Medikamentöse Therapiemöglichkeiten bei vestibulären Störungen, Nystagmus und zerebellären Ataxien Pharmacotherapy of Vestibular Disorders, Nystagmus and Cerebellar Disorders

1 Acetyl-DL-Leucin " vestibular disorders ● " therapy Abstract ! There are currently different groups of drugs for the pharmacotherapy of vertigo, nystagmus and cerebellar disorders: antiemetics; anti-inflam- matories, antimenieres, and antimigraineous med- ications and antidepressants, anticonvulsants, aminopyridines as well as acetyl-DL-leucine. In acute unilateral vestibulopathy, corticosteroids im- prove the recovery of peripheral vestibular func- tion, but currently there is not sufficient evidence for a general recommendation. There is insufficient evidence to support the view that 16mg t.i.d. or 48mg t.i.d. betahistine has an effect in Meniere's disease. Therefore, higher dosages are recommen- ded. In animal studies, it was shown that betahis- tine increases cochlear blood flow. In vestibular paroxysmia, oxcarbazepine was effective (one ran- domized controlled trial (RCT)). Aminopyridines are recommended for the treatment of downbeat nystagmus (two RCTs) and episodic ataxia type 2 (EA2, one RCT). There has been no RCT on the effi- cacy of beta-blockers or topiramate but one RCTon flunarizine investibular migraine. Based on clinical experience, a treatment analogous to that for mi- graine without aura can be recommended. Acetyl- DL-leucine improved cerebellar ataxia (two obser- vational studies); it also accelerated central com- pensation in an animal model of acute unilateral lesion, but RCTs were negative. There are ongoing RCTs on treatment of vestibular paroxysmia with carbamazepine (VESPA), acute unilateral vestibu- lopathy 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 atax- ias with acetyl-DL-leucine (ALCAT). Dieses Dokument wurde zum personlichen Gebrauch heruntergeladen. Vervielfaltigung nur mit Zustimmung des Verlages.