Drug treatment of vertigo anoxia cerebral

vestibular imbalance (Zee, 1988). The mixed antihistamine/anticholinergic drugs are often available OTC, or "over the counter". Examples are meclizine, dimenhydrinate, and diphenhydramine. The antihistamine component has side effects of sleepiness and long term weight gain (see below). Thus it makes some sense to use prescription anticholinergics rather than OTC mixed drugs (such as meclizine). Hyoscyamine, which is the L-isomer of atropine, is a common ingrediant in antispasmodic treatments for IBS. Hyoscine, or scopolamine, is mainly used in the patch form to prevent motion sickness.

are nonspecific muscarinic receptor antagonists (Barton et al, 1994; Soto et al, 2013). Diphenidol (Vontrol), is also an anticholinergic, although little used in the US.

There are also some reports of scopolamine inducing migraine, as well as a withdrawall syndrome. There is no reason to believe that any one nonselective ACH antagonist (e.g. scopolamine) is better than any other ACH antagonist (e.g. meclizine, hyocyamine, and many other antihistamines), but scopolamine has no central antihistamine component (which is associated with sleepiness and weight gain). Oral versions of scopolamine would seem equally likely to work as patches (e.g. oral drugs for IBS) for motion sickness, but there currently is no oral version of scopolamine (hyoscine). The atrophine derivitive, hyocyamine (L-atropine), can be used instead.

may also have addiction syndromes. Withdrawal has been described from a similar agent to meclizine, diphenhydramine. anoxic tank mixer Overdose is similar to acute psychosis. Hospitalization may then precipitate withdrawal. (Thomas et al, 2009). Addiction to the patch can be managed by withdrawall, sometimes facilitated by use of oral agents containing hyocyamine.

Histamine agonists that act on receptor subtypes are also used for treatment of vertigo (e.g. betahistine). This can sometimes result in a peculiar situation where individuals take both antihistamines and histamine agonists at the same time. When this is done, it would seem most logical to use a peripherally acting antihistamine that does not cross the blood brain barrier, with the hope that the central action will dominate. While in theory, one might attempt to avoid central antihistamine side effects (e.g. drowsiness, weight gain), by combining a mixed anticholinergic/antihistamine such as meclizine with betahistine, we do not know of any evidence one way or the other. We would guess that it does not work. Table 2 — Activity and Time constant of common benzodiazepines Drug

responses. postanoxic encephalopathy See this page for a longer discussion. They increase the affinity of chloride channel opening (Soto et al, 2013). There are differential effects across benzodiazepines on Gaba-A receptor subtypes. In small doses, these drugs are extremely useful. Addiction, impaired

be avoided by keeping the dose to 0.5 mg BID or less. Note that lorazepam and klonazepam have quite different time constants (i.e. durations of action), with lorazepam being shorter, which makes for some interesting trade-offs. Other problems with benzodiazepines include

According to Soto et al (2013) the most commonly used calcium channel blockers for vertigo are nimodipine, nitrendipine (long lasting) and verapamil. Other long lasting dihydropyridines such as amlodipine, felodipine, nicardipine and nifedipine are seldom used. The author has found daily verapamil to be helpful in a roughly 1/3 of his patients

difficulty in sleeping. Excessive dosage can lead to seizures. The typical starting dose is 10 mg three times/day. 4-AP is a similar agent that has better CNS absorption. We have had no success with this drug at all in treating suitable patients in our clinical practice, and while we continue to be hopeful. Note that the brand-name version of 4AP is priced about 20 times higher than the compounded version of the same chemical.

promise in reducing vestibular asymmetry. A human trial indicated that it is not useful in speeding up vestibular compensation (de Valc et al, 2009), but nevertheless this agent may have other uses. anxiety attack meaning in urdu GABA would be more likely to slow down compensation.

