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Медицинский Совет

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Возможности использования комбинации «дименгидринат + циннаризин» в терапии головокружений

https://doi.org/10.21518/2079-701X-2021-21-1-35-44

Аннотация

Головокружение достаточно частая жалоба, с которой пациенты обращаются к врачам разного профиля, и особенно к врачам общей практики, неврологам, оториноларингологам. Головокружение представляет собой иллюзию движений самого человека или окружающих предметов вокруг него. Головокружение является симптомом большого круга заболеваний, как доброкачественных, так и  угрожающих жизни больного. Головокружение может иметь разные причины, и  предлагаемое лечение должно зависеть от причины. Из-за многофакторной этиологии медицинской помощи многие пациенты получают недостаточное лечение в  рамках первичной медико-санитарной помощи, особенно при первом обращении. Основными причинами головокружения являются доброкачественное позиционное пароксизмальное головокружение, болезнь Меньера, вестибулярный неврит, вестибулярная мигрень и сосудистые заболевания головного мозга. У пациентов с другими расстройствами, такими как депрессия и  синдром гипервентиляции, могут присутствовать жалобы на  несистемное головокружение. Дифференциальный диагноз головокружения можно проводить с помощью простых в выполнении тестов во время физического осмотра, включая оценку нистагма, маневр Дикса – Холлпайка и измерение артериального давления при проведении ортостатических проб. Лечение пациентов с жалобами на головокружение включает медикаментозную и немедикаментозную терапию в зависимости от установленной нозологической формы. Однако из-за многофакторной этиологии многие пациенты получают недостаточное лечение в  рамках первичной медико-санитарной помощи, особенно при первичном обращении. Одним из препаратов для симптоматического лечения головокружения различного генеза у взрослых является комбинация дименгидрината с циннаризином.

Об авторе

Н. В. Пизова
Ярославский государственный медицинский университет
Россия

Пизова Наталия Вячеславовна, д.м.н., профессор, профессор кафедры нервных болезней с медицинской генетикой и нейрохирургией

150000, Ярославль, ул. Революционная, д. 5



Список литературы

1. Strupp M., Brandt T. Diagnosis and treatment of vertigo and dizziness. Dtsch Arztebl Int. 2008;105(10):173–180. https://doi.org/10.3238/arztebl.2008.0173.

2. Handschu R., Täuber A., Schuh A. Chronic vertigo. MMW Fortschr Med. 2019;161(11):45–52. https://doi.org/10.1007/s15006-019-0020-z.

3. Walther L.E., Blödow A. Current aspects of vertigo and dizziness in advanced age. HNO. 2020;68(3):191–198. https://doi.org/10.1007/s00106-019-00756-5.

4. Karatas M. Central vertigo and dizziness: Epidemiology, differential diagnosis, and common causes. Neurologist. 2008;14(6):355–364. https://doi. org/10.1097/NRL.0b013e31817533a3.

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

6. Neuhauser H.K., Lempert T. Vertigo: epidemiologic aspects. Semin Neurol. 2009;29:473–481. https://doi.org/10.1055/s-0029-1241043.

7. Neuhauser H.K. The epidemiology of dizziness and vertigo. Handb Clin Neurol. 2016;137:67–82. https://doi.org/10.1016/B978-0-444-63437-5.00005-4.

8. Bronstein A.M. Vision and vertigo: Some visual aspects of vestibular disorders. J Neurol. 2004;251:381–387. https://doi.org/10.1007/s00415-004-0410-7.

9. Sloan P.D. Dizziness in primary care. Results from the national ambulatory medical care survey. J Fam Pract. 1989;29(1):33–38. Available at: https://pubmed.ncbi.nlm.nih.gov/2738548.

10. Bird J.C., Beynon G.J., Prevost A.T., Baguley D.M. An analysis of referral pattern for dizziness in the primary care setting. Br J Gen Pract. 1998;48(437): 1828–1832. Available at: https://pubmed.ncbi.nlm.nih.gov/10198501.

11. Honrubia V., Bell T.S., Harris M.R., Baloh R.W., Fisher L.M. Quantitative evaluation of dizziness characteristics and impact on quality of life. Am J Otol. 1996;17(4):595–602. Available at: https://pubmed.ncbi.nlm.nih.gov/8841705.

