Pharmacology of vertigo/nystagmus/oscillopsia.
OBJECTIVE
To describe recent developments in the pharmacological treatment of vertigo and nystagmus while focusing on vestibular neuritis, Meniere's disease, downbeat nystagmus, periodic alternating nystagmus, acquired pendular nystagmus, and superior oblique myokymia.


RESULTS
In the last 2 years several studies have been published on possible pharmacological treatment options for nystagmus and oscillopsia. In the treatment of vestibular neuritis two studies showed that cortisone treatment was effective for restoring labyrinthine function. This benefit seems more likely if treatment is started within the first 2 days of onset. For recurrent vertigo attacks due to Meniere's disease, the titration technique with daily or weekly doses of intratympanic gentamicin until onset of vestibular symptoms, change in vertigo or hearing loss rated best for complete vertigo control. A new pharmacological treatment option for downbeat nystagmus is the administration of potassium channel blockers (e.g. 4-aminopyridine). They are thought to reinforce the inhibitory action of cerebellar Purkinje cells. Several case reports have proven the beneficial effect of baclofen on periodic alternating nystagmus, of gabapentin and memantine on acquired pendular nystagmus, and of carbamazepine and gabapentin on superior oblique myokymia.


CONCLUSIONS
There have been several new developments in the treatment of nystagmus and vertigo over the last 2 years. These include potassium channel blockers for the treatment of downbeat nystagmus, early cortisone treatment to improve recovery of the labyrinth function in vestibular neuritis, and intratympanic gentamicin treatment for Meniere's disease. Other pharmacological treatment options are baclofen for periodic alternating nystagmus, gabapentin and memantine for acquired pendular nystagmus, and carbamazepine for superior oblique myokymia.
Straube
Andreas
A
Department of Neurology, University of Munich, Munich, Germany. astraube@brain.nefo.med.uni-muenchen.de
D000588:Amines / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use; D018755:GABA Agonists / Q000627:therapeutic use; D000077206:Gabapentin; D006801:Humans; D009039:Motion Perception; D009759:Nystagmus, Pathologic / Q000188:drug therapy*; D026902:Potassium Channel Blockers / Q000627:therapeutic use; D013256:Steroids / Q000627:therapeutic use; D014717:Vertigo / Q000188:drug therapy*; D015837:Vestibular Diseases / Q000188:drug therapy; D014786:Vision Disorders / Q000188:drug therapy*; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
D000588:Amines; D003509:Cyclohexanecarboxylic Acids; D018691:Excitatory Amino Acid Antagonists; D018755:GABA Agonists; D026902:Potassium Channel Blockers; D013256:Steroids; D001569:Benzodiazepines; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin