© Borgis - New Medicine 1/2007, s. 2-5
*Jarosław Wysocki1, 2, Piotr Orszulak1
Analysis of key agents influencing therapeutic success in balance disturbances treated ambulatory by Betahistine
1Clinic of Otolaryngology and Rehabilitation II Medical Faculty University Medical School in Warsaw, Poland
Head of Clinic: Jarosław Wysocki, MD, PhD
2Institute of Physiology and Pathology of Hearing, Warsaw, Poland
Vertigo and dizziness are common medical problems, associated with several specialties. Management with these patients is lingering, difficult and not in every case successful. In order to find and assess possible factors influencing final therapeutic success in therapy of vertigo and balance disorders a prospective, questionnaire study in primary care units was realized. Patients (4648), adults and adolescents, both gender, suffering from vertigo or other balance disturbances were included into the study. Results of Betahistine (Histimerck(r)) application during a 30-60 days period in doses 24 or 48 mg/day was analyzed. Withdrawal of vertigo or dizziness in physical examination were undertaken as a therapeutic success. Generally results of therapy were better in patients with diagnosis of vertigo labyrhintica and in younger than in older patients. Statistically significant positive influence on therapeutic success was proved not for summaric dose of Betahistine but for summaric time of therapy and therapy according to alternative model: the different dose in the following 30 days. Head injury in the past, cervical spine degenerative changes and VIII nerve diseases deteriorated chances of headache, waving and visual disorders release but only for patients with diagnose of vertigo centralis. In patients with vertigo labyrhintica hypertension significantly deteriorated final result in headache release. It was also proved negative influence of acoustic injury on vertigo release in all the patients. We could conclude that to the group which is anticipated as having worse therapeutic effects belong older patients and patients burdened with cervical spine degenerative changes, acoustic injury and head or cervical spine injuries in the past. Extending the time of therapy until 60 days provides considerable positive effect.
Patients with vertigo, dizziness and other balance disorders more frequently suffer from metabolic disorders such as excess weight, hyperlipoproteinemia, intolerance of glucose, hyperinsulinemia, however arterial hypertension, degenerative changes in cervical spine, disorders of arterial flow are also common in these patients [1, 2, 3, 4, 5, 6, 7, 8].
Dizziness and other disorders of equilibrium are widespread in populations of industrialized countries, particularly in people that are more then 40 years old [9, 10, 11, 12, 13]. 80% of patients with vertigo suffer from significant drop in the life´s quality, which is caused by dysphoria, difficulties in everyday life and by continuous search for medical aid . In majority of the equilibrium´s disorders, attempts to discern the concrete etiologic factor, fail. Thus diagnoses often state a vascular background or idiopathic origin, which makes a causal treatment impossible [5, 10, 14, 15]. Thorough study of etiopathogenesis of vertigo is difficult because epidemiological research provides very little detailed data [10, 12, 15, 16]. Fortunately very recently appeared some detailed epidemiological works on occurrence of different burdens in patients with vertigo. This works were stating that, for example, the occurrence of the diabetes is 2-3 times more often in patients with vertigo than in control groups [1, 2, 3, 4, 5, 6, 7]. Nevertheless the research lacks of data on the influence of these burdens on results of therapy.
The Betahistine is an effective medicine in the practical treatment of vertigo. It is a medicine of complex and not fully understood mechanism of work . It is an analogue of histamine with large affinity to receptor H3 (the antagonist) and small affinity to receptor H1 [the agonist], exerting a final effect of vasodilatation in the area of vertebral and basilar arteries . Its curing influence concerns not only vestibulocochlear organ but also the central nervous system. In patients with vertigo and after recent brain apoplexy a betahistine therapy can be an equivalent of traditional treatment with antithrombotic drugs or even better .
Materials and methods
Research was carried on patients with hearing and balance impairment, treated by otolaryngologists or neurologists with Histimerck(r) at outpatient wards. The analysis includes 4648 persons in age spectrum from 16 to 91 years old. Diagnoses stated Vertigo originis centralis (diagnosis I) or Vertigo labyrhintica (diagnosis II). The inquiry was specially constructed for the needs of this investigation. Patients answered a questionnaire on how they were experiencing their ailments during the three major periods: 1) before undertaking the treatment, 2) after 30 days of treatment and 3) after 60 days of therapy. Apart from questions on demographic data and ailment, inquiry contained also a string of questions referring to possible coincident factors causing deterioration, such as: the diabetes, arterial hypertension, noise exposure, intake of ototoxic medicines, old head injury, degenerative changes in cervical spine and/or its injury, pathologies in middle or internal ear, and diseases of vestibulo-cochlear nerve.
In therapy of vertigo betahistine (Histimerck(r)) was applied in periods of 30-60 days, in doses of 24 or 48 mg/day.