12. Drachman D.A., Hart C.W. An approach to the dizzy patient. Neurology. 1972;22:323–334. https://doi.org/10.1212/wnl.22.4.323.

13. Edlow J.A. Diagnosing dizziness: we are teaching the wrong paradigm! Acad Emerg Med. 2013;20:1064–1066. https://doi.org/10.1111/acem.12234.

14. Newman-Toker D.E., Dy F.J., Stanton V.A., Zee D.S., Calkins H., Robinson K.A. How often is dizziness from primary cardiovascular disease true vertigo? A systematic review. J Gen Intern Med. 2008;23:2087–2094. https://doi. org/10.1007/s11606-008-0801-z.

15. Honrubia V., House M. Mechanism of posterior semicircular canal stimulation in patients with benign paroxysmal positional vertigo. Ann New York Acad Scienc. 2001;942(1):469. https://doi.org/10.1111/j.1749-6632.2001. tb03769.x.

16. Cavallaro A., Martines F., Cannizzaro C., Lavanco G., Brancato A., Carollo G., et al. Role of Cannabinoids In The Treatment of Tinnitus. Acta Med Mediterr. 2016;32:903–909. Available at: https://www.researchgate.net/publication/309661582_Role_of_cannabinoids_in_the_treatment_of_tinnitus.

17. Bisdorff A., Von Brevern M., Lempert T., Newman-Toker D.E. Classification of vestibular symptoms: towards an international classification of vestibular disorders. J Vestib Res. 2009;19:1–13. https://doi.org/10.3233/VES-2009-0343.

18. Bisdorff A.R., Staab J.P., Newman-Toker D.E. Overview of the international classification of vestibular disorders. Neurol Clin. 2015;33:541–550. https://doi.org/10.1016/j.ncl.2015.04.010.

19. Hanley K., O’ Dowd T. Symptoms of vertigo in general practice: a prospective study of diagnosis. Br J Gen Pract. 2002;52:809–812. Available at: https://pubmed.ncbi.nlm.nih.gov/12392120.

20. Maarsingh O.R., Dros J., Schellevis F.G., van Weert H.C., Bindels P.J., van der Horst H.E. Dizziness reported by elderly patients in family practice: prevalence, incidence, and clinical characteristics. BMC Fam Pract. 2010;11:2. https://doi.org/10.1186/1471-2296-11-2.

21. Stam H., Harting T., Sluijs M., Marum R., Horst H., Wouden J.C. et al. Usual care and management of fall risk increasing drugs in older dizzy patients in Dutch general practice. Scand J Prim Health Care. 2016;34(2):165–171. https://doi.org/10.3109/02813432.2016.1160634.

22. Viola P., Ralli M., Pisani D., Malanga D., Sculco D., Messina L. et al. Tinnitus and equilibrium disorders in COVID-19 patients: Preliminary results. Eur Arch Otorhinolaryngol. 2021;278:3725–3730. https://doi.org/10.1007/ s00405-020-06440-7.

23. Korkmaz M.Ö., Eğilmez O.K., Özçelik M.A., Güven M. Otolaryngological manifestations of hospitalised patients with confirmed COVID-19 infection. Eur Arch Otorhinolaryngol. 2021;278(5):1675–1685. https://doi. org/10.1007/s00405-020-06396-8.

24. Chen T., Wu D., Chen H., Yan W., Yang D., Chen G. et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: Retrospective study. BMJ. 2020;368:m1091. https://doi.org/10.1136/bmj.m1091.

25. Mao L., Jin H., Wang M., Hu Y., Chen S., He Q., et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020;77:683–690. https://doi.org/10.1001/jamaneurol.2020.1127.

26. Liotta E.M., Batra A., Clark J.R., Shlobin N.A., Hoffman S.C., Orban Z.S., Koralnik I.J. Frequent neurologic manifestations and encephalopathyassociated morbidity in COVID-19 patients. Ann Clin Transl Neurol. 2020;7:2221–2230. https://doi.org/10.1002/acn3.51210.

27. Almufarrij I., Munro K.J. One year on: an updated systematic review of SARS-CoV-2, COVID-19 and audio-vestibular symptoms. Int J Audiol. 2021;22:1–11. https://doi.org/10.1080/14992027.2021.1896793.