There are a large assortment of dopamine blockers used for emesis. These drugs may also treat migraine (as they are often effective migraine abortive drugs). In fact, Flunarizine is the dominant migraine prevention drug used in Europe. All are limited by their propensity to cause movement disorders (such as drug induced parkinsonism) as well as others. In our view, these drugs should be "last resort" for treatment of chronic vertigo conditions. We are, for example, against the use of Stugeron (cinnarizine) for any chronic dizzy condition. Flunarizine is a close relative to cinnarizine. These drugs are generally considered acceptable for acute use however.

more conventional category for decades. The main problem with it is that rigorous studies proving efficacy are generally are not available, although unrigorous studies abound. According to Timmerman quoting Laurikainen, H1 receptors do not appear

systems. Recently a 4th histamine receptor (H4) has been identified. H4 antagonists are reported to suppress rat primary vestibular neuron firing (Desmadryl et al, 2012). Also, according to these authors, betahistine does not have a significant effect on the H4 receptor in conventional doses. This may account for the recent suggestions to push the dose up to very high levels (e.g. hypoxic brain damage prognosis Strupp et al, 2008).

circulation to the inner ear (Halmagyi, 1992) or affect vestibular function through activity of H3 or H4 receptors (Kingma et al, 1997; Timmerman, 1994; Desmadryl et al, 2012). It is difficult to see why vasodilation should improve vertigo, as vasodilation/constriction are side effects of many medications that have no effect at all on vertigo (e.g isorbide). At this writing, as H2 agonism would be stimulatory, it appears most likely

Opiods often cause constipation, and drugs that cause constipation usually also reduce dizziness. Droperidol (a dopamine blocker) combined with fentanyl (a powerful opiate) was reported to be effective for acute attacks of Meniere’s disease (Soto et al, 2013). Our thought is that these drugs are far too dangerous to use for this purpose, and that there are much easier ways to stop Meniere’s attacks (e.g. lorazepam and ondansetron together).

They are also commonly used for sudden hearing loss. Data concerning efficacy for dizziness is presently conflicted (see here for a review of data). There are many possible mechanisms of efficacy — modulation of compensation (Cameron et al, 1999), reduction of immune responses in the inner ear (see here), reduction of swelling of the vestibular nerve (Strupp et al, 2004), reduction of emesis (Wattwil et al, 2003), increased activity promoting better recovery through a general effect on the sensation of wellbeing. ( See here for the references).

Dopamine agonists reduce firing rate in the frog hair cells and also reduces resposne to glutamine (the excitatory transmitter) (Soto et al, 2013). panic attack symptoms nausea On the other hand, dopamine antagonists are uncommonly used to treat vertigo (e.g. Droperidol, phenothiazines), suggesting that the net effect is against using dopamine agonists.

This drug, approved by the FDA for smoking cessation, has recently been reported useful for treatment of cerebellar ataxia (Zesiewicz et al, 2009). It is extremely surprising to find an agent that will ameliorate disorders caused by genetic damage to neurons. It is also disturbing that the number of individuals in the trial (7) was exactly the same as the number of authors on the study. In other words, it would seem to us that if this drug was effective, the number of subjects should be larger as patients with cerebellar disorders are common. We are frankly very dubious. We have never encountered a patient who responded to this mediation (who wasn’t attempting to stop smoking).

This drugs is a medication developed for angina (cardiac disturbance). It has been reported useful in diverse disorders (Soto et al, 2013), including Meniere’s disease. The evidence for this drug working is presently weak. For example, it is reported to be "as effective" as betahistine. Trimetazidine can also induce a myriad of CNS disorders, largely similar to those produced by dopamine antigonists (i.e. similar to haloperidol — Haldol).

This drug is mainly a glutamate blocker (NMDA), and thus might be a vestibular suppressant. It was approved in the US for prevention of progression of Alzheimer’s disease. It also is reported to act on 5HT3, D2, and various cholinergic receptors (Soto et al, 2013). We have never encountered a dizzy patient who responded to memantine. We have also never encountered a patient whose pendular nystagmus responded to memantine. This is hardly suprising as it is a low-affinitive NMDA antagonist. A similar drug is caroverine, that is a glutamate AMPA receptor antagonist.

These include MK-01, phencyclidine (PCP, "angel dust"), and ketamine ("special K") among others. Of course, side effects and abuse are a problem. Ketamine produces a general "lack of responsive awareness", as well as dizziness (Soto et al, 2013).

• Zeiseiwicz T and others. hypoxic ischaemic encephalopathy prognosis Treatment of spinocerebellar ataxia and fragile X associated tremor ataxia syndrome (FXTAS) with varenicline (Chantx): Results of a restrospective, blinded video analysis. Neurology 72: 2009, Suppl3, P01.142 (poster abstract).