Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus

Michael Strupp; Matthew J Thurtell; Aasef G Shaikh; Thomas Brandt; David S Zee; R John Leigh

doi:10.1007/s00415-011-5999-8

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Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus

Journal article

Open access

Peer reviewed

Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus

Michael Strupp, Matthew J Thurtell, Aasef G Shaikh, Thomas Brandt, David S Zee and R John Leigh

Journal of neurology, Vol.258(7), pp.1207-1222

07/2011

DOI: 10.1007/s00415-011-5999-8

PMCID: PMC3132281

PMID: 21461686

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Abstract

We review current pharmacological treatments for peripheral and central vestibular disorders, and ocular motor disorders that impair vision, especially pathological nystagmus. The prerequisites for successful pharmacotherapy of vertigo, dizziness, and abnormal eye movements are the "4 D's": correct diagnosis, correct drug, appropriate dosage, and sufficient duration. There are seven groups of drugs (the "7 A's") that can be used: antiemetics; anti-inflammatory, anti-Ménière's, and anti-migrainous medications; anti-depressants, anti-convulsants, and aminopyridines. A recovery from acute vestibular neuritis can be promoted by treatment with oral corticosteroids. Betahistine may reduce the frequency of attacks of Ménière's disease. The aminopyridines constitute a novel treatment approach for downbeat and upbeat nystagmus, as well as episodic ataxia type 2 (EA 2); these drugs may restore normal "pacemaker" activity to the Purkinje cells that govern vestibular and cerebellar nuclei. A limited number of trials indicate that baclofen improves periodic alternating nystagmus, and that gabapentin and memantine improve acquired pendular and infantile (congenital) nystagmus. Preliminary reports suggest suppression of square-wave saccadic intrusions by memantine, and ocular flutter by beta-blockers. Thus, although progress has been made in the treatment of vestibular neuritis, some forms of pathological nystagmus, and EA 2, controlled, masked trials are still needed to evaluate treatments for many vestibular and ocular motor disorders, including betahistine for Ménière's disease, oxcarbazepine for vestibular paroxysmia, or metoprolol for vestibular migraine.

Vestibular Diseases - drug therapy

Ocular Motility Disorders - drug therapy

Drug Therapy - methods

Nystagmus, Pathologic - drug therapy

Humans

Details

Title: Subtitle: Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus
Creators: Michael Strupp - Department of Neurology, University of Munich, Munich, Germany
Matthew J Thurtell
Aasef G Shaikh
Thomas Brandt
David S Zee
R John Leigh
Resource Type: Journal article
Publication Details: Journal of neurology, Vol.258(7), pp.1207-1222
DOI: 10.1007/s00415-011-5999-8
PMID: 21461686
PMCID: PMC3132281
NLM abbreviation: J Neurol
ISSN: 1432-1459
eISSN: 1432-1459
Publisher: Germany
Grant note: R01EY01849 / NEI NIH HHS R01EY06717 / NEI NIH HHS R01 EY001849 / NEI NIH HHS R01 EY006717 / NEI NIH HHS
Language: English
Date published: 07/2011
Academic Unit: Neurology; Ophthalmology and Visual Sciences
Record Identifier: 9983979964902771

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