28. Вейс Г.Д. Головокружение. В: Самуэльс М. (ред.). Неврология. М.: Практика; 1997. С. 9–120. Режим доступа: https://promedall.com/neurology_ samuels/4.htm.

29. Jung I., Kim J.-S. Approach to dizziness in the emergency department. Clin Exp Emerg Med. 2015;2(2):75–88. https://doi.org/10.15441/ceem.15.026.

30. Walther L.E. Current diagnostic procedures for diagnosing vertigo and dizziness. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2017;16:2. https://doi.org/10.3205/cto000141.

31. Strupp M., Brandt T. Peripheral vestibular disorders. Curr Opin Neurol. 2013;26:81–89. https://doi.org/10.1097/WCO.0b013e32835c5fd4.

32. Oh S.R., Min S.J., Kim C.E., Chang M., Mun S.-K. The effects of climate on the incidence of benign paroxysmal positional vertigo. Int J Biometeorol. 2020;64:2119–2125. https://doi.org/10.1007/s00484-020-02002-y.

33. Li S., Wang Z., Liu Y., Cao J., Zheng H., Jinget Y. et al. Risk factors for the recurrence of benign paroxysmal positional vertigo: a systematic review and metaanalysis. Ear Nose Throat J. 2020. https://doi.org/10.1177/0145561320943362.

34. Kim J.S., Zee D.S. Clinical practice. Benign paroxysmal positional vertigo. N Engl J Med. 2014;370(12):1138–1147. https://doi.org/10.1056/NEJMcp1309481.

35. Parnes L.S., Agrawal S.K., Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV) CMAJ. 2003;169(7):681–693. Available at: https://pubmed.ncbi.nlm.nih.gov/14517129.

36. Kim H.J., Lee J.O., Choi J.Y., Kim J.S. Etiologic distribution of dizziness and vertigo in a referral-based dizziness clinic in South Korea. J Neurol. 2020;267(8):2252–2259. https://doi.org/10.1007/s00415-020-09831-2.

37. Brandt T., Huppert D., Hecht J., Karch C., Strupp M. Benign paroxysmal positioning vertigo: a long-term follow-up (6–17 years) of 125 patients. Acta Otolaryngol. 2006;126(2):160–163. https://doi.org/10.1080/ 00016480500280140.

38. Nunez R.A., Cass S.P., Furman J.M. Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2000;122(5):647–652. https://doi.org/10.1016/S0194- 5998(00)70190-2.

39. Martens C., Goplen F.K., Aasen T., Nordfalk K.F., Nordahl S.H.G. Dizziness handicap and clinical characteristics of posterior and lateral canal BPPV. Eur Arch Otorhinolaryngol. 2019;276(8):2181–2189. https://doi. org/10.1007/s00405-019-05459-9.

40. Pereira A.B., Santos J.N., Volpe F.M. Effect of Epley’s maneuver on the quality of life of paroxismal positional benign vertigo patients. Braz J Otorhinolaryngol. 2010;76(6):704–708. https://doi.org/10.1590/S1808- 86942010000600006.

41. von Brevern M., Bertholon P., Brandt T., Fife T., Imai T., Nuti D., NewmanToker D. Benign paroxysmal positional vertigo: diagnostic criteria. J Vestib Res. 2015;25(3–4):105–117. https://doi.org/10.3233/VES-150553.

42. Jeon E.J., Lee D.H., Park J.M., Oh J.H., Seo J.H. The efficacy of a modified Dix–Hallpike test with a pillow under shoulders. J Vestib Res. 2019;29(4):197–203. https://doi.org/10.3233/VES-190666.

43. Anft D., Jamali Y., Scholz G., Mrowinski D. Electrocochleography and phase audiometry in diagnosis of Meniere disease. HNO. 2001;49:102–108. https://doi.org/10.1007/s001060050717.

44. Wright T. Menière’s disease. BMJ Clin Evid. 2015;2015:0505. https://pubmed.ncbi.nlm.nih.gov/26545070.

45. Lopez-Escamez J.A., Batuecas-Caletrio A., Bisdorff A. Towards personalized medicine in Meniere’s disease. F1000Res. 2018;7(F1000 Faculty Rev):1295. https://doi.org/10.12688/f1000research.14417.1.

