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Strupp M, Churchill GC, Naumann I, Mansmann U, Al Tawil A, Golentsova A, Goldschagg N. Examination of betahistine bioavailability in combination with the monoamine oxidase B inhibitor, selegiline, in humans-a non-randomized, single-sequence, two-period titration, open label single-center phase 1 study (PK-BeST). Front Neurol 2023; 14:1271640. [PMID: 37920833 PMCID: PMC10619746 DOI: 10.3389/fneur.2023.1271640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/04/2023] [Indexed: 11/04/2023] Open
Abstract
Background Betahistine was registered in Europe in the 1970s and approved in more than 80 countries as a first-line treatment for Menière's disease. It has been administered to more than 150 million patients. However, according to a Cochrane systematic review of betahistine and recent meta-analyses, there is insufficient evidence to say whether betahistine has any effect in the currently approved dosages of up to 48 mg/d. A combination with the monoamine oxidase B (MAO-B) inhibitor, selegiline, may increase the bioavailability of betahistine to levels similar to the well-established combination of L-DOPA with carbidopa or benserazide in the treatment of Parkinson's disease. We investigated the effect of selegiline on betahistine pharmacokinetics and the safety of the combination in humans. Methods In an investigator-initiated prospective, non-randomized, single-sequence, two-period titration, open label single-center phase 1 study, 15 healthy volunteers received three single oral dosages of betahistine (24, 48, and 96 mg in this sequence with at least 2 days' washout period) without and with selegiline (5 mg/d with a loading period of 7 days). Betahistine serum concentrations were measured over a period of 240 min at eight time points (area under the curve, AUC0-240 min). This trial is registered with EudraCT (2019-002610-39) and ClinicalTrials.gov. Findings In all three single betahistine dosages, selegiline increased the betahistine bioavailability about 80- to 100-fold. For instance, the mean (±SD) of the area under curve for betahistine 48 mg alone was 0.64 (+/-0.47) h*ng/mL and for betahistine plus selegiline 53.28 (+/-37.49) h*ng/mL. The half-life time of around 30 min was largely unaffected, except for the 24 mg betahistine dosage. In total, 14 mild adverse events were documented. Interpretation This phase 1 trial shows that the MAO-B inhibitor selegiline increases betahistine bioavailability by a factor of about 80 to 100. No safety concerns were detected. Whether the increased bioavailability has an impact on the preventive treatment of Menière's disease, acute vestibular syndrome, or post-BPPV residual dizziness has to be evaluated in placebo-controlled trials. Clinical trial registration https://clinicaltrials.gov/study/NCT05938517?intr=betahistine%20and%20selegiline&rank=1, identifier: NCT05938517.
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Affiliation(s)
- Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
| | - Grant C. Churchill
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Ivonne Naumann
- Department of Neurology and German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
| | - Ulrich Mansmann
- Department of Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilians University, Munich, Germany
| | - Amani Al Tawil
- Department of Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilians University, Munich, Germany
| | - Anastasia Golentsova
- Department of Neurology and German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
| | - Nicolina Goldschagg
- Department of Neurology and German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
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Erdur ZB, Evran N. Effect of betahistine treatment on dizziness and anxiety symptoms of BPPV patients. Niger J Clin Pract 2023; 26:1383-1387. [PMID: 37794554 DOI: 10.4103/njcp.njcp_305_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background Patients with benign paroxysmal positional vertigo (BPPV) may experience significant deterioration in their quality of life due to dizziness and anxiety symptoms. Aim To evaluate the effect of betahistine add-on therapy on dizziness and anxiety symptoms of BPPV patients. Materials and Methods Eighty-four patients who were diagnosed as having posterior canal BPPV were included in the study. Patients were divided into two groups according to the treatment regimen: Group 1 included 42 subjects who were treated with the Epley maneuver alone and Group 2 included 42 subjects who received betahistine 48 mg/day for ten days with the Epley maneuver. Dizziness handicap inventory (DHI) and Beck anxiety inventory (BAI) were evaluated at the time of diagnosis and at the control examination on the tenth day. Results The mean before and after treatment DHI scores were 38.8 ± 14.6 and 5.47 ± 6.4 for Group 1 (P < 0.001), and 45.8 ± 21.1 and 10.3 ± 12.9 for Group 2 (P < 0.001). The mean before and after treatment BAI scores were 11.8 ± 6 and 1.33 ± 1.8 for Group 1 (P < 0.001), and 13.6 ± 8.3 and 2.9 ± 3.8 for Group 2 (P < 0.001). There was no significant difference between the before and after treatment DHI and BAI score differences of the two groups (P = 0.27, P = 0.43). Conclusion Canalith repositioning maneuvers (CRMs) should be the main treatment modality in the management of BPPV patients and adding on betahistine treatment to CRMs have no impact in the relieving of dizziness and anxiety symptoms.
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Affiliation(s)
- Z B Erdur
- Department of Otolaryngology Head and Neck Surgery, Kirklareli Training and Research Hospital, Kirklareli, Türkiye
| | - N Evran
- Department of Audiology, Kirklareli Training and Research Hospital, Kirklareli, Türkiye
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Antons M, Lindner M, Eilles E, Günther L, Delker A, Branner C, Krämer A, Beck R, Oos R, Wuehr M, Ziegler S, Strupp M, Zwergal A. Dose- and application route-dependent effects of betahistine on behavioral recovery and neuroplasticity after acute unilateral labyrinthectomy in rats. Front Neurol 2023; 14:1175481. [PMID: 37538257 PMCID: PMC10395078 DOI: 10.3389/fneur.2023.1175481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/28/2023] [Indexed: 08/05/2023] Open
Abstract
Introduction Betahistine is widely used for the treatment of various vestibular disorders. However, the approved oral administration route and maximum daily dose are evidently not effective in clinical trials, possibly due to a major first-pass metabolism by monoamine oxidases (MAOs). The current study aimed to test different application routes (i.v./s.c./p.o.), doses, and concurrent medication (with the MAO-B inhibitor selegiline) for their effects on behavioral recovery and cerebral target engagement following unilateral labyrinthectomy (UL) in rats. Methods Sixty rats were subjected to UL by transtympanic injection of bupivacaine/arsanilic acid and assigned to five treatment groups: i.v. low-dose betahistine (1 mg/kg bid), i.v. high-dose betahistine (10 mg/kg bid), p.o. betahistine (1 mg/kg bid)/selegiline (1 mg/kg once daily), s.c. betahistine (continuous release of 4.8 mg/day), and i.v. normal saline bid (sham treatment; days 1-3 post-UL), respectively. Behavioral testing of postural asymmetry, nystagmus, and mobility in an open field was performed seven times until day 30 post-UL and paralleled by sequential cerebral [18F]-FDG-μPET measurements. Results The therapeutic effects of betahistine after UL differed in extent and time course and were dependent on the dose, application route, and selegiline co-medication: Postural asymmetry was significantly reduced on 2-3 days post-UL by i.v. high-dose and s.c. betahistine only. No changes were observed in the intensity of nystagmus across groups. When compared to sham treatment, movement distance in the open field increased up to 5-fold from 2 to 30 days post-UL in the s.c., i.v. high-dose, and p.o. betahistine/selegiline groups. [18F]-FDG-μPET showed a dose-dependent rCGM increase in the ipsilesional vestibular nucleus until day 3 post-UL for i.v. high- vs. low-dose betahistine and sham treatment, as well as for p.o. betahistine/selegiline and s.c. betahistine vs. sham treatment. From 1 to 30 days post-UL, rCGM increased in the thalamus bilaterally for i.v. high-dose betahistine, s.c. betahistine, and p.o. betahistine/selegiline vs. saline treatment. Discussion Betahistine has the potential to augment the recovery of dynamic deficits after UL if the administration protocol is optimized toward higher effective plasma levels. This may be achieved by higher doses, inhibition of MAO-based metabolism, or a parenteral route. In vivo imaging suggests a drug-target engagement in central vestibular networks.
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Affiliation(s)
- Melissa Antons
- German Center for Vertigo and Balance Disorders, DSGZ, LMU University Hospital, LMU Munich, Munich, Germany
| | - Magdalena Lindner
- German Center for Vertigo and Balance Disorders, DSGZ, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Eva Eilles
- German Center for Vertigo and Balance Disorders, DSGZ, LMU University Hospital, LMU Munich, Munich, Germany
| | - Lisa Günther
- German Center for Vertigo and Balance Disorders, DSGZ, LMU University Hospital, LMU Munich, Munich, Germany
| | - Astrid Delker
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christina Branner
- German Center for Vertigo and Balance Disorders, DSGZ, LMU University Hospital, LMU Munich, Munich, Germany
| | - Anja Krämer
- German Center for Vertigo and Balance Disorders, DSGZ, LMU University Hospital, LMU Munich, Munich, Germany
| | - Roswitha Beck
- German Center for Vertigo and Balance Disorders, DSGZ, LMU University Hospital, LMU Munich, Munich, Germany
| | - Rosel Oos
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders, DSGZ, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sibylle Ziegler
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Michael Strupp
- German Center for Vertigo and Balance Disorders, DSGZ, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Andreas Zwergal
- German Center for Vertigo and Balance Disorders, DSGZ, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
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Su Y, Deng C, Liu X, Lian J. Epigenetic Histone Methylation of PPARγ and CPT1A Signaling Contributes to Betahistine Preventing Olanzapine-Induced Dyslipidemia. Int J Mol Sci 2023; 24:ijms24119143. [PMID: 37298094 DOI: 10.3390/ijms24119143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/08/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023] Open
Abstract
As a partial histamine H1 receptor agonist and H3 antagonist, betahistine has been reported to partially prevent olanzapine-induced dyslipidemia and obesity through a combination therapy, although the underlying epigenetic mechanisms are still not known. Recent studies have revealed that histone regulation of key genes for lipogenesis and adipogenesis in the liver is one of the crucial mechanisms for olanzapine-induced metabolic disorders. This study investigated the role of epigenetic histone regulation in betahistine co-treatment preventing dyslipidemia and fatty liver caused by chronic olanzapine treatment in a rat model. In addition to abnormal lipid metabolism, the upregulation of peroxisome proliferator-activated receptor γ (PPARγ) and CCAAT/enhancer binding protein (C/EBPα), as well as the downregulation of carnitine palmitoyltransferase 1A (CPT1A) in the liver induced by olanzapine, were significantly attenuated by betahistine co-treatment. In addition, betahistine co-treatment significantly enhanced the global expression of H3K4me and the enrichment of H3K4me binding on the promoter of Cpt1a gene as revealed by ChIP-qPCR, but inhibited the expression of one of its site-specific demethylases, lysine (K)-specific demethylase 1A (KDM1A). Betahistine co-treatment also significantly enhanced the global expression of H3K9me and the enrichment of H3K9me binding on the promoter of the Pparg gene, but inhibited the expression of two of its site-specific demethylases, lysine demethylase 4B (KDM4B) and PHD finger protein 2 (PHF2). These results suggest that betahistine attenuates abnormal adipogenesis and lipogenesis triggered by olanzapine through modulating hepatic histone methylation, and thus inhibiting the PPARγ pathway-mediated lipid storage, while at the same time promoting CP1A-mediated fatty acid oxidation.
