for complaints of vertigo and unsteadiness defines many therapeutic approaches to the treatment of these diseases. In recent times, modern drug and non-drug approaches to the treatment have been developed for patients with various diseases manifested by vertigo and unsteadiness. The most effective treatment is a comprehensive therapeutic approach that combines non-drug therapy, including vestibular gymnastics, training on the stabilographic platform with biofeedback according to the support reaction, and drugs that help reduce the severity, duration, and frequency of vertigo attacks, as well as accelerate vestibular compensation. Many studies have shown the efficacy of drugs enhancing microcirculation used for the prophylactic treatment of various causes of vertigo and unsteadiness.

About the Author

L. M. Antonenko
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Ludmila M. Antonenko, Dr. of Sci. (Med.), Professor, Department of Nervous Diseases and Neurosurgery

8, Bldg. 2, Trubetskaya St., Moscow, 119991



References

1. Neuhauser H.K., von Brevern M., Radtke A., Lezius F., Feldmann M., Ziese T., Lempertet T. Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology. 2005;65(6):898–904. doi: 10.1212/01.wnl.0000175987.59991.3d.

2. Brandt Т., Dieterich M., Strupp M. Vertigo and dizziness: common complains. London: Springer; 2004. 503 p. doi: 10.1007/b138527.

3. Antonenko L.M. Diagnosis, treatment, and rehabilitation in patients with dizziness and cognitive impairment. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2017;9(3):76–80. (In Russ.) doi: 10.14412/2074-2711-2017-3-76-80.

4. Antonenko L.M. Rehabilitation of patients with vestibular desorders. Meditsinskiy sovet = Medical Council. 2017;(1 агаSuppl.):33–37. (In Russ.) doi: 10.21518/2079-701X-2017-0-33-37.

5. Antonenko L.M., Vakhnina N.V., Gromova D.O. Cognitive impairment, dizziness, and unsteadiness in hypertensive patients. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2020;12(5):92–97. (In Russ.) doi: 10.14412/2074-2711-2020-5-92-97.

6. Bowler J.V. Vascular cognitive impairment. Stroke. 2004;35(2):386–388. doi: 10.1161/01.STR.0000115301.12426.2B.

7. Williams B., Mancia G., Spiering W., Agabiti Rosei E., Azizi M., Burnier M. et al. ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021–3104. doi: 10.1093/eurheartj/ehy339.

8. Parfenov V.A. Differential diagnosis and treatment of vertigo in hypertensive patients. Terapevticheskii arkhiv = Therapeutic Archive. 2005;77(1):56–59. (In Russ.) Available at: https://elibrary.ru/item.asp?id=9133810.

9. Parfyonov V.A., Antonenko L.M. Diagnosis and treatment of patients diagnosed with vertebrobasilar insufficiency. Meditsinskiy sovet = Medical Council. 2014;(17):81–85. (In Russ.) doi: 10.21518/2079-701X-2014-17-81-85.

10. Lebedeva N.V., Zamergrad M.V., Parfenov V.A., Antonenko L.M. Diagnosis and treatment of benign paroxysmal positional vertigo in common clinical practice. Terapevticheskii arkhiv = Therapeutic Archive. 2017;89(1):57–61. (In Russ.) doi: 10.17116/terarkh201789157-61.

11. Balaban C.D., Jacob R.G., Furman J.M. Neurologic bases for comorbidity of balance disorders, anxiety disorders and migraine: neurotherapeutic implications. Expert Rev Neurother. 2011;11(3):379–394. doi: 10.1586/ern.11.19.

12. Felisati G., Pipolo C., Portaleone S. Migraine and vertigo: two diseases with the same pathogenesis? Neurol Sci. 2010;31:107—109. doi: 10.1007/s10072-010-0299-0.

13. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders 3 rd edition (beta version). Cephalalgia. 2013;33(9):629–808. doi: 10.1177/0333102413485658.

14. Sohn J.H. Recent advances in the understanding of vestibular migraine. Behav Neurol. 2016;2016:1801845. doi: 10.1155/2016/1801845.

15. Yollu U., Uluduz D.U., Yilmaz M., Yener H.M., Akil F., Kuzu B. et al. Vestibular migraine screening in a migraine-diagnosed patient population, and assessment of vestibulocochlear function. Clin Otolaryngol. 2017;42(2):225–233. doi: 10.1111/coa.12699.

16. Lempert T., Olesen J., Furman J., Waterston J., Seemungal B., Carey J. et al. Vestibular migraine: Diagnostic criteria. J Vestib Res. 2012;22(4):167–172. doi: 10.3233/VES-2012-0453.

17. Parfenov V.A., Zamergrad M.V., Melnikov O.A. Vertigo: diagnosis, treatment, common diagnostic errors. Moscow: Meditsinskoe informatsionnoe agentstvo; 2011. 190 p. (In Russ.).

18. Parfenov V.A., Antonenko L.M. Major diseases manifesting by vestibular vertigo: Treatment and rehabilitation. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2015;7(2):56–60. (In Russ.) doi: 10.14412/2074-2711-2015-2-56-60.

19. Zamergrad M.V. Vestibular rehabilitation. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2009;1(2):19–22. (In Russ.) doi: 10.14412/2074-2711-2009-33.

20. Parfenov V.A., Golyk V.A., Matsnev E.I., Morozova S.V., Melnikov O.A., Antonenko L.M. et al. Effectiveness of betahistine (48 mg/day) in patients with vestibular vertigo during routine practice: The VIRTUOSO study. PLoS One. 2017;12(3):e0174114. doi: 10.1371/journal.pone.0174114.