46. Hallpike C.S., Cairns H. Observations on the pathology of Meniere’s syndrome: (Section of otology). Proc R Soc Med. 1938;31:1317–1336. Available at: https://pubmed.ncbi.nlm.nih.gov/19991672.

47. Caulley L., Quimby A., Karsh J., Ahrari A., Tse D., Kontorinis G. Autoimmune arthritis in Meniere’s disease: A systematic review of the literature. Semin Arthritis Rheum. 2018;48:141–147. https://doi.org/10.1016/j.semarthrit.2017.11.008.

48. Strupp M., Brandt T. Vestibular neuritis. Semin Neurol. 2009;29(05):509–519. https://doi.org/10.1055/s-0029-1241040.

49. Smith T., Rider J., Cen S., Borger J. Vestibular Neuronitis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. Available at: https://pubmed.ncbi.nlm.nih.gov/31751056.

50. Furman J.M., Cass S.P. Benign paroxysmal positional vertigo. N Engl J Med. 1999;341(21):1590–1596. https://doi.org/10.1056/NEJM199911183412107.

51. Jeong S.H., Kim H.J., Kim J.S. Vestibular neuritis. Semin Neurol. 2013;33(03):185–194. https://doi.org/10.1055/s-0033-1354598.

52. Bronstein A.M., Lempert T. Dizziness: A Practical Approuch to Diagnosis and Managment. Cambrige University Press; 2007:83–91. Available at: https://assets.cambridge.org/97805218/37910/frontmatter/9780521837910_frontmatter.pdf.

53. Lempert T., Olesen J., Furman J., Waterston J., Seemungal B., Carey J. et al. Vestibular migraine: diagnostic criteria. J Vest Res. 2012;22:167–172. https://doi.org/10.3233/VES-2012-0453.

54. International Headache Society Classification Subcommittee. The international classification of headache disorders. 3rd ed. (beta version). Cephalalgia. 2013;33:629–808. https://doi.org/10.1177/0333102413485658.

55. Geser R., Straumann D. Referral and final diagnoses of patients assessed in an academic vertigo center. Front Neurol. 2012;3:169. https://doi. org/10.3389/fneur.2012.00169.

56. Cass S.P., Furman J.M., Ankerstjerne K., Balaban C., Yetişer S., Aydogan B. Migraine-related vestibulopathy. Ann Otol Rhinol Laryngol. 1997;106:182–189. https://doi.org/10.1177/000348949710600302.

57. Dieterich M., Brandt T. Episodic vertigo related to migraine. J Neurol. 1999;246:883–892. https://doi.org/10.1007/s004150050478.

58. Neuhauser H., Leopold M., von Brevern M., Arnold G., Lempert T. The interrelations of migraine, vertigo and migrainous vertigo. Neurology. 2001;56:436–441. https://doi.org/10.1212/WNL.56.4.436.

59. Oh A.K., Lee H., Jen J.C., Corona S., Jacobson K.M., Baloh R.W. Familial benign recurrent vertigo. Am J Med Genet. 2001;100:287–291. https://doi. org/10.1002/ajmg.1294.

60. Balaban C.D. Migraine, vertigo and migrainous vertigo: links between vestibular and pain mechanisms. J Vestibular Res. 2011;21(6):315–321. https://doi.org/10.3233/VES-2011-0428.

61. Furman J.M., Balaban C.D. Vestibular migraine. Ann NY Acad Sci. 2015;1343:90–96. https://doi.org/10.1111/nyas.12645.

62. 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;11:379–394. https://doi.org/10.1586/ern.11.19.

63. Furman J.M., Marcus D.A., Balaban C.D. Vestibular migraine: clinical aspects and pathophysiology. Lancet Neurol. 2013;12:706–715. https://doi. org/10.1016/S1474-4422(13)70107-8.

64. Ли А.В., Пархоменко Е.В., Баринов А.Н. Вестибулярная мигрень: диагностика и оптимизация терапии. Журнал неврологии и психиатрии им. С.С. Корсакова. 2017;(8):59–66. https://doi.org/10.17116/jnevro20171178159-66.