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Affiliation(s)
- Yueqing Su
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynaecology and Paediatrics, Fujian Medical University, Fuzhou 350005, China
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
- School of Medical, Indigenous and Health Sciences, and Molecular Horizons, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Chao Deng
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
- School of Medical, Indigenous and Health Sciences, and Molecular Horizons, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Xuemei Liu
- School of Pharmaceutical Sciences, Medical Research Institute, Southwest University, Chongqing 400716, China
| | - Jiamei Lian
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
- School of Medical, Indigenous and Health Sciences, and Molecular Horizons, University of Wollongong, Wollongong, NSW 2522, Australia
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Singh G, Aggarwal A, Sahni D, Kumar Sharma D, Yadav V, Bhagat S. Comparative Effectiveness Research: Betahistine add-on Therapy with Epley's Manoeuvre Versus Epley's Manoeuvre Alone in Treating Posterior BPPV Patients. Indian J Otolaryngol Head Neck Surg 2023; 75:204-209. [PMID: 37206840 PMCID: PMC10188886 DOI: 10.1007/s12070-022-03369-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Benign paroxysmal positional vertigo is one of the common vestibular disorders encountered in ENT clinics with accompanying vertigo. Study to evaluate the additive effects of betahistine on Epley's manoeuvre in treating posterior BPPV patients. MATERIAL AND METHODS Prospective study was conducted on 50 patients of posterior BPPV diagnosed by the Dix Hallpike test. Subjects were divided into Group A which received the Betahistine therapy along with the canalith repositioning technique (Epley's manoeuvre) and the second group (Group B) which received the Epley's manoeuvre alone. The patients were assessed at 1 week and 4 weeks by Visual Analogue Scale (VAS), Dizziness Handicap Inventory (DHI) and Short Form 36 (SF-36). RESULTS At the end of 4 weeks, 2 patients in group A (E + B) had positive Dix-Hallpike and 23(92%) had negative Dix-Hallpike, while 11 patients in group B (E) had positive Dix-Hallpike and 14 (56%) had negative Dix-Hallpike with P value < 0.001. The Mean baseline (T0) Visual Analogue Scale (VAS) score in group A (E + B) was 8.60 ± 1.080 and in group B (E) was 8.92 ± 0.996. Post-treatment VAS score was significantly lower in both the groups and was significantly lower in group A(E + B) than in group B (E) (0.680 ± 1.930 vs. 3.96 ± 3.587, respectively, p-value < 0.001). The Mean baseline (T0) Dizziness Handicap Inventory (DHI) scores were similar in groups A and B (77.36 ± 9.49 vs. 80.00 ± 8.9, respectively, p = 0.271). After treatment, the DHI values were significantly lower in both groups. Group A had a better DHI score than group B (10.56 ± 17.12 vs. 44.72 ± 27.35, p < 0.001). The mean baseline (T0) Short Form 36 (SF-36) scores were also similar in groups A and B (19.53 ± 6.85 vs. 18.79 ± 5.50, p = 0.823). Post-treatment of 4 weeks, the SF-36 score significantly improved in both the groups and significantly improved in group A than group B (84.27 ± 17.28 vs. 46.53 ± 24.53, p < 0.001). CONCLUSION Betahistine therapy in conjunction with Epley's manoeuvre leads to better symptom control and is more effective than Epley's alone in treating BPPV patients.
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Affiliation(s)
- Garima Singh
- Department of Otolaryngology, Head and neck Surgery, Government Medical College Patiala, Patiala, India
| | - Ankita Aggarwal
- Department of Otolaryngology, Head and neck Surgery, Government Medical College Patiala, Patiala, India
| | - Dimple Sahni
- Department of Otolaryngology, Head and neck Surgery, Government Medical College Patiala, Patiala, India
| | - Dinesh Kumar Sharma
- Department of Otolaryngology, Head and neck Surgery, Government Medical College Patiala, Patiala, India
| | - Vishav Yadav
- Department of Otolaryngology, Head and neck Surgery, Government Medical College Patiala, Patiala, India
| | - Sanjeev Bhagat
- Department of Otolaryngology, Head and neck Surgery, Government Medical College Patiala, Patiala, India
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Li W, Sun J, Zhao Z, Xu J, Wang H, Ding R, Zhang Y. Efficacy of Epley's maneuver plus betahistine in the management of PC-BPPV: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33421. [PMID: 37000080 PMCID: PMC10063308 DOI: 10.1097/md.0000000000033421] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND To evaluate the efficacy of Epley's maneuver plus betahistine in the management of patients with posterior canal benign paroxysmal positional vertigo (PC-BPPV). METHODS Electronic databases including PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, and Wanfang were searched from their inception to April, 2022. The effect size was analyzed by calculating the pooled risk ratio estimates of efficacy rate, recurrence rate, and standardized mean differences (SMD) of dizziness handicap inventory (DHI) score with a 95% confidence interval (CI). Sensitive analysis was performed simultaneously. RESULTS A total of 9 randomized controlled trials with 860 PC-BPPV patients were included in the meta-analysis, in which 432 were treated with Epley's maneuver plus betahistine, and 428 received Epley's maneuver alone. The meta-analysis revealed that Epley's maneuver plus betahistine significantly improved DHI score than Epley's maneuver alone (SMD = -0.61, 95% CI -0.96 to -0.26, P = .001). In addition, both Epley's maneuver plus betahistine and Epley's maneuver groups had comparable outcomes in efficacy rate and recurrence rate. CONCLUSION This meta-analysis shows that Epley's maneuver plus betahistine in PC-BPPV patients had favorable effects on DHI score.
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Affiliation(s)
- Wei Li
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jinqiang Sun
- Department of Otolaryngology, Head and Neck Surgery, Suining People’s Hospital, Xuzhou, China
| | - Zeqi Zhao
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jifeng Xu
- The First Clinical Medical College of Xuzhou Medical University, Xuzhou, China
- Otorhinolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Xuzhou, China
| | - Hao Wang
- The First Clinical Medical College of Xuzhou Medical University, Xuzhou, China
| | - Rui Ding
- The First Clinical Medical College of Xuzhou Medical University, Xuzhou, China
| | - Yanqiu Zhang
- Department of Otolaryngology Head and Neck Surgery, Xuzhou Cancer Hospital, Xuzhou, China
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Pålbrink AK, In 't Zandt R, Magnusson M, Degerman E. Betahistine prevents development of endolymphatic hydrops in a mouse model of insulin resistance and diabetes. Acta Otolaryngol 2023; 143:127-133. [PMID: 36735299 DOI: 10.1080/00016489.2023.2171116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Diabetes is associated with inner ear dysfunction. Furthermore, C57BL/6J mice fed high fat diet (HFD), a model for insulin resistance and diabetes, develop endolymphatic hydrops (EH). AIM Evaluate if betahistine, spironolactone (aldosterone antagonist) and empagliflozin (sodium -glucose cotransporter2 inhibitor) can prevent EH induced by HFD and explore potential mechanisms. METHODS C57BL/6J mice fed HFD were treated with respective drug. The size of the endolymphatic fluid compartment was measured using contrast enhanced MRI. Secondarily, mice treated with cilostamide, a phosphodiesterase3 inhibitor, to induce EH and HEI-OC1 auditory cells were used to study potential cellular mechanisms of betahistine. RESULTS HFD-induced EH was prevented by betahistine but not by spironolactone and empagliflozin. Betahistine induced phosphorylation of protein kinaseA substrates but did not prevent cilostamide-induced EH. CONCLUSIONS Betahistine prevents the development of EH in mice fed HFD, most likely not involving pathways downstream of phosphodiesterase3, an enzyme with implications for dysfunction in diabetes. The finding that spironolactone did not prevent HFD-induced EH suggests different mechanisms for EH induction/treatment since spironolactone prevents EH induced by vasopressin, as previously observed. SIGNIFICANCE This further demonstrates that independent mechanisms can cause hydropic inner ear diseases which suggests different therapeutic approaches and emphazises the need for personalized medicine.
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Affiliation(s)
- Ann-Ki Pålbrink
- Department of Experimental Medical Science, Section for Diabetes, Metabolism and Endocrinology, Lund University Diabetes Centre, Lund, Sweden
| | - René In 't Zandt
- Lund University Bioimaging Center, Lund University, Lund, Sweden
| | - Måns Magnusson
- Department of Clinical Science, Section for Otorhinolaryngology, Lund University & Skåne University Hospital, Lund, Sweden
| | - Eva Degerman
- Department of Experimental Medical Science, Section for Diabetes, Metabolism and Endocrinology, Lund University Diabetes Centre, Lund, Sweden
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Bai L, Liang W, Wang Y, Fan N, Zhang Q, Bian Y, Yang F. Effects of Adjunctive Betahistine Therapy on Lipid Metabolism in Patients with Chronic Schizophrenia: A Randomized Double-Blind Placebo-Controlled Study. Neuropsychiatr Dis Treat 2023; 19:453-460. [PMID: 36874957 PMCID: PMC9984272 DOI: 10.2147/ndt.s392770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/27/2023] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVE This study aims to explore the ability of betahistine to inhibit weight gain and abnormal lipid metabolism in patients with chronic schizophrenia. METHODS A comparison study of betahistine or placebo therapy was conducted for 4 weeks in 94 patients with chronic schizophrenia, who were randomly divided into two groups. Clinical information and lipid metabolic parameters were collected. Positive and Negative Syndrome Scale (PANSS) was used to assess psychiatric symptoms. Treatment Emergent Symptom Scale (TESS) was used to evaluate treatment-related adverse reactions. The differences in lipid metabolic parameters before and after treatment between the two groups were compared. RESULTS Repeated measures analysis of variance (ANOVA) revealed that after 4 weeks of betahistine/placebo treatment, the interaction effect of time and group was statistically significant on low-density lipoprotein cholesterol (F = 6.453, p = 0.013) and waist-to-hip ratio (F = 4.473, p = 0.037), but did not reveal any significant interaction effect of time and group on weight, body mass index or other lipid metabolic parameters, as well as the time main effect and group main effect (all p > 0.05). Betahistine had no significant impact on PANSS, and no side effects related to betahistine were detected. CONCLUSION Betahistine may delay metabolic abnormalities in patients with chronic schizophrenia. It does not affect the efficacy of the original antipsychotics. Thus, it provides new ideas for the treatment of metabolic syndrome in patients with chronic schizophrenia.
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Affiliation(s)
- Luyuan Bai
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, People's Republic of China
| | - Weiye Liang
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, People's Republic of China
| | - Yongqian Wang
- Office of Scientific Research, Peking University Health Science Center, Beijing, People's Republic of China
| | - Ning Fan
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, People's Republic of China
| | - Qi Zhang
- Department of Psychology, Wuxi Mental Health Center, Wuxi, People's Republic of China
| | - Yun Bian
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, People's Republic of China
| | - Fude Yang
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, People's Republic of China
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Kloos B, Bertlich M, Spiegel JL, Freytag S, Lauer SK, Canis M, Weiss BG, Ihler F. Low Dose Betahistine in Combination With Selegiline Increases Cochlear Blood Flow in Guinea Pigs. Ann Otol Rhinol Laryngol 2022; 132:519-526. [PMID: 35656811 PMCID: PMC10108341 DOI: 10.1177/00034894221098803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Betahistine is frequently used in the pharmacotherapy for Menière's Disease (MD). Little is known about its mode of action and prescribed dosages vary. While betahistine had an increasing effect on cochlear microcirculation in earlier studies, low dose betahistine of 0.01 mg/kg bw or less was not able to effect this. Selegiline inhibits monoaminooxidase B and therefore potentially the breakdown of betahistine. The goal of this study was to examine whether the addition of selegiline to low dose betahistine leads to increased cochlear blood flow. METHODS Twelve Dunkin-Hartley guinea pigs were anesthetized, the cochlea was exposed and a window opened to the stria vascularis. Blood plasma was visualized by injecting fluoresceinisothiocyanate-dextrane and vessel diameter and erythrocyte velocity were evaluated over 20 minutes. One group received low dose betahistine (0.01 mg/kg bw) and selegiline (1 mg/kg bw) i.v. while the other group received only selegiline (1 mg/kg bw) and saline (0.9% NaCl) as placebo i.v. RESULTS Cochlear microcirculation increased significantly (P < .001) in guinea pigs treated with low dose betahistine combined with selegiline by up to 58.3 ± 38.7% above baseline over a period of up to 11 minutes. In one guinea pig, the increase was 104.6%. Treatment with Selegiline alone did not affect microcirculation significantly. CONCLUSIONS Low dose betahistine increased cochlear microcirculation significantly when combined with selegiline. This should be investigated in further studies regarding dose-effect relation in comparison to betahistine alone. Side effects, in particular regarding circulation, should be considered carefully in view of the clinical applicability of a combination therapy in patients with MD.
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Affiliation(s)
- Benedikt Kloos
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany.,Institute of Surgical Research, Walter-Brendel-Centre of Experimental Medicine, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Dizziness (DSGZ), LMU Munich, Munich, Germany
| | - Mattis Bertlich
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany.,Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Jennifer L Spiegel
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Saskia Freytag
- Molecular Medicine, Harry Perkins Institute of Medical Research, Perth, WA, Australia
| | - Susanne K Lauer
- Clinic for Small Animal Surgery and Reproduction, LMU Munich, Munich, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Bernhard G Weiss
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Friedrich Ihler
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany.,Institute of Surgical Research, Walter-Brendel-Centre of Experimental Medicine, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Dizziness (DSGZ), LMU Munich, Munich, Germany.,Department of Ear, Nose and Throat Diseases, Head and Neck Surgery, Greifswald, Germany
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10
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Dela Peña IC, Figueroa JD, Shi WX. Hypothesis: Amelioration of obesity-induced cognitive dysfunction via a lorcaserin- betahistine combination treatment. Pharmacol Res Perspect 2022; 10:e00947. [PMID: 35599337 PMCID: PMC9124816 DOI: 10.1002/prp2.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/11/2022] [Indexed: 11/12/2022] Open
Abstract
The prolonged exposure to obesogenic diets disrupts the mesocortical dopaminergic input to the prefrontal cortex (PFC). This leads to suboptimal dopamine levels in this brain region, which affects cognition and control of food intake. Treatments that restore mesocortical dopaminergic neurotransmission may improve obesity‐associated cognitive dysfunction and modulate food intake to induce weight loss. Given the complexity and multifactorial nature of obesity, combination treatments would likely achieve sizeable and sustained body weight loss and improve obesity‐linked outcomes, such as cognitive dysfunction. Given this background, we hypothesize that concomitant activation of serotonin 5‐HT2C and histamine H1 receptors, coupled with antagonism of histamine H3 receptors, synergistically modulates mesocortical dopamine neurotransmission and ameliorates obesity‐induced cognitive dysfunction. We propose to test the hypothesis in a diet‐induced obesity (DIO) rat model by treating animals with the 5‐HT2C agonist lorcaserin and the H1 agonist and H3 antagonist betahistine. Consistent with our hypothesis, both lorcaserin and betahistine have been shown to reduce body weight in humans with obesity and animals. Both drugs have been demonstrated to improve cognitive functions by influencing dopaminergic signaling in the PFC. The proposed combination treatment addresses the paucity of studies on obesity treatments that improve cognitive function. This research may also help identify a potential targetable mechanism connecting obesity and neurocognitive outcomes.
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Affiliation(s)
- Ike C Dela Peña
- Departments of Pharmaceutical and Administrative Sciences, Loma Linda University Schools of Pharmacy, Loma Linda, California, USA
| | - Johnny D Figueroa
- Center for Health Disparities and Molecular Medicine, Department of Basic Sciences, Physiology Division, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Wei-Xing Shi
- Departments of Pharmaceutical and Administrative Sciences, Loma Linda University Schools of Pharmacy, Loma Linda, California, USA.,Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
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11
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Pilicheva B, Uzunova Y, Marudova M. Polyelectrolyte Multilayer Films as a Potential Buccal Platform for Drug Delivery. Polymers (Basel) 2022; 14:polym14040734. [PMID: 35215645 PMCID: PMC8879725 DOI: 10.3390/polym14040734] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 02/06/2023] Open
Abstract
The goal of this research was to study the potential of polyelectrolyte multilayers as buccal dosage forms for drug delivery and to investigate how the properties of the drugs impact the overall performance of the delivery system. Multilayer films based on the polyelectrolyte interaction between casein and chitosan were developed using benzydamine, tolfenamic acid and betahistine as model drugs. The samples were characterized for surface pH, moisture content and moisture absorption, swelling behavior and mucoadhesion. Additionally, surface morphology was investigated, as well as the drugs' physical state after incorporation in the multilayer films. The samples proved to be non-irritant (pH was within the physiological range), physically stable (moisture content and moisture absorption below 5%) and mucoadhesive, adsorbing from 60 to 70% mucin. The release behavior corelated to the swelling index profiles of the samples and was strongly dependent on the drug solubility. The developed multilayer films appeared to be an optimum delivery system for sparingly soluble drugs due to the high drug loading achieved.
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Affiliation(s)
- Bissera Pilicheva
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Medical University of Plovdiv, 15A Vassil Aprilov Blvd, 4002 Plovdiv, Bulgaria
- Research Institute, Medical University of Plovdiv, 15A Vassil Aprilov Blvd, 4002 Plovdiv, Bulgaria;
- Correspondence:
| | - Yordanka Uzunova
- Research Institute, Medical University of Plovdiv, 15A Vassil Aprilov Blvd, 4002 Plovdiv, Bulgaria;
- Department of Bioorganic Chemistry, Faculty of Pharmacy, Medical University of Plovdiv, 15A Vassil Aprilov Blvd, 4002 Plovdiv, Bulgaria
| | - Maria Marudova
- Department of Physics, Faculty of Physics and Technology, University of Plovdiv “Paisii Hilendarski”, 24 Tzar Asen Str., 4000 Plovdiv, Bulgaria;
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12
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Wang Y, Huang X, Fan H, An H, Ma T, Zhang Q, Zhao W, Yun Y, Yang W, Zhang X, Wang Z, Yang F. High-Dose Betahistine Improves Cognitive Function in Patients With Schizophrenia: A Randomized Double-Blind Placebo-Controlled Trial. Front Psychiatry 2021; 12:762656. [PMID: 34790138 PMCID: PMC8591287 DOI: 10.3389/fpsyt.2021.762656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022] Open
Abstract
Background: There is currently no effective treatment for cognitive impairment associated with schizophrenia (CIAS). Recent studies have shown that increased histamine levels in the brain may help to improve CIAS symptoms. Betahistine is an H1-receptor agonist and H3-receptor antagonist. This study evaluated the effect of high-dose betahistine on cognitive function as well as its safety in Chinese Han patients with schizophrenia. Methods: This randomized double-blind, placebo-controlled trial enrolled 89 patients with schizophrenia who were randomly administered betahistine (72 mg/d) or placebo for 12 weeks. At baseline and at 4, 8, and 12 weeks after commencing the intervention, we measured changes in cognitive function and clinical symptoms using the MATRICS Consensus Cognitive Battery (MCCB) and Positive and Negative Syndrome Scale (PANSS), respectively. Furthermore, we used the Treatment Emergent Symptom Scale (TESS) to assess the adverse effects of the patients' medications. Results: Compared to the placebo group, the betahistine group showed significant improvements in the MCCB composite score after 12 weeks of treatment (p = 0.003) as well as improvements in MCCB verbal learning (p = 0.02) and visual learning (p = 0.001) domain scores. However, there were no significant improvements in the PANSS total scores or subscores (p > 0.05). Generally, high-dose betahistine treatment was considered safe in patients with schizophrenia. Conclusions: Additional use of high-dose betahistine can effectively improve cognitive function but not psychiatric symptoms in patients with schizophrenia. Betahistine (72 mg/d) is well tolerated by Chinese Han patients with schizophrenia. Trial Registration: chictr.org.cn, identifier: ChiCTR1900021078. http://www.chictr.org.cn/edit.aspx?pid=35484&htm=4.
