Acupuncture for vertebrobasilar insufficiency vertigo: Protocol for a systematic review and meta-analysis

Clinical efficacy and safety of flunarizine tablets combined with betahistine hydrochloride tablets in patients with vertebrobasilar insufficiency vertigo

OBJECTIVE

To explore the clinical efficacy and safety of betahistine hydrochloride tablets in patients with vertebrobasilar insufficiency vertigo (VBIV).

METHODS

A total of 133 patients with vertigo caused by vertebrobasilar insufficiency treated in The First People's Hospital of Shangqiu City from March 2019 to August 2021 were selected and analyzed retrospectively. Among them, 63 patients treated with flunarizine tablets were seen as the control group (CG), and 70 with flunarizine tablets combined with betastine hydrochloride tablets were considered as the observation group (OG). The treatment efficacy and adverse reactions were compared, and the vertigo symptom score, quality of life and vertebrobasilar artery hemodynamics were observed before and after treatment.

RESULTS

The effective rate in the OG was higher than that of the CG (P<0.05), but there was no obvious difference in adverse reactions (P>0.05). Compared with the CG, the arterial hemodynamics and cerebral blood perfusion as well as SF-36 score were higher, while the scores of dizziness assessment rating scale (DARS) and dizziness handicap inventory (DHI) scale were lower in the OG (all P<0.05).

CONCLUSION

Betahistine hydrochloride can effectively improve arterial hemodynamics and cerebral blood flow perfusion in vertebrobasilar insufficiency patients and enhance the clinical efficacy with high safety profile, which is worthy of wide application.

Chiropractic Management of Neck Pain Complicated by Symptomatic Vertebral Artery Stenosis and Dizziness

BACKGROUND Vertebrobasilar insufficiency (VBI) is most often caused by vertebrobasilar atherosclerosis, often presenting with dizziness and occasionally neck pain. Little research or guidelines regarding management of neck pain in affected patients exists. CASE REPORT A 62-year-old male hypertensive smoker presented to a chiropractor with a 13-year history of insidious-onset neck pain, dizziness, and occipital headache with a Dizziness Handicap Inventory (DHI) of 52%. The patient had known VBI, caused by bilateral vertebral artery plaques, and cervical spondylosis, and was treated with multiple cardiovascular medications. The chiropractor referred patient to a neurosurgeon, who cleared him to receive manual therapies provided manual-thrust cervical spinal manipulative therapy (SMT) was not performed. The chiropractor administered thoracic SMT and cervicothoracic soft tissue manipulation. The neck pain and dizziness mostly resolved by 1 month. At 1-year follow-up, DHI was 0%; at 2 years it was 8%. A literature search revealed 4 cases in which a chiropractor used manual therapies for a patient with VBI. Including the present case, all patients had neck pain, 60% had dizziness, and all were treated with SMT either avoiding manual cervical manipulation altogether or modifying it to avoid or limit cervical rotation, yielding positive outcomes. CONCLUSIONS The present and previous cases provide limited evidence that some carefully considered chiropractic manual therapies can afford patients with VBI relief from concurrent neck pain and possibly dizziness. Given the paucity of research, cervical SMT cannot be recommended in such patients. These findings do not apply to vertebral artery dissection, for which SMT is an absolute contraindication.

Influence of laser needle-knife on PI-3K, AKT and VEGF mRNA expression in cervical spondylotic arteriopathy model rabbits

Objective

To determine the effect of laser needle-knife on PI-3K, AKT and VEGF mRNA expression of vertebral arteries in a rabbit model of cervical spondylotic arteriopathy (CSA) and the mechanism of action involved.

Methods

Forty healthy general-grade rabbits were divided into a normal control group, model group, acupuncture group, and laser needle-knife group (n = 10 rabbits per group), and the CSA rabbit model was established in all but groups but the normal control group. CSA model rabbits in the acupuncture group were treated by acupuncture at the Fengchi (GB 20) and Cervical Jiaji (EX-B 2) points, whereas rabbits in the laser needle-knife group were treated with laser needle-knife targeting the Jiaji points near the C5 spinous process. Rabbits in the normal control and model groups were fixed using similar methods. Behavioral characteristics of all rabbits were evaluated before and after treatment. Peak systolic velocity (PSV) of the right carotid and vertebral arteries in each group were examined using beside B ultrasound, and PI-3K, AKT, VEGF mRNA expression in vertebral arteries were determined by real-time PCR.

Results

The behavioral signs of rabbits were improved after treatment in both the acupuncture and laser needle-knife groups. In comparison with control group, PSV of right carotid arteries in acupuncture group and laser needle-knife group were enhanced significantly (P < 0.05 and P < 0.01), PSV of right vertebral arteries in acupuncture group and laser needle-knife group were enhanced significantly too (P < 0.01 and P < 0.05). PI-3K mRNA expression in laser needle-knife and acupuncture group was significantly higher than that in control group (P < 0.01, P < 0.05). AKT mRNA expression in laser needle-knife and acupuncture group was significantly higher than that in control group (P < 0.01). VEGF mRNA expression in laser needle-knife and acupuncture group was significantly higher than that in control group too (P < 0.01, P < 0.05). No significant differences were found in PI-3K, AKT and VEGF mRNA expression levels among acupuncture and laser needle-knife groups (P > 0.05).

Conclusion

Laser needle-knife could effectively intervene the mRNA expression of PI-3K, AKT and VEGF, this may be one of the mechanisms of the effect of laser needle-knife in treating CSA in rabbits.