65. Inui H., Kitaoku Y., Yoneyama K., Nakane M., Ohue S., Yamanaka T. et al. MR-angiographic findings of patients with central vestibular disorders. Acta Otolaryngol Suppl. 1998;533:51–56. Available at: https://pubmed.ncbi. nlm.nih.gov/9657312.

66. Albuquerque F.C., Hu Y.C., Dashti S.R., Abla A.A., Clark J.C., Alkire B. et al. Craniocervical arterial dissections as sequelae of chiropractic manipulation: patterns of injury and management. J Neurosurg. 2011;115(6):1197–1205. https://doi.org/10.3171/2011.8.JNS111212.

67. Di Stadio A., Dipietro L., Ralli M., Meneghello F., Minni A., Greco A. et al. Sudden hearing loss as an early detector of multiple sclerosis: a systematic review. Eur Rev Med Pharmacol Sci. 2018;22(14):4611–4624. https://doi.org/10.26355/eurrev_201807_15520.

68. Tamás T.L., Garai T., Tompos T., Szirmai Á. Vertigo in the Emergency Department: new bedside tests. Orv Hetil. 2016;157(11):403–409. https://doi.org/10.1556/650.2016.30388.

69. Kerber K.A., Meurer W.J., West B.T., Fendrick A.M. Dizziness presentations in US emergency departments, 1995–2004. Acad Emerg Med. 2008;15:744–750. https://doi.org/10.1111/j.1553-2712.2008.00189.x.

70. Newman-Toker D.E., Hsieh Y.H., Camargo C.A. Jr., Pelletier A.J., Butchy G.T., Edlow J.A. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc. 2008;83:765–775. https://doi.org/10.4065/83.7.765.

71. Helmchen C., Machner B., Lehnen N., Jahn K., Schneider E., Sprenger A. Current state of diagnostic management of acute vertigo: a survey of neurologists in Germany. J Neurol. 2014;261:1638–1640. https://doi. org/10.1007/s00415-014-7405-9.

72. Navi B.B., Kamel H., Shah M.P., Grossman A.W., Wong C., Poisson S.N. et al. The use of neuroimaging studies and neurological consultation to evaluate dizzy patients in the emergency department. Neurohospitalist. 2013;3(1):7–14. https://doi.org/10.1177/1941874412458677.

73. Pirau L., Lui F. Vertebrobasilar Insufficiency. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. Available at: https://pubmed.ncbi.nlm. nih.gov/29489229.

74. Tong D., Chen X., Wang Y., Wang Y., Du L., Bao J. Acute and episodic vestibular syndromes caused by ischemic stroke: predilection sites and risk factors. J Int Med Res. 2020;48(4):300060520918039. https://doi. org/10.1177/0300060520918039.

75. Arch A.E., Weisman D.C., Coca S., Nystrom K.V., Wira C.R., Schindler J.L. Missed ischemic stroke diagnosis in the emergency department by emergency medicine and neurology services. Stroke. 2016;47(3):668–673. https://doi.org/10.1161/STROKEAHA.115.010613.

76. Cejas L.L., Mazziotti J., Zinnerman A., Nofal P., Pardal M.F., Bonardo P. et al. Misdiagnosis of acute ischemic stroke in young patients. Medicina. 2019;79(2):90–94. Available at: https://pubmed.ncbi.nlm.nih.gov/31048273.

77. Lempert T. Vertigo: differential diagnosis and treatment. Fortschr Neurol Psychiatr. 2005;73(10):605–620. https://doi.org/10.1055/s-2004-830216.

78. Agus S., Benecke H., Thum C., Strupp M. Clinical and demographic features of vertigo: findings from the REVERT registry. Front Neurol. 2013;4(48):1–8. https://doi.org/10.3389/fneur.2013.00048.

79. Neuhauser H.K., Radtke A., von Brevern M., Lezius F., Feldmann M., Lempert T. Burden of dizziness and vertigo in the community. Arch Intern Med. 2008;168(19):2118–2124. https://doi.org/10.1001/archinte.168.19.2118.

80. Kirtane M.V., Bhandari A., Narang P., Santani R. Cinnarizine: A Contemporary Review. Indian J Otolaryngol Head Neck Surg. 2019;71(2 Suppl.):1060–1068. https://doi.org/10.1007/s12070-017-1120-7.