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Affiliation(s)
- Yongqian Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Xufeng Huang
- Illawarra Health and Medical Research Institute, School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Hongzhen Fan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Huimei An
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Ting Ma
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Qi Zhang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Wenxuan Zhao
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Yajun Yun
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Wenshuang Yang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Xiaolu Zhang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Zhiren Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Fude Yang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
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13
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Molnár A, Maihoub S, Tamás L, Szirmai Á. Effectiveness of intratympanic dexamethasone for the treatment of vertigo attacks in patients with Ménière's disease compared with betahistine pharmacotherapy. J Int Med Res 2021; 49:300060520985647. [PMID: 33845616 PMCID: PMC8047842 DOI: 10.1177/0300060520985647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study analyzed the possible effects of intratympanic steroid (ITS) therapy in the symptomatic treatment of vertigo attacks in patients with Ménière's disease. METHODS Thirty-five patients treated with ITS (dexamethasone) plus betahistine (Group A) and 35 patients treated with betahistine alone (Group B) were enrolled in this investigation. Complaints were analyzed using medical records and vertigo diaries. Statistical analysis was conducted using IBM SPSS V24 software. RESULTS Based on the analysis, there were no significant differences in baseline features between the two groups. When the occurrence of vertigo attacks was compared using the Kaplan-Meier method, no significant difference was detected between Groups A and B (odds ratio [OR] = 1.051, 95% confidence interval [CI] = 0.965-1.067; p = 0.972). In addition, no difference in the incidence of vertigo attacks was noted in group A between the periods of treatment with betahistine alone and betahistine plus ITS when the groups were analyzed via logistic regression (OR = 1.07, 95% CI = 0.065-1.467; p = 0.614). CONCLUSION It can be concluded that the addition of ITS therapy to betahistine did not improve outcomes in patients with Ménière's disease. Further prospective studies should be conducted to analyze the results in a more detailed manner.
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Affiliation(s)
- András Molnár
- 37637Semmelweis University, Department of Otolaryngology and Head and Neck Surgery, Budapest, Hungary
| | - Stefani Maihoub
- 37637Semmelweis University, Department of Otolaryngology and Head and Neck Surgery, Budapest, Hungary
| | - László Tamás
- 37637Semmelweis University, Department of Otolaryngology and Head and Neck Surgery, Budapest, Hungary
| | - Ágnes Szirmai
- 37637Semmelweis University, Department of Otolaryngology and Head and Neck Surgery, Budapest, Hungary
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14
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Zamergrad MV, Kunelskaya NL, Guseva AL, Amelin AV, Lilenko SV, Samartcev IN, Zaytseva OV, Melnikov OA, Voronov VA, Lyapin AV. [ Betahistine in vestibular disorders: current concepts and perspectives]. Vestn Otorinolaringol 2021; 86:73-81. [PMID: 33929156 DOI: 10.17116/otorino20218602173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The goal of this paper is to review the pharmacological profile of betahistine and evidence for using it in the treatment of common vestibular disorders. Betahistine is a weak agonist for histamine H1 receptors and strong antagonist for histamine H3 receptors. It demonstrates the maximum benefit in different types of peripheral vertigo, especially in Meniere's disease. The best results in decreasing intensity of vertigo, frequency of attacks and stimulation of vestibular compensation were obtained in daily dose 48 mg during 3 months. In benign paroxysmal positional vertigo betahistine is used to treat residual dizziness after successful treatment of otolithiasis and to reduce the severity of vertigo during repositioning maneuvers. In vestibular neuritis betahistine stimulates central compensation during vestibular rehabilitation. A new once-daily drug formulation of modified-release betahistine is non-inferior to traditional and has a comparable safety profile, and could improve patient adherence. The implication of betahistine in the treatment of central vestibular disorders is under-researched. The efficacy of betahistine in increasing of vestibular compensation in post-stroke central vestibular disorders, persistent postural-perceptual dizziness and its role in vestibular migraine need further investigation.
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Affiliation(s)
- M V Zamergrad
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia.,Russian Gerontology Clinical Research Center of Pirogov Russian National Research Medical University
| | - N L Kunelskaya
- Russian Gerontology Clinical Research Center of Pirogov Russian National Research Medical University.,Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia
| | - A L Guseva
- Russian Gerontology Clinical Research Center of Pirogov Russian National Research Medical University
| | - A V Amelin
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - S V Lilenko
- Saint Petersburg ENT and Speech Research Institute, St. Petersburg, Russia.,North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - I N Samartcev
- Kirov Military Medical Academy, St. Petersburg, Russia
| | - O V Zaytseva
- Scientific and Clinical Center of Otorhinolaryngology of the Federal Medico-Biological Agency of the Russian Federation, Mosco, Scientific and Clinical Center of Otorhinolaryngology of the Federal Medico-Biological Agency of the Russian Federation, Moscow
| | - O A Melnikov
- Center of vertigo and balance disorders, GUTA CLINIC, Moscow, Russia
| | - V A Voronov
- North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - A V Lyapin
- Federal Siberian Research Clinical Centre under the Federal Medical Biological Agency, Krasnoyarsk, Russia
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15
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Qiao YL, Xiang WQ, Liu F, Jin S. Clinical therapeutic effects of gastrodin in combination with betahistine on vertigo: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e23825. [PMID: 33725810 PMCID: PMC7969318 DOI: 10.1097/md.0000000000023825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Vertigo is a well-known presenting complaint common in the main care offices as well as departments. It is also regarded as a symptom of vestibular dysfunction and has been expressed as a feeling of motion, specifically rotational motion. As patients grow older, vertigo also becomes a commonly presenting complaint. The current study will carry out a widespread systematic review to estimate clinical therapeutic effects of gastrodin in combination with betahistine on vertigo. METHODS We will systematically search different databases, including PubMed, EMBASE, Web of Science, the Cochrane Library, Chinese BioMedical Literature Database (CBM), China National Knowledge Infrastructure Database (CNKI), and WanFang to collect the randomised controlled studies that evaluate the efficiency of gastrodin and betahistine in treating patients with vertigo from their inception to November 2020. However, only studies in English or Chinese will be included. Two authors will independently perform selection, data extraction, and assessment of risk of bias for the included papers. Accordingly, any disagreements between the independent authors will be addressed via discussion or by consulting a third author when needful. Additionally, we will use RevMan 5.3 software to perform the data synthesis. RESULTS The efficiency of gastrodin and betahistine in treating patients with vertigo will be systematically evaluated. CONCLUSIONS The current study aims to stipulate more consistent substantiation to explore whether gastrodin combined with betahistine is more effective for the treatment of vertigo. REGISTRATION NUMBER DOI 10.17605/OSF.IO/HQTZA (https://osf.io/hqtza/).
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Affiliation(s)
- Yu-Lin Qiao
- Department of Neurology, Hanyang Hospital of Wuhan
| | | | - Fang Liu
- Department of Respiratory Medicine, Hubei NO.3 People's Hospital of Jianghan University
| | - Sheng Jin
- Nephrology Department of Integrated Traditional Chinese and Western Medicine, Hubei NO.3 People's Hospital of Jianghan University, Wuhan, Hubei, China
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16
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Zabaneh SI, Voss LJ, Szczepek AJ, Olze H, Stölzel K. Methods for Testing the Subjective Visual Vertical during the Chronic Phase of Menière's Disease. Diagnostics (Basel) 2021; 11:diagnostics11020249. [PMID: 33562708 PMCID: PMC7915072 DOI: 10.3390/diagnostics11020249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/25/2022] Open
Abstract
The subjective visual vertical (SVV) evaluates the function of the utricle, which, in patients with Menière’s disease (MD), can be affected by endolymphatic hydrops. This study aimed to determine the SVV in MD patients during the chronic phase of illness compared to healthy participants. The second aim was to compare the SVV measurement tools: the analog bucket test, digital bucket test, and C-SVV© goggles. The SVV scores differed significantly between MD patients and the control group for the analog bucket test (p < 0.001) and the C-SVV® goggles (p = 0.028), but no significance was shown when using the digital bucket test (p = 0.062). When comparing the analog bucket test and the C-SVV® goggles applying the calculated threshold (1.125° in analog bucket test, 2.5° in C-SVV® goggles), the bucket test showed higher accuracy (bucket test 73.84%, C-SVV® goggles 69.23%). When examining the influence of betahistine on SVV scores, there were no statistically significant differences in both the analog bucket test and C-SVV© goggles. We conclude that SVV test can be used as an additional tool to evaluate utricle function during the chronic phase of MD and that the analog bucket test produces the most reliable results. The intake of betahistine does not influence the perception of SVV.
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Affiliation(s)
- Samira Ira Zabaneh
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany; (S.I.Z.); (A.J.S.); (H.O.)
| | - Linda Josephine Voss
- Department of Audiology and Phoniatrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany;
| | - Agnieszka J. Szczepek
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany; (S.I.Z.); (A.J.S.); (H.O.)
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany; (S.I.Z.); (A.J.S.); (H.O.)
| | - Katharina Stölzel
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany; (S.I.Z.); (A.J.S.); (H.O.)
- Correspondence:
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17
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Soni A, Dubey A. Chronic Primary Tinnitus: A Management Dilemma. Audiol Res 2020; 10:55-66. [PMID: 33255533 PMCID: PMC7768479 DOI: 10.3390/audiolres10020010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/29/2020] [Accepted: 11/04/2020] [Indexed: 11/24/2022] Open
Abstract
Tinnitus often described as sound in the ear in absence of any external stimulus. It poses a challenge to the psychological and mental wellbeing of the patient and professional unsatisfaction to the clinician. The patient often an old aged individual usually approaches the outpatient department with various sounds in the ear, making him feel ill or unable to have a sound sleep. The middle-aged patient often complains of professional incapability and lack of concentration due to tinnitus. Despite vast academic research and advances, the efficiency of available treatment is debatable, often compelling the clinician to convey the message that “you may have to learn to live with it”. In the present overview of reviews, we tend to look into the management of tinnitus and present a comprehensive outlook of various evidence-based reviews from Cochrane and augmented with various studies from PubMed.
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18
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Devantier L, Hougaard D, Händel MN, Liviu-Adelin Guldfred F, Schmidt JH, Djurhuus B, Callesen HE. Using betahistine in the treatment of patients with Menière's disease: a meta-analysis with the current randomized-controlled evidence. Acta Otolaryngol 2020; 140:845-853. [PMID: 32580600 DOI: 10.1080/00016489.2020.1777326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Betahistine is used worldwide to treat patients with Menière's disease. However, despite it being used for decades, diverging opinions on the effect of betahistine on Menière's symptomatology still exist.Aims: The objective of this systematic review was to provide an overview and rate the certainty of the current evidence base regarding the use of betahistine to treat patients with Menière's disease.Materials and methods: A systematic literature search was conducted in October 2019. The search strategy was subdivided into searches for existing guidelines, systematic reviews and individual randomized controlled trials (RCT) investigating the usage of betahistine as compared to placebo, in patients with Ménière's disease. The primary outcome was the frequency of vertigo attack(s) and occurrence of serious adverse events.Results: We identified three relevant guidelines and three systematic reviews: however, neither included any relevant trials matching our inclusion criteria. An individual search for RCTs identified one trial. The results from this particular trial showed no difference in effects on symptoms following treatment with betahistine.Conclusions and Significance: There is a need for further well-conducted placebo RCTs. Currently, there is still a lack of substantial evidence supporting betahistine as a significant and adequate treatment for patients diagnosed with Menière's disease. Trial registration number: The protocol is registered in PROSPERO. Registration number: CRD42018110127 Accepted 11.10.2018.
