Medical treatment of vestibular disorders

Thomas Brandt, Andreas Zwergal, Michael Strupp
Expert Opinion on Pharmacotherapy 2009, 10 (10): 1537-48

BACKGROUND: The lifelong prevalence of rotatory vertigo is 30%. Despite this high figure, patients with vertigo generally receive either inappropriate or inadequate treatment. However, the majority of vestibular disorders have a benign cause, take a favorable natural course, and respond positively to therapy.

OBJECTIVE: This review puts special emphasis on the medical rather than the physical, operative, or psychotherapeutic treatments available.

METHODS: A selected review of recent reports and studies on the medical treatment of peripheral and central vestibular disorders.

RESULTS/CONCLUSIONS: In vestibular neuritis, recovery of the peripheral vestibular function can be improved by oral corticosteroids; in Menière's disease, there is first evidence that high-dose, long-term administration of betahistine reduces attack frequency; carbamazepine or oxcarbamazepine is the treatment of first choice in vestibular paroxysmia, a disorder mainly caused by neurovascular cross-compression; the potassium channel blocker aminopyridine provides a new therapeutic principle for treatment of downbeat nystagmus, upbeat nystagmus, and episodic ataxia type 2.

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