21. Helminski J.O., Zee D.S., Janssen I., Hain T.C. Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review. Phys Ther. 2010;90(5):663–678. doi: 10.2522/ptj.20090071.

22. Neuhauser H., Radtke A., von Brevern M., Lempert T. Zolmitriptan for treatment of migrainous vertigo: a pilot randomized placebo-controlled trial. Neurology. 2003;60(5):882–883. doi: 10.1212/01.wnl.0000049476.40047.a3.

23. Perez A.J., Jardine D.A., Gille T.M., Conley G.S. Topiramate for the Management of Vestibular Migraine. Otolaryngology – Head and Neck Surgery. 2013;149(2 Suppl.):238. doi: 10.1177/0194599813496044a291.

24. Qelebisoy N., Gokgay F., Karahan C., Bilgen C., Kirazlı T., Karapolat H., Köse T. Acetazolamide in vestibular migraine prophylaxis: a retrospective study. Eur Arch Otorhinolaryngol. 2016;273(10):2947–2951. doi: 10.1007/s00405-015-3874-4.

25. Lacour M. Restoration of vestibular function: basic aspects and practical advances for rehabilitation. Curr Med Res Opin. 2006;22(9):1651–1659. doi: 10.1185/030079906X115694.

26. Antonenko L.M., Zastenskaya E.N. Persistent postural-perceptual dizziness: current approaches to diagnosis and treatment. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(4):136–140. (In Russ.) doi: 10.14412/2074-2711-2019-4-136-140.

27. Lee J.O., Lee E.S., Kim J.S., Lee Y.-B., Jeong Y., Choi B.S. et al. Altered brain function in persistent postural perceptual dizziness: A study on resting state functional connectivity. Hum Brain Mapp. 2018;39(8):3340–3353. doi: 10.1002/hbm.24080.

28. Antonenko L.M. Psychogenic dizziness. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2016;8(2):50–54. (In Russ.) doi: 10.14412/2074-2711-2016-2-50-54.

29. Popkirov S., Staab J.P., Stone J. Persistent postural-perceptual dizziness (PPPD): A common, characteristic and treatable cause of chronic dizziness. Pract Neurol. 2018;18(1):5–13. doi: 10.1136/practneurol-2017-001809.

30. Xue H., Chong Y., Jiang Z.D., Liu Z.L., Ding L., Yang S.L. et al. Etiological analysis on patients with vertigo or dizziness. Zhonghua Yi Xue Za Zhi. 2018;98(16):1227–1230. (In Chinese) doi: 10.3760/cma.j.issn.0376-2491.2018.16.008.

31. Dieterich M., Staab J.P. Functional dizziness: From phobic postural vertigo and chronic subjective dizziness to persistent postural-perceptual dizziness. Curr Opin Neurol. 2017;30(1):107–113. doi: 10.1097/WCO.0000000000000417.

32. Zastenskaya E.N., Antonenko L.M., Barinov A.N. Comorbidities and their correction in patients with persistent postural perceptual dizziness. Voprosy prakticheskoy pediatrii = Clinical Practice in Pediatrics. 2020;15(1):48–52. (In Russ.) doi: 10.20953/1817-7646-2020-1-48-52.

33. Popkirov S., Stone J., Holle-Lee D. Treatment of Persistent PosturalPerceptual Dizziness (PPPD) and Related Disorders. Curr Treat Options Neurol. 2018;20(12):50. doi: 10.1007/s11940-018-0535-0.

34. Staab J.P., Eckhardt-Henn A., Horii A., Jacob R., Strupp M., Brandt T., Bronstein A.J. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res. 2017;27(4):191–208. doi: 10.3233/VES-170622.

35. Antonenko L.M., Parfenov V.A. Vestibular vertigo. Zhurnal nevrologii i psihiatrii imeni S.S. Korsakova = Korsakov’s Journal of Neurology and Psychiatry. 2020;120(6):125–130. (In Russ.) doi: 10.17116/jnevro2020120061125.

36. Uncie H., Sirman M.S., James E. Dizziness: Approach to evaluation and management. Am Fam Physician. 2017;95(3):154–162. Available at: https://aafp.org/afp/2017/0201/p154.html.

37. Heinrichs N., Edler C., Eskens S., Mielczarek M., Moschner C. Predicting Continued Dizziness After an Acute Peripheral Vestibular Disorder. Psychosom Med. 2007;69(7):700–707. doi: 10.1097/PSY.0b013e318151a4dd.

38. Staab J., Balaban C., Furman J. Threat Assessment and Locomotion: Clinical Applications of an Integrated Model of Anxiety and Postural Control. Semin Neurol. 2013;33(3):297–306. doi: 10.1055/s-0033-1356462.

39. Antonenko L.M., Parfenov V.A. A specialized approach to diagnosing and treating vertigo. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2016;8(1):56–60. (In Russ.) doi: 10.14412/2074-2711-2016-1-56-60.

40. Hall C.D., Herdman S.J., Whitney S.L., Cass S.P., Clendaniel R.A., Fife T.D. et al. Vestibular rehabilitation for peripheral vestibular hypofunction: An evidence-based clinical practice guideline: From the American physical therapy association neurology section. J Neurol Phys Ther. 2016;40(2):124–155. doi: 10.1097/NPT.0000000000000120.


Review

For citations:


Antonenko LM. Drug and non-drug treatments of vertigo. Meditsinskiy sovet = Medical Council. 2021;(2):39-44. (In Russ.) https://doi.org/10.21518/2079-701X-2021-2-39-44

Views: 726


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


ISSN 2079-701X (Print)
ISSN 2658-5790 (Online)