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Affiliation(s)
- Louise Devantier
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Oto-Rhino-Laryngology, Regional Hospital West Jutland, Holstebro, Denmark
- Department of Audiology, Aarhus University Hospital, Aarhus, Denmark
| | - Dan Hougaard
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
| | - Mina Nicole Händel
- The Danish Health Authority, Copenhagen, Denmark
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Jesper Hvass Schmidt
- Department of ORL, Head and Neck Surgery and Audiology, Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Bjarki Djurhuus
- Department of Ear, Nose, Throat and Maxillofacial Surgery, Zealand University Hospital, Koege, Denmark
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19
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Molnár A, Maihoub S, Tamás L, Szirmai Á. Conservative Treatment Possibilities of Ménière Disease, Involving Vertigo Diaries. Ear Nose Throat J 2019; 100:536-542. [PMID: 31617407 DOI: 10.1177/0145561319881838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ménière disease is a disorder of the inner ear, characterized by rotational vertigo, hearing loss, tinnitus, and vegetative symptoms. The aim of the present research is to examine the effectiveness of betahistine and piracetam in the reduction of vertigo attacks in Ménière disease. To verify our hypothesis, 105 (31 male and 74 females, mean age [standard deviation], 57.4 [11.05]) adult patients with definite Ménière disease were enrolled in this investigation. Beside the analysis of the hospital records, the subjective complaints of the patients and the completed vertigo diaries were taken into consideration too. The statistical analysis was completed using the IBM SPSS version 24 software. Retrospective analysis, including a 12 years period was conducted. Based on our results, betahistine was successful in the reduction of attacks. Statistically significant decrease was achieved in frequency of dizziness (P = .000331) and vertigo (P < .00001) and in the duration of them (P = .000098), although in the mean power of them was not (P = .0887). The mean dose in the symptomatic treatment was determined as 87.5 ± 27.2 mg per day; however, there was no connection detected between the dose of the agent and the effectiveness of the symptomatic control. By using dual therapy (betahistine and piracetam), vertigo episodes appeared significantly less often (P = .027, Odds ratio: 4.9, 95% confidence interval: 1.2-20.2). Finally, it can be concluded that betahistine is effective in Ménière disease, but the daily dose of it should be set up for every patient individually. The advantage of the dual therapy was also confirmed.
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Affiliation(s)
- András Molnár
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, 37637Semmelweis University, Budapest, Hungary
| | - Stephanie Maihoub
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, 37637Semmelweis University, Budapest, Hungary
| | - László Tamás
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, 37637Semmelweis University, Budapest, Hungary
| | - Ágnes Szirmai
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, 37637Semmelweis University, Budapest, Hungary
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20
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Dyhrfjeld-Johnsen J, Attali P. Management of peripheral vertigo with antihistamines: New options on the horizon. Br J Clin Pharmacol 2019; 85:2255-2263. [PMID: 31269270 DOI: 10.1111/bcp.14046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 12/12/2022] Open
Abstract
Vertigo is associated with a wide range of vestibular pathologies. It increasingly affects the elderly, with a high cost to society. Solutions include vestibular suppressants and vestibular rehabilitation, which form the mainstay of therapy. Antihistamines represent the largest class of agents used to combat vestibular vertigo symptoms. Agents targeting the H1 and H3 receptors have been in clinical use for several decades as single agents. Nonetheless, effective management of vertigo proves elusive as many treatments largely address only associated symptoms, and with questionable efficacy. Additionally, the primary and limiting side effect of sedation is counterproductive to normal functioning and the natural recovery process occurring via central compensation. To address these issues, the timing of administration of betahistine, the mainstay H3 antihistamine, can be fine-tuned, while bioavailability is also being improved. Other approaches include antihistamine combination studies, devices, physical therapy and behavioural interventions. Recently demonstrated expression of H4 receptors in the peripheral vestibular system represents a new potential drug target for treating vestibular disorders. A number of novel selective H4 antagonists are active in vestibular models in vivo. The preclinical potential of SENS-111 (Seliforant), an oral first-in-class selective H4 antagonist is the only such molecule to date to be translated into the clinical setting. With an excellent safety profile and notable absence of sedation, encouraging outcomes in an induced vertigo model in healthy volunteers have led to ongoing clinical studies in acute unilateral vestibulopathy, with the hope that H4 antagonists will offer new effective therapeutic options to patients suffering from vertigo.
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Sanchez-Vanegas G, Castro-Moreno C, Buitrago D. Betahistine in the Treatment of Peripheral Vestibular Vertigo: Results of a Real-Life Study in Primary Care. Ear Nose Throat J 2019; 99:356-360. [PMID: 31111729 DOI: 10.1177/0145561319849946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The present research was carried out with the objective to establish the clinical effect and safety of betahistine (48 mg daily), for the management of peripheral vestibular vertigo, in patients treated by primary care physicians in Colombia. An observational prospective cohort study was conducted including patients older than 15 years with clinical diagnosis of peripheral vestibular vertigo who were candidates to be treated with betahistine (48 mg daily). A sample size of 150 individuals was calculated, and weekly follow-ups were planned for 12 weeks. Rotatory movement sensation, loss of balance, and global improvement scale from 0 to 100 points were evaluated. Complete improvement was defined when the patient reached a level of 100 points. We calculated average weekly improvement, cumulative incidence of complete improvement, incidence rate of complete improvement, and the probability of complete improvement as a function of time. After the first week, the average improvement was 56.6 points (95% confidence interval [CI]: 50.4-62.7). At the end of week 12, it was 89.3 points (95% CI: 86.5-92.2). Sixty-one percent of the patients had achieved complete improvement at the end of the second week. After the sixth week, the percentage of cumulative improvement was 72%, and after 12 weeks of follow-up, the cumulative incidence of complete improvement was 73% (95% CI: 65%-80%). Based on the follow-up times, a complete improvement incidence rate of 16 cases per 100 people/week was calculated (95% CI: 13-19). We concluded that Betahistine (48 mg daily) has a positive effect, controlling the symptoms associated with benign paroxysmal vertigo, with an adequate safety profile.
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Affiliation(s)
- Guillermo Sanchez-Vanegas
- SIIES-Research and Education in Health, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia
| | - Carlos Castro-Moreno
- SIIES-Research and Education in Health, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia
| | - Diana Buitrago
- SIIES-Research and Education in Health, Bogotá, Colombia
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Arhami Dolatabadi A, Larimi SR, Safaie A. Oral Piracetam vs Betahistine in Outpatient Management of Peripheral Vertigo; a Randomized Clinical Trial. Arch Acad Emerg Med 2019; 7:e9. [PMID: 30847444 PMCID: PMC6377226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although vertigo is a common complaint in patients presenting to the emergency department (ED), its ideal treatment is still under debate. This study was conducted to compare oral betahistine and oral piracetam in management of outpatients with peripheral vertigo. METHODS This was a randomized clinical trial performed on patients who were presented to the EDs of 4 teaching hospitals, with complaint of true vertigo. Patients were randomly allocated to either betahistine or piracetam group and their 7-day outcomes were compared. RESULTS 100 cases with the mean age of 54.72 ± 14.09 years were randomly allocated to either group (62.0% female). The two groups were similar regarding age, sex, and intensity of symptom at the time of presenting to the ED. Twelve (24%) patients in piracetam group and 6 (12%) patients in betahistine group experienced adverse events (odds ratio: 2.32, CI 95%: 0.79-6.76; p = 0.125). There were 3 (6%) patients in each group that experienced a recurrence of their symptoms and 2 (4%) patients in each group saw another physician for vertigo. CONCLUSION Oral piracetam is a potentially proper treatment for management of peripheral vertigo and there are few adverse effects associated with it.
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Affiliation(s)
- Ali Arhami Dolatabadi
- Department of Emergency Medicine, Imam Hossein Hospital, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Roghieh Larimi
- Department of Emergency Medicine, Imam Hossein Hospital, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Safaie
- Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. ,Corresponding author: Arash Safaie; Sina Hospital, Imam Khomeini Avenue, Tehran, Iran. Tel: +989111366966, Fax: +982163121413 ,
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23
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Wan TJ, Yu YC, Zhao XG, Tang P, Gong YS. Efficacy of betahistine plus cognitive behavioral therapy on residual dizziness after successful canalith repositioning procedure for benign paroxysmal positional vertigo. Neuropsychiatr Dis Treat 2018; 14:2965-2971. [PMID: 30464481 PMCID: PMC6223332 DOI: 10.2147/ndt.s182809] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Some patients still complain of residual dizziness after successful canalith repositioning procedure (CRP) for benign paroxysmal positional vertigo (BPPV). Previous study found that compared to the low-dose betahistine, the high-dose betahistine could yield better efficacy in treating residual dizziness. Therefore, this study was conducted to assess whether the addition of cognitive behavioral therapy (CBT) could make low-dose betahistine produce similar results to high-dose betahistine in treating residual dizziness. METHODS The recruited patients were randomly assigned to receive either low-dose betahistine (6 mg/time, three times/day) or high-dose betahistine (12 mg/time, three times/day). Patients in the low-dose group also received CBT (twice a week, 1 hour per time). The treatment was continued for 4 weeks. The duration of residual dizziness, 25-item Dizziness Handicap Inventory (DHI), Hamilton Anxiety Rating Scale (HARS), and Hamilton Depression Rating Scale (HDRS) were recorded and analyzed. The duration of residual dizziness and DHI score were the primary outcomes, and the HARS and HDRS scores were the secondary outcomes. RESULTS Each group had 50 patients. After treatment, the average DHI scores, HDRS scores, and HARS scores were significantly decreased in both groups. The duration of residual dizziness and average DHI score were nonsignificantly different (P=0.08; P=0.06) between the two groups, although they were lower in the low-dose group. Compared to the high-dose group, the low-dose group had the significantly lower average HDRS score (P=0.007) and HARS score (P=0.02). Meanwhile, four patients in the high-dose group experienced intolerable stomach upset. CONCLUSION These results demonstrated that the addition of CBT could make low-dose beta-histine produce similar results to high-dose betahistine in treating residual dizziness. Moreover, the low-dose betahistine plus CBT showed some advantages over high-dose betahistine in relieving depressive and anxiety symptoms and should be further explored.