81. Hahn A., Novotný M., Shotekov P.M., Cirek Z., Bognar-Steinberg I., Baumann W. Comparison of cinnarizine/dimenhydrinate fixed combination with the respective monotherapies for vertigo of various origins: a randomized, double-blind, active-controlled, multicentre study. Clin Drug Investig. 2011;31:371–383. https://doi.org/10.2165/11588920-000000000-00000.

82. Hahn A., Sejna I., Stefflova B., Schwarz M., Baumann W. A fixed combination of cinnarizine/dimenhydrinate for the treatment of patients with acute vertigo due to vestibular disorders: a randomized, referencecontrolled clinical study. Clin Drug Investig. 2008;28:89–99. https://doi. org/10.2165/00044011-200828020-00003.

83. Cinnarizine/dimenhydrinate for vertigo. Aust Prescr. 2021;44(2):62–63. https://doi.org/10.18773/austprescr.2021.009.

84. Scholtz A.-W., Steindl R., Burchardi N., Bognar-Steinberg I., Baumann W. Comparison of the therapeutic efficacy of a fixed low-dose combination of cinnarizine and dimenhydrinate with betahistine in vestibular neuritis: a randomized, double-blind, non-inferiority study. Clin Drug Investig. 2012;32:387–399. https://doi.org/10.2165/11632410-000000000-00000.

85. Novotný M., Kostrica R. Fixed combination of cinnarizine and dimenhydrinate versus betahistine dimesylate in the treatment of Meniere’s disease: a randomized, double-blind, parallel group clinical study. Int Tinnitus J. 2002;8:115–123. Available at: https://pubmed.ncbi.nlm.nih.gov/14763223.

86. Cirek Z., Schwarz M., Baumann W., Novotny M. Efficacy and tolerability of a fixed combination of cinnarizine and dimenhydrinate versus betahistine in the treatment of otogenic vertigo: a double-blind, randomised clinical study. Clin Drug Investig. 2005;25:377–389. https://doi. org/10.2165/00044011-200525060-00003.

87. Otto V., Fischer B., Schwarz M., Baumann W., Preibisch-Effenberger R. Treatment of vertebrobasilar insufficiency-associated vertigo with a fixed combination of cinnarizine and dimenhydrinate. Int Tinnitus J. 2008;14:57–67. Available at: https://pubmed.ncbi.nlm.nih.gov/18616088.

88. Scholtz A.W., Hahn A., Stefflova B., Medzhidieva D., Ryazantsev S.V., Paschinin A. et al. Efficacy and Safety of a Fixed Combination of Cinnarizine 20 mg and Dimenhydrinate 40 mg vs Betahistine Dihydrochloride 16 mg in Patients with Peripheral Vestibular Vertigo: A Prospective, Multinational, Multicenter, Double-Blind, Randomized, Noninferiority Clinical Trial. Clin Drug Investig. 2019;39(11):1045–1056. https://doi.org/10.1007/s40261-019-00858-6.

89. Ким О.В., Маджидова Е.Н., Носирова Д.Ш. Оптимизация лечение пациентов с головокружением. Вестник КазНМУ. 2015;(2):404–405. Режим доступа: https://kaznmu.kz/press/wp-content/uploads/2015/07/ Вестник-КазНМУ-№2-2015.pdf.

90. Хайдарова Г.С., Тошпултов Ю.А., Ходжаева З.Х. Оценка выраженности вегетативных нарушений у пациентов с головокружением. Авиценна. 2018;(20):19–22. Режим доступа: https://avicenna-idp.ru/wp-content/ uploads/v20.pdf.


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Пизова Н.В. Возможности использования комбинации «дименгидринат + циннаризин» в терапии головокружений. Медицинский Совет. 2021;(21-1):35-44. https://doi.org/10.21518/2079-701X-2021-21-1-35-44

For citation:


Pizova N.V. Potential use of dimensionhydrinate/cinnarizine combination in the treatment of vertigo. Meditsinskiy sovet = Medical Council. 2021;(21-1):35-44. (In Russ.) https://doi.org/10.21518/2079-701X-2021-21-1-35-44

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