Use of the drug "Betastin" in the treatment of vestibular disorders

Vertigo refers to the common symptoms of cardiovascular, infectious and toxic lesions of the nervous system and may be a manifestation of various diseases.

First of all, these are diseases of the inner ear (Meniere's disease, labyrinthitis, circulatory problems in the internal auditory artery, etc.), dysfunction of the central vestibular structures due to toxic effects and disorders of blood circulation in the vertebrobasilar and other causes. Vertigo can be associated with cardio-vascular system (arterial hypo-and hypertension, irregular heartbeat), nervous system (multiple sclerosis, encephalopathy, acoustic neuroma, benign paroxysmal vertigo). Many patients in these cases is characterized by dizziness as "staggering when walking," presyncope "haze". In addition, the dizziness may be a manifestation of constitutionally-related vestibulopathy and neurotic disorders (phobias, psychovegetative syndrome).

Thus, patients with dizziness are quite heterogeneous group, and seek the help of doctors of various specialties - internists, neurologists, otolaryngologist, psychotherapists. Treatment of vestibular dysfunction represents a major health problem, because in these patients, in most cases there is a decrease of efficiency, leading to a deterioration in the quality of life.

The purpose of this study - to evaluate the clinical efficacy of the drug Betastin (Pharmacare PLC), containing betahistine. Currently, betahistine is considered one of the most effective treatment of vestibular dysfunction of various origins. The drug activates the microcirculation in the maze leads to increased blood flow in the arteries of the inner ear and the basilar artery system, and regulates the pressure of the endolymph in the labyrinth and the cochlea, providing clinical improvement in vertigo of various etiology.

The most probable mechanism of action of betahistine is a central inhibition of neuronal transmission in the polysynaptic neurons in the lateral nuclei of the vestibular nerve at the level of the brain stem, betahistine - H2-receptor agonist involved in the stimulation of neurons in the vestibular nuclei, which may explain its positive effect for dizziness. It blocks the H3-receptor stimulates postsynaptic histamine receptors (H1 and / or H2), and also has vasoactive effects. Acceptance of betahistine has virtually no effect on memory impairment, memory processes and the severity of pain syndromes caused by degenerative lesions of the cervical and cervico-thoracic spine.

Of the patients with vertigo of various origins we were allocated into two groups.

The first group consisted of patients with encephalopathy of different genesis (arteriosclerotic, toxic, dysmetabolic), with complaints of dizziness, a non-systemic nature, instability when walking. This group was represented by 58 patients aged from 34 to 72 years (mean age - 53.4 years), giddy from 6 months to 9-11 years. Phenomena vestibulopathies combined, usually with headaches, nausea, panic attacks and have been so intense that led to the disruption to work, and in some cases, and disability. In the neurological status of patients in this group there was diffuse neurological symptoms in the form of anizorefleksii, non pathological Iambic signs on the one hand, etc. All the patients were hospitalized in a planned manner.

The second group included 17 patients aged 18 to 53 years (mean age - 34.5 years) admitted to hospital for emergency indications. In this case, the dizziness was of a systemic nature and occurred acutely. The disease duration ranged from several hours to days. A leading symptom in this patient group had acute vestibular dysfunction, manifested vestibulosomaticheskimi (nystagmus, the reaction of the body of deviation in the direction of the slow component of nystagmus), vestibulosensornymi (vertigo) and vestibulovegetativnymi (nausea, vomiting) reactions. 11 patients of this group vestibulopathy accompanied by pain in verhnesheynogo spine.

Along with a neurological examination were used Doppler ultrasound of the brachiocephalic arteries (USDG BTSS) otonevrologa inspection, radiography of skull and cervical spine, in some cases - computed tomography of the brain. All patients performed hemorheological and biochemical research.

Patients receive appropriate, as a unified vascular and metabolic therapy (according to treatment protocols), against which the prescribed Betastin tablets at a dose of 24 mg 3 times a day during the first week, then to 8 mg 3 times daily for 3 weeks. Preliminary results were evaluated 2 weeks after starting treatment. The majority of patients treated with betastin under the influence of the therapy condition improved significantly.

The earliest effect was regression vestibulosomaticheskih vestibulovegetativnyh and manifestations, with more rapid regression observed in patients of the second group. It is important that this group has a 1-2nd day after applying Betastina dose of 24 mg in acute attack of vertigo docked.

In the first group after completion of treatment in 96.6% of patients had reduction in severity and frequency of vertigo, while in 10 (17.2%), they completely stopped in 34 (58.6%) was significant improvement in 12 (20 7%), relatively small, and only 2 (3.4%) patients with no improvement recorded.

The positive dynamics for inclusion in the therapeutic range betastina observed in both groups with regard to complaints and related syndromes. Thus, improvement occurred in 25 (33.3%) patients with hearing loss, 34 (45.3%) patients with tinnitus. Of the 56 patients with complaints of instability when walking, gait improvement noted 48 (85.7%), with 14 of them are staggering when walking completely stopped.

These changes were accompanied by improvement in the emotional background, improvement in mood and ability to work.

In the neurological status at the end of treatment regressed nystagmus, vestibular-atactic disorders (stagger in the Romberg position, when the mimopopadanie koordinatornyh samples intentsionnogo jitter). Was less pronounced dynamics of pyramidal, extrapyramidal and intellectual-mental disorders.

Marked by good tolerability. Despite the high dosage betastina none of the patients complained of its side effects.

Thus, betastin applied in therapeutic doses, was effective for relief of acute vestibular paroxysms, and to prevent a recurrence of vertigo, the normalization of autonomic responses and, consequently, contributed to improving the quality of life for patients.

References:

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