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Affiliation(s)
- Tian-Ju Wan
- Department of Emergency, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Yi-Chuan Yu
- Department of Emergency, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Gang Zhao
- Department of Emergency, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Tang
- Department of Emergency, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Yong-Shu Gong
- Department of Pediatrics, Yongchuan Hospital of Chongqing Medical University, Chongqing, China,
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Tighilet B, Léonard J, Watabe I, Bernard-Demanze L, Lacour M. Betahistine Treatment in a Cat Model of Vestibular Pathology: Pharmacokinetic and Pharmacodynamic Approaches. Front Neurol 2018; 9:431. [PMID: 29942281 PMCID: PMC6005348 DOI: 10.3389/fneur.2018.00431] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/22/2018] [Indexed: 11/13/2022] Open
Abstract
This study is a pharmacokinetic (PK) and pharmacodynamics (PD) approach using betahistine doses levels in unilateral vestibular neurectomized cats (UVN) comparable to those used in humans for treating patients with Menière's disease. The aim is to investigate for the first time oral betahistine administration (0.2 and 2 mg/kg/day) with plasma concentrations of betahistine and its major metabolite 2-pyridylacetic acid (2-PAA) (N = 9 cats), the time course of posture recovery (N = 13 cats), and the regulation of the enzyme synthesizing histamine (histidine decarboxylase: HDC) in the tuberomammillary nuclei (TMN) of UVN treated animals (N = the same 13 cats plus 4 negative control cats). In addition the effect of co-administration of the lower betahistine dose (0.2 mg/kg/day) and selegiline (1 mg/kg/day), an inhibitor of the monamine oxidase B (MAOBi) implicated in betahistine catabolism was investigated. The PK parameters were the peak concentration (Cmax), the time when the maximum concentration is reached (Tmax) for both betahistine and 2-PAA and the area under the curve (AUC). The PD approach consisted at quantifying the surface support area, which is a good estimation of posture recovery. The plasma concentration-time-profiles of betahistine and 2-PAA in cats were characterized by early Cmax-values followed by a phase of rapid decrease of plasma concentrations and a final long lasting low level of plasma concentrations. Co administration of selegiline and betahistine increased values of Cmax and AUC up to 146- and 180-fold, respectively. The lowest dose of betahistine (0.2 mg/kg) has no effects on postural function recovery but induced an acute symptomatic effect characterized by a fast balance improvement (4–6 days). The higher dose (2 mg/kg) and the co-administration treatment induced both this acute effect plus a significant acceleration of the recovery process. The histaminergic activity of the neurons in the TMN was significantly increased under treatment with the 2 mg/kg betahistine daily dose, but not with the lower dose alone or in combination with selegiline. The results show for the first time that faster balance recovery in UVN treated cats is accompanied with high plasma concentrations of betahistine and 2-PAA, and upregulation of HDC immunopositive neurons in the TMN. The higher betahistine dose gives results similar to those obtained with the lower dose when co-administrated with an inhibitor of betahistine metabolism, selegiline. From a clinical point of view, the study provides new perspectives for Menière's disease treatment, regarding the daily betahistine dose that should be necessary for fast and slow metabolizers.
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Affiliation(s)
- Brahim Tighilet
- Aix-Marseille Université - Centre National de la Recherche Scientifique, Laboratoire de Neurosciences Sensorielles et Cognitives, UMR 7260, Physiopathologie et Thérapie des Désordres Vestibulaires, Centre Saint-Charles, Marseille, France
| | - Jacques Léonard
- Aix-Marseille Université - Centre National de la Recherche Scientifique, Laboratoire de Neurosciences Sensorielles et Cognitives, UMR 7260, Physiopathologie et Thérapie des Désordres Vestibulaires, Centre Saint-Charles, Marseille, France
| | - Isabelle Watabe
- Aix-Marseille Université - Centre National de la Recherche Scientifique, Laboratoire de Neurosciences Sensorielles et Cognitives, UMR 7260, Physiopathologie et Thérapie des Désordres Vestibulaires, Centre Saint-Charles, Marseille, France
| | - Laurence Bernard-Demanze
- Aix-Marseille Université - Centre National de la Recherche Scientifique, Laboratoire de Neurosciences Sensorielles et Cognitives, UMR 7260, Physiopathologie et Thérapie des Désordres Vestibulaires, Centre Saint-Charles, Marseille, France.,Service ORL et de Chirurgie Cervico-Faciale Hôpital de la Conception Marseille, Marseille, France
| | - Michel Lacour
- Aix-Marseille Université - Centre National de la Recherche Scientifique, Laboratoire de Neurosciences Sensorielles et Cognitives, UMR 7260, Physiopathologie et Thérapie des Désordres Vestibulaires, Centre Saint-Charles, Marseille, France
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25
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Kang D, Jing Z, Li R, Hei G, Shao T, Li L, Sun M, Yang Y, Wang Y, Wang X, Long Y, Huang X, Wu R. Effect of Betahistine and Metformin on Antipsychotic-Induced Weight Gain: An Analysis of Two Clinical Trials. Front Psychiatry 2018; 9:620. [PMID: 30542300 PMCID: PMC6277778 DOI: 10.3389/fpsyt.2018.00620] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 11/02/2018] [Indexed: 01/16/2023] Open
Abstract
Antipsychotic-induced weight gain is one of the most common adverse effects of antipsychotic treatment. However, there are no well-established interventions for the weight gain yet. In this study, we pooled the data from two clinical trials, which were originally examining the efficacy of betahistine and the efficacy of metformin in treating antipsychotic-induced weight gain and insulin resistance. A total of 67 people with schizophrenia or bipolar disorder treated with antipsychotics were assigned to 36 mg day-1 betahistine (n = 13) or 1,000 mg day-1 metformin (n = 25) or placebo (n = 29) treatment for 12 weeks, with evaluation at baseline and week 12. The primary outcome was the body mass index (BMI). After treatment, metformin group had a mean decrease in BMI of 1.46 ± 0.14 (p < 0.001) and insulin resistance index (IRI) of 4.30 ± 2.02 (p < 0.001). The betahistine group had no significant alteration in BMI or IRI. However, placebo group had a mean increase in BMI of 1.27 ± 0.77 (p < 0.001) and IRI of 0.45 ± 0.86 (p < 0.001). Between the two treatment groups, metformin significantly decreased weight, BMI, fasting glucose, insulin level, and IRI but not waist circumference when compared with betahistine. Moreover, metformin significantly decreased weight, BMI, waist circumference, fasting glucose, insulin level, and IRI when compared with placebo, whereas betahistine significantly decreased body weight, waist circumference, BMI, insulin level, and IRI but not fasting glucose when compared with placebo. In this study, we found that both metformin treatment and betahistine treatment were efficacious in improving antipsychotic-induced weight gain and insulin resistance, and metformin was more efficacious in preventing and revising the weight gain induced by antipsychotics. Clinical Trial Registration: www.ClinicalTrials.gov, NCT00451399(Study 1), NCT00709202(Study 2).
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Affiliation(s)
- Dongyu Kang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,The China National Clinical Research Center for Mental Health Disorders, Changsha, China.,National Technology Institute of Psychiatry, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China
| | - Zhihui Jing
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,The China National Clinical Research Center for Mental Health Disorders, Changsha, China.,National Technology Institute of Psychiatry, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China
| | - Ranran Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,The China National Clinical Research Center for Mental Health Disorders, Changsha, China.,National Technology Institute of Psychiatry, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China
| | - Gangrui Hei
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,The China National Clinical Research Center for Mental Health Disorders, Changsha, China.,National Technology Institute of Psychiatry, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China
| | - Tiannan Shao
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,The China National Clinical Research Center for Mental Health Disorders, Changsha, China.,National Technology Institute of Psychiatry, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China
| | - Li Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,The China National Clinical Research Center for Mental Health Disorders, Changsha, China.,National Technology Institute of Psychiatry, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China
| | - Mengxi Sun
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,The China National Clinical Research Center for Mental Health Disorders, Changsha, China.,National Technology Institute of Psychiatry, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China
| | - Ye Yang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,The China National Clinical Research Center for Mental Health Disorders, Changsha, China.,National Technology Institute of Psychiatry, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China
| | - Ying Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,The China National Clinical Research Center for Mental Health Disorders, Changsha, China.,National Technology Institute of Psychiatry, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China
| | - Xiaoyi Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,The China National Clinical Research Center for Mental Health Disorders, Changsha, China.,National Technology Institute of Psychiatry, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China
| | - Yujun Long
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,The China National Clinical Research Center for Mental Health Disorders, Changsha, China.,National Technology Institute of Psychiatry, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China
| | - Xiansheng Huang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Renrong Wu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,The China National Clinical Research Center for Mental Health Disorders, Changsha, China.,National Technology Institute of Psychiatry, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China.,Shanghai Institute for Biological Science, Chinese Academy of Sciences, Shanghai, China
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Abstract
ABSTRACT Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, accounting for 20% of all vertigo cases. Idiopathic BPPV is most common between the ages of 50 and 70, although the condition is found in all age groups. This study was conducted in our institute on 90 patients who presented to the outpatient department with history of vertigo and were diagnosed with BPPV via a positive Dix Hallpike test. Patients were randomnly placed in three groups of 30 each. Patients in Group A were treated with Epleys manoeuvre alone, in Group B were treated with Epleys Manouvre followed by oral Betahistine and patients in Group C were treated with Betahistine alone. All the patients were followed up after 1 week and 4 weeks following treatment. In our study we found that patients responded better when they were treated with Epleys Manouvre with Betahistine with less relapse and recurrence. Treatment with Epleys manouvre resulted in early improvement of symptoms. It was found in our study that Betahistine as a sole modality of treatment of vertigo in BPPV can be preferred in patients who are unfit to undergo canal repositioning manouvres.
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Affiliation(s)
- Japneet Kaur
- Senior Resident, Department of Otolaryngology, GGS Medical College, Faridkot
| | - Karthik Shamanna
- Associate Professor, Department of Otolaryngology, Bangalore Medical College and Research Institute
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Abstract
Olanzapine's efficacy in schizophrenia is attributed to antagonism of dopamine and serotonin receptors. Olanzapine is also a potent histamine-H1 antagonist that results in weight gain and somnolence. Betahistine is a centrally acting histamine-H1 agonist, and therefore may reduce olanzapine's effect on histamine receptors in the brain. Olanzapine's high affinity for the histamine-H1 receptor warrants the use of high doses of betahistine. Forty-eight healthy women were recruited and randomized to receive either betahistine 144 mg/day or matching placebo for 4 weeks. Due to the high dose of betahistine, olanzapine was started only on the second week and titrated up to 10 mg/day, and co-administration continued for an additional 2 weeks. Only nominal differences in adverse events were noted between the treatment groups. Betahistine caused a 37% reduction in mean weight gain (1.24 kg in the betahistine arm vs. 1.93 kg in the placebo arm; p=.049) and 60% reduction in the mean increase in daytime Epworth sleepiness scores (1.82 units in the betahistine group vs. 3.57 units in the placebo group; p=.042). The present study suggests that betahistine-olanzapine co-administration, in healthy female subjects, yields an acceptable safety profile with mitigation of weight gain and somnolence. This should be further tested in a patient cohort.
