title: Pharmacotherapy of vestibular and cerebellar disorders and downbeat nystagmus: translational and back-translational research.
abstract: There are currently eight groups of drugs for the pharmacotherapy of vertigo, nystagmus, and cerebellar disorders: antiemetics; anti-inflammatories, antimenieres, and antimigraineous medications; antidepressants, anticonvulsants, aminopyridines, and acetyl-DL-leucine ("the eight A's"). In acute unilateral vestibulopathy, corticosteroids improve the recovery of peripheral vestibular function, but there is not sufficient current evidence for a general recommendation. There is also insufficient evidence that 48 or 144 mg/day betahistine has an effect in Ménière's disease. Therefore, higher dosages are currently recommended; in animal studies, it was shown that betahistine increases cochlear blood flow. In vestibular paroxysmia, oxcarbazepine was effective (one yet not randomized controlled trial (RCT)). Aminopyridines are recommended for the treatment of downbeat nystagmus (two RCTs) and episodic ataxia type 2 (EA2, one RCT). There are so far no RCTs on vestibular migraine, so currently no treatment can be recommended. Acetyl-dl-leucine improves cerebellar ataxia (three observational studies); it also accelerates central compensation in an animal model of acute unilateral lesion, but RCTs were negative. There are ongoing RCTs on vestibular paroxysmia with carbamazepine (VESPA), acute unilateral vestibulopathy with betahistine (BETAVEST), vestibular migraine with metoprolol (PROVEMIG), benign paroxysmal positional vertigo with vitamin D (VitD@BPPV), EA2 with 4-aminopyridine versus acetazolamide (EAT-2-TREAT), and cerebellar ataxias with acetyl-DL-leucine (ALCAT).
authors.affiliation: Department of Neurology, German Center for Vertigo and Balance Disorders and Institute for Clinical Neurosciences, University Hospital Munich, Campus Grosshadern, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Strupp
authors.forename: Andreas
authors.initials: A
authors.lastname: Zwergal
authors.forename: Katharina
authors.initials: K
authors.lastname: Feil
authors.forename: Tatiana
authors.initials: T
authors.lastname: Bremova
authors.forename: Thomas
authors.initials: T
authors.lastname: Brandt
mesh_terms: D000631:Aminopyridines / Q000627:therapeutic use; D000818:Animals; D001621:Betahistine / Q000627:therapeutic use; D006801:Humans; D009759:Nystagmus, Pathologic / Q000188:drug therapy*; D004856:Postural Balance / Q000187:drug effects; D057170:Translational Research, Biomedical; D015837:Vestibular Diseases / Q000188:drug therapy*; D014722:Vestibule, Labyrinth / Q000503:physiopathology
chemical_list: D000631:Aminopyridines; D001621:Betahistine
keywords: Ménière's disease; acute unilateral vestibulopathy; aminopyridines; central vestibular disorders; cerebellar ataxias; downbeat nystagmus; episodic ataxia type 2; vestibular migraine; vestibular paroxysmia