Dizziness - Treatment

The main goal of treating a patient with dizziness is the maximum possible elimination of unpleasant sensations and accompanying neurological and otitis disorders (impaired coordination, hearing, vision, etc.). Treatment tactics are determined by the cause of the disease and the mechanisms of its development. Important tasks are to ensure maximum independence in everyday life, minimize the risk of falls as a potential source of injury, and eliminate or reduce the likelihood of developing a situation that is psychotraumatic for the patient.

The main directions of treatment of a patient with dizziness are determined by its etiology.

• In case of cerebral circulation disorders, effective control of blood pressure, the use of nootropics, antiplatelet agents, vasodilators or venotonics, and, if necessary, antiepileptic drugs are mandatory.
• Patients with Meniere's disease are advised to limit their intake of table salt, use diuretics, and if there is no effect and there are frequent severe attacks of dizziness, the issue of surgical treatment is considered.
• Vestibular neuronitis may require antiviral medications.
• The basis of treatment for patients with BPPV is non-drug therapy.
  • The essence of the method is that the patient makes head movements that help shift the otoliths from the semicircular canal to the vestibule. The Epley maneuver is considered the most effective manipulation. The patient is placed on the couch on his back with the head turned toward the affected labyrinth and slightly tilted back. The head is slowly (over the course of 1 minute) turned in the opposite direction, which causes the otoliths to shift. As the turn is performed, a feeling of systemic dizziness occurs, which intensifies toward the end of its execution. At the same time, horizontal or horizontal-rotatory binocular nystagmus can be detected in the patient. Intense dizziness can be associated with the displacement of the otoliths into the elliptical saccule, which is the purpose of the manipulation. Supporting the patient, he should be seated on the couch and the manipulation with the head turning in the opposite direction should be performed. Displaced otoliths can cause irritation of receptors for several hours, which is accompanied by dizziness (iatrogenic instability of the otolith apparatus). After repositioning the otoliths, it is advisable to remain in a position with the head raised for 24 hours.
  • The use of drugs that suppress the activity of the vestibular analyzer in benign paroxysmal positional vertigo is considered inappropriate.

[ 1 ]

Symptomatic treatment of dizziness

Symptomatic therapy for dizziness involves the use of vestibulolytics that inhibit the activity of vestibular receptors and ascending conduction systems. The duration of their use should not be excessively long, since some drugs, inhibiting the activity of the corresponding nerve formations, prevent the development of compensatory changes. Betahistine is widely used to relieve and prevent attacks of systemic dizziness; its effect is realized through histamine H2- _and H3 _- receptors of the inner ear and vestibular nuclei. The drug is usually prescribed at 48 mg per day (24 mg tablets - 2 times a day), the effectiveness increases with simultaneous therapeutic exercises. In case of non-systemic dizziness (balance disorders, pre-syncope, psychogenic dizziness), the use of betahistine as the main therapy is inappropriate.

In case of predominant damage to the vestibular analyzer, antihistamines have an effect - meclizine (12.5-25 mg 3-4 times a day), promethazine (25-50 mg 4 times a day).

Drugs that limit the flow of calcium ions into the cell are widely used, which in this situation have a variety of clinical effects (cinnarizine 25 mg 3 times a day).

Traditionally, combined drugs with vestibulolytic and sedative action are widely used, helping to reduce the severity of both dizziness itself and the accompanying vegetative manifestations. Such drugs contain belladonna alkaloids, sedatives, vasoactive components (for example, belladonna alkaloids + phenobarbital + ergotamine-bellataminal). The expediency of their use has been established empirically, clinically significant effects include a decrease in nausea, hyperhidrosis, hypersalivation, bradycardia, as a result of which episodes of dizziness are tolerated much easier.

An extremely complex problem is the management of patients with a predominantly non-systemic nature of dizziness, in particular, balance disorders. The therapeutic approach is determined by the nature of the leading pathological process (the degree and level of organic damage to the brain or spinal cord, proprioceptive afferentation disorders, etc.). Of great importance is non-drug therapy aimed at restoring coordination of movements, improving gait, teaching the patient skills to overcome balance disorders. Often, non-drug treatment is limited by concomitant cognitive decline.

In the vast majority of cases of dizziness, systematic exercise therapy is advisable, which allows not only to reduce subjective unpleasant symptoms, but also to ensure the maximum possible independence of the patient in everyday life, as well as to reduce the risk of falls in the elderly.

It is advisable to treat patients with psychogenic dizziness with the participation of a psychotherapist (psychiatrist). Along with non-drug treatment, in most cases it is necessary to use antidepressants and anxiolytics. In some cases, a positive effect can be achieved by prescribing anticonvulsants (carbamazepine, gabapentin). It should be taken into account that most of the above medications themselves, in certain situations (with inadequate dosing, rapid increase in dose), can cause dizziness. In order to avoid independent discontinuation of treatment, the patient must be informed about possible side effects.

In many patients with dizziness caused by organic damage to the vestibular apparatus or other sensory systems, recovery may be incomplete, which is why rehabilitation methods aimed at compensating for the defect and providing the patient with a certain level of independence in everyday life are of exceptional importance.