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Affiliation(s)
- Nir Barak
- Obesity Clinic, Leumit Health Fund, Tel-Aviv, Israel
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Chen YY, Chen W, Zhang Q, Li H, Zhang YW, Kang Q, Lan YI, Wu Q. Puerarin and betahistine treatment of vertebrobasilar ischemia vertigo: A meta-analysis of randomized controlled trials. Exp Ther Med 2016; 11:1051-1058. [PMID: 26998036 DOI: 10.3892/etm.2016.3004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 11/05/2015] [Indexed: 01/26/2023] Open
Abstract
The present meta-analysis aimed to evaluate the effectiveness and safety of puerarin co-treatment with betahistine in treating vertebrobasilar ischemia (VBI) vertigo. A total of 6 medical databases were searched, identifying randomized controlled trials (RCTs) of VBI vertigo performed until August 2014 that investigated a combined treatment of puerarin with betahistine or with other conventional drugs. The quality of the literature was evaluated using the Cochrane Collaboration's tool for assessing risk of bias, and Rev Man 5.0 software was used for statistical analysis and evaluation. The present study included 7 RCTs, involving a total of 664 subjects, and revealed a statistically significant increase in efficacy between the control and the experimental group (odds ratio [OR], 4.99; 95% confidence interval [CI], 3.05 to 8.15). The average blood flow velocity within the vertebrobasilar arteries increased following treatment with puerarin and betahistine compared with that of the control groups (OR, 7.59; 95% CI, 6.19 to 9.00); however, no difference was detected between these groups in the average flow velocity within the left vertebral artery (OR, 6.17; 95% CI, 5.22 to 7.13). The frequency of adverse reactions in the experimental group was lower (OR, 0.75; 95% CI, 0.32 to 1.77) compared with the control group. Combined puerarin and betahistine regimens were more effective in treating VBI vertigo compared with other, conventional drugs; effectively alleviating the associated symptoms, including dizziness and increased average blood flow velocity within the vertebrobasilar arteries, without causing an increased number of serious side effects. However, the efficacy and safety of puerarin and betahistine use in treating VBI vertigo requires additional investigation.
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Affiliation(s)
- Yan-Yan Chen
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, P.R. China
| | - Wen Chen
- Key Laboratory of Food Nutrition and Safety, Tianjin University of Science and Technology, Ministry of Education, Tianjin 300457, P.R. China
| | - Qing Zhang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, P.R. China
| | - Hui Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, P.R. China
| | - Ye-Wen Zhang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, P.R. China
| | - Qian Kang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, P.R. China
| | - Y I Lan
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, P.R. China
| | - Qing Wu
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, P.R. China
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29
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Morozova SV, Alekseeva NS, Lilenko SV, Matsnev EI, Melnikov OA. Effects and safety profile of betahistine in patients in the Russian contingent of OSVaLD, an open-label observational study in vestibular vertigo. Int J Gen Med 2015; 8:47-53. [PMID: 25653552 PMCID: PMC4310344 DOI: 10.2147/ijgm.s73842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We report here data from the >200 patients recruited in Russia to take part in OSVaLD, a 12-week, open-label, post-marketing surveillance study of the response to betahistine 48 mg/day in vertigo of peripheral vestibular origin carried out in a total of 13 countries. METHODS The primary efficacy endpoint was change in the Dizziness Handicap Inventory (DHI; 100-point scale). Changes in Hospital Anxiety and Depression Scale (HADS) and Medical Outcomes Study Short-Form 36, version 2 (SF-36v2(®)) scores were a priori secondary Outcomes. RESULTS Total DHI score improved by 43 points during betahistine treatment. This aggregate improvement was equally distributed across the three domains of the DHI (physical, emotional, and functional; P<0.0001 for main and subscore changes from baseline). Statistically significant improvements versus baseline were also observed in mean HADS scores for anxiety and depression (both P<0.0001), and in the Physical Component Summary and Mental Component Summary scores of the SF-36v2 (both P<0.0001 versus baseline). Only one suspected adverse drug reaction was recorded in the Russian safety population (n=204), indicating that betahistine was well tolerated in those patients. CONCLUSION Betahistine 48 mg/day was associated with clear improvements in well-configured and widely validated measures of health-related quality of life and an encouraging tolerability profile in patients in Russia who took part in OSVaLD.
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Affiliation(s)
- Svetlana Vyacheslavovna Morozova
- Department of Ear, Nose, and Throat, State Budgetary Educational Institution of Higher Professional Training, IM Sechenov First Moscow State Medical University of the Ministry of Healthcare and Social Development of the Russian Federation, Moscow, Russian Federation
| | - Natalia Stepanovna Alekseeva
- Federal State Budgetary Institution, Scientific Neurology Center of the Russian Academy of Medical Sciences, Moscow, Russian Federation
| | | | - Eduard Ivanovich Matsnev
- Department of Physiology and Pathology of Auditory and Vestibular Systems, Federal Scientific Center (FSC), Institute for Biomedical Problems, Russian Academy of Sciences (RAS), Moscow, Russian Federation
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Băjenaru O, Roceanu AM, Albu S, Zainea V, Pascu A, Georgescu MG, Cozma S, Mărceanu L, Mureşanu DF. Effects and tolerability of betahistine in patients with vestibular vertigo: results from the Romanian contingent of the OSVaLD study. Int J Gen Med 2014; 7:531-8. [PMID: 25506241 PMCID: PMC4260659 DOI: 10.2147/ijgm.s71015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background and methods An efficacy population of 245 patients with vertigo of peripheral vestibular origin was recruited in Romania as part of a 3-month multinational, post-marketing surveillance study of open-label betahistine 48 mg/day (OSVaLD). Endpoints were changes in the Dizziness Handicap Index (primary endpoint), Medical Outcome Study Short-Form 36 (SF-36v2®), and the Hospital Anxiety and Depression Scale. Results During treatment, the total Dizziness Handicap Index score improved by 41 points (on a 100-point scale). Statistically significant improvements of 12–14 points were recorded in all three domains of the Dizziness Handicap Index scale (P<0.0001). Betahistine therapy was also accompanied by progressive improvements in mean Hospital Anxiety and Depression anxiety and depression scores (P<0.0001) and significant improvements in both the physical and mental component summary of the SF-36v2 (P<0.0001). Betahistine was well tolerated, with only one suspected adverse drug reaction recorded in the Romanian safety population (n=259). Conclusion Betahistine 48 mg/day was associated with improvements in multiple measures of health-related quality of life and had a good tolerability profile in these Romanian patients with recurrent peripheral vestibular vertigo.
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Affiliation(s)
- Ovidiu Băjenaru
- Department of Neurology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Silviu Albu
- IInd Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Viorel Zainea
- Institute of Phono-Audiology and ENT Functional Surgery Prof Dr Dorin Hociota, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexandru Pascu
- Institute of Phono-Audiology and ENT Functional Surgery Prof Dr Dorin Hociota, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mădălina Gabriela Georgescu
- Institute of Phono-Audiology and ENT Functional Surgery Prof Dr Dorin Hociota, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Sebastian Cozma
- ENT Department, University of Medicine and Pharmacy Grigore T Popa, Audiology and Vestibulogy Department, Rehabilitation Clinical Hospital, Iasi, Romania
| | - Luigi Mărceanu
- Transilvania University, Faculty of Medicine, Department: Doctoral Program (PhD), Brasov, Romania
| | - Dafin Fior Mureşanu
- "RoNeuro" Institute for Neurological Research and Diagnostic Cluj-Napoca, University of Medicine and Pharmacy "Iuliu Haţieganu", Department of Clinical Neurosciences, Cluj-Napoca, Romania
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Abstract
OBJECTIVE Betahistine augments cochlear blood flow and is currently used as an efficient therapeutic agent. Amikacin is used in a wide range of areas, but its ototoxic effect continues to be problematic. This study investigates the effect of betahistine on amikacin-induced ototoxicity. METHODS Thirty-two healthy rats were randomized to 4 groups of 8 rats in each group (amikacin, amikacin+betahistine, betahistine, and no treatment). Amikacin was administered intramuscularly to groups 1 and 2 for 14 days. Betahistine was delivered by oral gavage to groups 2 and 3 for 21 days. Distortion-product otoacoustic emissions (DPOAE) and auditory brainstem response (ABR) tests were conducted on all rats. RESULTS There were significant decreases in the DPOAE levels and significant increases in the ABR thresholds of the amikacin and amikacin+betahistine groups on the 7th, 14th, and 21st days, as compared to their basal values. The DPOAE levels of the amikacin+betahistine group significantly decreased on days 7, 14, and 21, and the ABR thresholds significantly increased on the same days, as compared to the amikacin group. CONCLUSION Our study implies that amikacin's ototoxic effects are augmented by the concurrent use of betahistine. Experimental and clinical research, supported by histopathological studies, is needed to affirm our findings.
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Affiliation(s)
- Fadlullah Aksoy
- Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
| | - Remzi Dogan
- Bayrampasa State Hospital, Department of Otorhinolaryngology, Bayrampasa, Istanbul, Turkey
| | - Orhan Ozturan
- Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
| | - Yavuz Selim Yildirim
- Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
| | - Bayram Veyseller
- Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
| | - Alper Yenigun
- Karaman State Hospital, Department of Otorhinolaryngology, Karaman, Turkey
| | - Burak Ozturk
- Bezmialem Vakif University, Faculty of Health Sciences, Department of Audiology, Fatih, Istanbul, Turkey
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van Ruitenbeek P, Mehta MA. Potential enhancing effects of histamine H₁ agonism/H₃ antagonism on working memory assessed by performance and bold response in healthy volunteers. Br J Pharmacol 2014; 170:144-55. [PMID: 23517178 DOI: 10.1111/bph.12184] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 01/23/2013] [Accepted: 02/13/2013] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND AND PURPOSE Schizophrenia is a highly debilitating disorder characterized by hallucinations and delusions, but also impaired cognition such as memory. While hallucinations and delusions are the main target for pharmacological treatment, cognitive impairments are rarely treated. Evidence exists that histamine has a role in the cognitive deficits in schizophrenia, which could be the basis of the development of a histamine-type treatment. Histamine H₃ antagonists have been shown to improve memory performance in experimental animals, but these effects have been little investigated in humans within the context of impaired cognition in schizophrenia and using sensitive measures of brain activity. In the present study, the effects of betahistine (H₃ antagonist/H₁ agonist) on learning and memory, and associated brain activity were assessed. EXPERIMENTAL APPROACH Sixteen healthy volunteers (eight female) aged between 18 and 50 years received two p.o. doses of betahistine (48 mg) or placebo separated by 30 min, on separate days according to a two-way, double-blind, crossover design. Volunteers performed an N-back working memory task and a spatial paired associates learning task while being scanned using a MRI scanner. KEY RESULTS Task-related activity changes in well-defined networks and performance were observed. No betahistine-induced changes in brain activity were found in these networks. Alternatively, liberal whole-brain analyses showed activity changes in areas outside task networks, like the lateral geniculate nucleus. CONCLUSIONS AND IMPLICATIONS Clear effects of betahistine on working memory could not be established. Future studies should use higher doses and explore the role of histamine in visual information processing.