The data from questionnaires were saved on the computer using special, author´s coding program. These operations allowed to obtain a data with possibly little mistakes, which are additionally dividable in to homogeneous groups.
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1. Doroszewska G, Kaźmierczak H: Hyperinsulinemia in vertigo, tinnitus and hearing impairment [in Polish]. Otolaryngol. Pol., 2002, 56, 57-62. 2. Hoffer ME, Gottshall KR, Moore R, Balough BJ, Wester D: Characterizing and treating dizziness after mild head trauma. Otol. Neurotol., 2004, 25, 135-138. 3. Kaźmierczak H, Doroszewska G: Metabolic disorders in vertigo, tinnitus, and hearing loss. Int. Tinnitus J., 2001, 7, 54-58. 4. Olszewski J, Majak J, Pietkiewicz P, Luszcz C, Repetowski M: The association between positional vertebral and basilar artery flow lesion and prevalence of vertigo in patients with cervical spondylosis. Otolaryngol. Head Neck Surg., 2006, 134, 680-684. 5. Pulec JL, Pulec MB, Mendoza I: Progressive sensorineural hearing loss, subjective tinnitus and vertigo caused by elevated blood lipids. Ear Nose Throat J., 1997, 76, 716-20, 725-6. 6. Rybak LP: Metabolic disorders of the vestibular system. Otolaryngol. Head Neck Surg., 1995, 112, 128-132. 7. Welsh LW, Welsh JJ, Lewin B: Vertigo, analysis by magnetic resonance imaging and angiography. Ann. Otol. Rhinol. Laryngol., 2000, 109, 239-248. 8. Zalewski P, Konopka W, Pietkiewicz P: Analysis of vascular vertigo due to cervical spondylosis and vertebro-basilar insufficiency based on sex and age in clinical materials. Otolaryngol. Pol. [in Polish], 2004, 58, 97-100. 9. Hale WE, Perkins LL, May FE, Marks RG, Stewart RB: Symptom prevalence in the elderly. An evaluation of age, sex, disease, and medication use. J. Am. Geriatr. Soc., 1986, 34, 333-340. 10. Katsarkas A: Dizziness in aging, a retrospective study of 1194 cases. Otolaryngol. Head. Neck. Surg., 1994, 110, 296-301. 11. Lawson J, Fitzgerald J, Birchall J, Aldren CP, Kenny RA: Diagnosis of geriatric patients with severe dizziness. J. Am. Geriatr. Soc., 1999, 47, 12-17. 12. Neuhauser HK, von Brevern M, Radtke A, Feldmann M, Ziese T, Lempert T: Epidemiology of vestibular vertigo, a neurotologic survey of the general population. Neurology, 2005, 65, 898-904. 13. Sloane P, Blazer D, George LK: Dizziness in a community elderly population. J. Am. Geriatr. Soc., 1989, 37, 101-108. 14. Baloh RW: Disorders of the Vestibular System. New York, Oxford, Oxford University Press, 1996. 15. Kentala E: Characteristics of six otologic diseases involving vertigo. Am. J. Otol., 1996, 17, 883-892. 16. Strupp M, Glaser M, Karch C, Rettinger N, Dieterich M, Brandt T: The most common form of dizziness in middle age, phobic postural vertigo. Nervenarzt, 2003, 74, 911-914. 17. Timmerman H: Pharmocotherapy of vertigo, any news to be expected? Acta Otolaryngol. [Stockh], 1994, Suppl. 513, 28-32. 18. Van Cauvenberge PB, De Moor SE: Physiopathology of H3 receptors and pharmacology of betahistine. Acta Otolaryngol. [Stockh], 1997, 526, 43-46. 19. Gekht AB, Vialkova AB, Galanov DV: Clinico-neurological and stabilometric analysis of betahistine [betaserc] efficacy in the patients with vertigo in the rehabilitation period of ischemic stroke. Nevrol. Psikhiatr. Im. S. S. Korsakova Zh. [in Russian], 2005, Suppl 15, 32-38. 20. Kaźmierczak H, Pawlak-Osinska K, Kaźmierczak W: Betahistine in vertebrobasilar insufficiency. Int. Tinnitus J., 2004,10,191-193. 21. Muller H, Buttkus R: Clinical experiences with betahistine Laryngol. Rhinol. Otol. [Stuttg], 1983, 62, 151-153. 22. Petrova D, Sachansca T, Datcov E: Investigation of Betaserc in auditory and vestibular disturbances. Int. Tinnitus J., 2004, 10, 177-182. 23. Oosterveld WJ: Betahistine dihydrochloride in the treatment of vertigo of peripheral vestibular origin. A double-blind placebo-controlled study. J. Laryngol. Otol., 1984, 98, 37-41.