Paper reading

1
Paper reading

• Topic Vertigo and Sodium bicarbonate
• Presented by R2 ???
• Supervised by V.S.???

2

• Title Inhibition by intravenously administered
  sodium bicarbonate of neuronal activity in medial
  vestibular nucleus neurons.
• Source Japanese Journal of Pharmacology.
  54(4)383-9, 1990 Dec
• Abstract animal study (cat)
• The effects of 7 sodium bicarbonate on medial
  vestibular nucleus (MVN) neurons were observed.

3

• Intravenous injection of the drug at 1, 2 and 4
  ml/kg every 10 min dose-dependently inhibited
  rotation- and glutamate-induced firing of type1
  neurons, although a low dose of the drug enhanced
  firing in a few neurons.
• An increase in PH, and bicarbonate ion.
• Po2 no change

4

• Title Acid-base equilibrium in Meniere's
  disease.
• Source Journal of Laryngology Otology.
  90(3)263-75, 1976 Mar.
• 57 patients suffering from Meiere's disease have
  been examined metabolic alkalosis has been found
  in 39 and metabolic acidosis in 4.

5

• Follow-up of several patients, from one to three
  years, resulted in a realization of a parallel
  between metabolic disturbance and Meniere
  symptoms.
• Meniere patients found in alkalosis were given
  acidifying drugs to normalize their acid-base
  equilibrium.
• Such treatment proved effective in preventing
  acute cochleo-vestibular crises and in improving
  tinnitus and deafness.

6

• The physiological-pathological meaning of
  metabolic alkalosis in Meniere's disease still
  remains unclear and, consequently, this can be
  considered merely a predisposing factor in
  endolymphatic hydrops.

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Betahistine for Meniere's disease or syndrome
(Cochrane Review)

• This systematic review was last made on 22 May
  2000.
• Selection criteria Randomised controlled studies
  of betahistine versus placebo in Menieres
  disease.
• Six trials involving 162 patients were included.

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• No trial met the highest quality standard set by
  the review because of inadequate diagnostic
  criteria or methods.
• Most trials suggested a reduction of vertigo with
  betahistine and some suggested a reduction in
  tinnitus but all these effects may have been
  caused by bias in the methods.

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• One trial with good methods showed no effect of
  betahistine on tinnitus compared with placebo in
  35 patients.
• None of the trials showed any effect of
  betahistine on hearing loss. No adverse effects
  were found with betahistine.

10

• Title Homeopathic vs conventional treatment of
  vertigo a randomized double-blind controlled
  clinical study.
• Source Archives of Otolaryngology -- Head Neck
  Surgery. 124(8)879-85, 1998 Aug.
• Both remedies reduced the frequency, duration,
  and intensity of vertigo attacks during a 6-week
  treatment period.

11
The effectiveness of piracetam in vertigo.

• Source Pharmacopsychiatry. 32 Suppl 154-60,
  1999 Mar.
• The origin of vertigo is frequently unknown or
  untreatable.
• Pharmacotherapy is required for symptomatic
  treatment. Piracetam has been shown to be
  effective in vertigo of both central and
  peripheral origin.

12

• This review of double-blind trials shows that
  piracetam alleviates vertigo after head injury,
  vertigo of central origin as, in vertebrobasilar
  insufficiency and in peripheral vestibular
  disorders, especially in middle-aged and elderly
  subjects.
• The usual dosage of piracetam in vertigo is
  2.4-4.8 g daily. Tolerability of piracetam is
  good and adverse effects have been mild and
  infrequent.

13

• Title Vertigo.
• Lancet. 352(9143)1841-6, 1998 Dec 5.
• Three common presentations of vertigo prolonged
  spontaneous vertigo, recurrent attacks of
  vertigo, and positional vertigo.
• The most common cause of vertigo, benign
  paroxysmal positional vertigo, can be cured with
  a simple positional manoeuvre.

14

• Vestibular neuritis, Meniere's syndrome,
  migraine, and vertebrobasilar insufficiency
  should be directed at the underlying causes.
• Antivertiginous and antiemetic drugs can suppress
  symptoms when a specific cause cannot be found.
• These drugs are generally not indicated for
  long-term daily use, however, since they may
  interfere with the normal compensation process.

15

• Title Vestibular training for benign paroxysmal
  positional vertigo. Its efficacy in comparison
  with antivertigo drugs.
• Source Archives of Otolaryngology -- Head Neck
  Surgery. 120(5)497-504, 1994 May.
• Three different groups patients treated by
  medication, by VT, and by VT with medication
  during 8 weeks.

16

• VT can be used as a first-choice treatment in
  patients with benign paroxysmal positional
  vertigo, even in long-term cases or older
  patients.

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• The Epley (canalith repositioning) manoeuvre for
  benign paroxysmal positional vertigo (Cochrane
  Review).
• This systematic review was last made on 25
  October 2001.
• To assess the effectiveness of the Epley
  manoeuvre compared to other treatments available
  for posterior canal benign paroxysmal positional
  vertigo, or no treatment.

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• Selection criteria Randomised trials of adults
  diagnosed with posterior canal BPPV (including a
  positive Dix-Hallpike test).
• Eleven trials were identified but nine studies
  were excluded because of a high risk of bias,
  leaving two trials in the review.
• Both studies included in the review (Lynn
  1995, Froehling 2000) addressed the
  efficacy of the Epley manoeuvre against a sham
  manoeuvre

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• There is no good evidence that the Epley
  manoeuvre provides a long term resolution of
  symptoms.
• There is no good evidence comparing the Epley
  manoeuvre with other physical, medical or
  surgical therapy for posterior canal BPPV.

20

• Title Treatment of benign positional vertigo
  using heels-over-head rotation.
• Source Annals of Otology, Rhinology
  Laryngology. 107(12)1046-53, 1998 Dec.
• Rotated patients 360 degrees heels-over-head in
  their sagittal body plane while their heads were
  turned to align the posterior semicircular canal
  with the plane of rotation.

21

• Heels-over-head rotation is an extremely
  efficacious procedure for treating patients with
  BPV.
• The pattern of nystagmus during repositioning is
  consistent with the theory that free-floating
  debris is highly likely to account for BPV.

22

• Title Effect of smoking on the treatment of
  vertigo.
• Source Otology Neurotology. 22(3)369-72, 2001
  May.
• For patients with vertigo who smoke during the
  course of treatment, the treatment may be
  ineffective.