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Affiliation(s)
- P van Ruitenbeek
- Centre for Neuroimaging Sciences, Institute of Psychiatry, King's College London, UK.
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Abstract
Betahistine dihydrochloride (betahistine) is currently used in the management of vertigo and vestibular pathologies with different aetiologies. The main goal of this review is to clarify the mechanisms of action of this drug, responsible for the symptomatic relief of vertigo and the improvement of vestibular compensation. The review starts with a brief summary recalling the role of histamine as a neuromodulator/neurotransmitter in the control of the vestibular functions, and the role of the histaminergic system in vestibular compensation. Then are presented data recorded in animal models demonstrating that betahistine efficacy can be explained by mechanisms targeting the histamine receptors (HRs) at three different levels: the vascular tree, with an increase of cochlear and vestibular blood flow involving the H1R; the central nervous system, with an increase of histamine turnover implicating the H3R, and the peripheral labyrinth, with a decrease of vestibular input implying the H3R/H4R. Clinical data from vestibular loss patients show the impact of betahistine treatment for the long-term control of vertigo, improvement of balance and quality of life that can be explained by these mechanisms of action. However, two conditions, at least, are required for reaching the betahistine therapeutic effect: the dose and the duration of treatment. Experimental and clinical data supporting these requirements are exposed in the last part of this review.
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Affiliation(s)
- Michel Lacour
- UMR 7420, CNRS/Université Aix-Marseille, Marseille, France
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Ballve Moreno JL, Carrillo Muñoz R, Villar Balboa I, Rando Matos Y, Arias Agudelo OL, Vasudeva A, Bigas Aguilera O, Almeda Ortega J, Capella Guillén A, Buitrago Olaya CJ, Monteverde Curto X, Rodero Perez E, Rubio Ripollès C, Sepulveda Palacios PC, Moreno Farres N, Hernández Sánchez AM, Martin Cantera C, Azagra Ledesma R. Effectiveness of the Epley's maneuver performed in primary care to treat posterior canal benign paroxysmal positional vertigo: study protocol for a randomized controlled trial. Trials 2014; 15:179. [PMID: 24886338 PMCID: PMC4043960 DOI: 10.1186/1745-6215-15-179] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/13/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Vertigo is a common medical condition with a broad spectrum of diagnoses which requires an integrated approach to patients through a structured clinical interview and physical examination. The main cause of vertigo in primary care is benign paroxysmal positional vertigo (BPPV), which should be confirmed by a positive D-H positional test and treated with repositioning maneuvers. The objective of this study is to evaluate the effectiveness of Epley's maneuver performed by general practitioners (GPs) in the treatment of BPPV. METHODS/DESIGN This study is a randomized clinical trial conducted in the primary care setting. The study's scope will include two urban primary care centers which provide care for approximately 49,400 patients. All patients attending these two primary care centers, who are newly diagnosed with benign paroxysmal positional vertigo, will be invited to participate in the study and will be randomly assigned either to the treatment group (Epley's maneuver) or to the control group (a sham maneuver). Both groups will receive betahistine. Outcome variables will be: response to the D-H test, patients' report on presence or absence of vertigo during the previous week (dichotomous variable: yes/no), intensity of vertigo symptoms on a Likert-type scale in the previous week, total score on the Dizziness Handicap Inventory (DHI) and quantity of betahistine taken. DISCUSSION Positive results from our study will highlight that treatment of benign paroxysmal positional vertigo can be performed by trained general practitioners (GPs) and, therefore, its widespread practice may contribute to improve the quality of life of BPPV patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01969513.
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Affiliation(s)
- José Luis Ballve Moreno
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Ricard Carrillo Muñoz
- Centre d’Atenció Primària (CAP) Florida Sud, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Iván Villar Balboa
- Centre d’Atenció Primària (CAP) Florida Sud, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Yolanda Rando Matos
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Olga Lucia Arias Agudelo
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Asha Vasudeva
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Olga Bigas Aguilera
- Centre d’Atenció Primària (CAP) Florida Sud, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Jesús Almeda Ortega
- Técnico de Salud de Soporte a la Investigación. Unitat de Suport a la Recerca. Direcció d’Atenció Primaria de Costa de Ponent. Gerencia Territorial Metropolitana Sud, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Alicia Capella Guillén
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Clara Johanna Buitrago Olaya
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Xavier Monteverde Curto
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Estrella Rodero Perez
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Carles Rubio Ripollès
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | | | - Noemí Moreno Farres
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | | | - Carlos Martin Cantera
- Departament de Medicina, Equip d’Atenció Primària Barcelona, Universitat Autònoma de Barcelona, Passeig Sant Joan, Barcelona, Spain
| | - Rafael Azagra Ledesma
- Equip d’Atenció Primària Badia del Valles. Servei d’Atenció Primària Vallés Occidental. USR IDIAP Jordi Gol. Direcció d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
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Agus S, Benecke H, Thum C, Strupp M. Clinical and Demographic Features of Vertigo: Findings from the REVERT Registry. Front Neurol 2013; 4:48. [PMID: 23675366 PMCID: PMC3650561 DOI: 10.3389/fneur.2013.00048] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 04/23/2013] [Indexed: 11/21/2022] Open
Abstract
Introduction: Despite being a common disease, data on vertigo management in a real-world setting are scarce. Aims: To provide information on the vertigo and its management in a real-world setting. Methods: Data were collected from 4,294 patients with vertigo in 13 countries over 28 months via a multi-national, non-interventional observational study (the so-called REVERT registry). Data included medical history and details of anti-vertigo therapy. “Clinical global impression” (CGI) of severity (CGI-S) was assessed at baseline (V1) and then at 6 months follow-up (V2) along with CGI change (CGI-C). All variables were analyzed descriptively. Results: The majority of patients were female, >40 years of age, and almost half had co-morbid cardio-vascular disease. Diagnoses were split into four categories: 37.2% “other vertigo of peripheral vestibular origin,” 26.9% benign paroxysmal positional vertigo (BPPV), 20.5% “peripheral vestibular vertigo of unknown origin,” and 15.4% Ménière’s disease (MD). Betahistine was the most commonly prescribed therapy prior to and after enrollment, and was followed by piracetam, ginkgo biloba, and diuretics. MD had the highest proportion of betahistine treated patients. Almost half of patients were “moderately ill” at V1 based on CGI-S. At V2, patient distribution moved toward “less severe illness” (91.0% improved). The greatest improvements were in the more severely ill, and those with BPPV or “other vertigo of peripheral origin.” Conclusion: There was a reduction in illness severity over the course of the study, some of which is likely to be due to pharmacological intervention. Further studies are needed to confirm these results.
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Affiliation(s)
- Sam Agus
- Abbott Products Operations AG Allschwil, Switzerland
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Lacour M, van de Heyning PH, Novotny M, Tighilet B. Betahistine in the treatment of Ménière's disease. Neuropsychiatr Dis Treat 2007; 3:429-40. [PMID: 19300572 PMCID: PMC2655085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Ménière's disease and related disease of the vestibular system are common and debilitating. Current therapy is multi-modal and includes drug therapy and lifestyle adaptations. Unfortunately many of the drugs used in treatment (particularly those used to control nausea) are sedative and hamper the process of vestibular compensation. Although betahistine (Serc®), BetaSerc®); Solvay Pharmaceuticals) is the mainstay of drug treatment in these illnesses, its efficacy has not, until recently, been evaluated to modern standards. Betahistine is an analog of histamine with weak agonist properties at histamine H1 receptors and more potent anatgonistic effects at histamine H3 receptors. Growing evidence suggests that the mechanism of action of betahistine lies in the central nervous system and in particularly in the neuronal systems involved in the recovery from process after vestibular loss. The histaminergic neurones of the tuberomamillary and vestibular nuclei are implicated. In recent years the clinical efficacy of betahistine has been demonstrated in double-blind, randomized, placebo, and active controlled studies in adequate numbers of patients. Although the results of comparative studies between betahistine and other drugs (flunarizine, cinnarizine, and cinnarizine + dimenhydrate) are equivocal, the efficacy of betahistine is now clear.
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Affiliation(s)
- Michel Lacour
- UMR 6149 Université de Provence/CNRS "Neurobiologie Intégrative et Adaptative", Marseille Cedex 3, France.
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Della Pepa C, Guidetti G, Eandi M. Betahistine in the treatment of vertiginous syndromes: a meta-analysis. Acta Otorhinolaryngol Ital 2006; 26:208-215. [PMID: 18236637 PMCID: PMC2640000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Accepted: 07/19/2006] [Indexed: 05/25/2023]
Abstract
Vertigo is a very frequent disorder, associated with highly disabling symptomatology. Since the aetiology cannot always be easily identified, treatment is often addressed to the symptoms. Betahistine, a drug characterized by a multi-factorial mode of action of the modulatory type, has been widely employed in the management of various vertiginous syndromes. Its use in Italy is, currently, authorized to treat the vertiginous symptoms related to Ménière's disease. A meta-analysis has, therefore, been carried out to assess, the efficacy of betahistine in the treatment of other vertiginous syndromes, such as positional paroxysmal vertigo (cupulo-canalolithiasis) and vertigo secondary to arterial deficiency of the vertebrobasilar area, regardless of the specific cause. A review has been made of the literature concerning clinical trials performed with betahistine versus placebo in a randomised double-blind, parallel-group or cross-over design. Only studies evaluating betahistine in patients with vertiginous symptomatology not related to Ménière's disease were selected. Of the 104 publications, obtained from an analysis of "Medline", "EMBASE" and "CINAHL" databases, 7 clinical studies, which met the selection criteria, for a total of 367 patients, were extrapolated and analysed. The meta-analysis was conducted using the "Cochrane Collaboration's Review Manager" software in all the case series and in the sub-groups identified by the experimental design (parallel or crossover design), range of dosages (32-48 mg/day) and range of treatment duration (from 3 weeks to 4 months). The various parameters used to evaluate efficacy, adopted in the trials, and taken into account in the metaanalysis, as overall judgement of the patient or physician, number of vertiginous episodes and their duration, were classified according to the binary classification of "improved" and "not improved". The results of the meta-analysis confirm the therapeutic benefit of betahistine versus placebo. In particular, the investigation carried out on the overall sample shows an odds ratio of 3.52 (95% confidence interval 2.40-5.18) and a relative risk of 1.78 (95% confidence interval 1.48-2.13), while the analysis of the sub-groups denotes a maximum efficacy after doses of 32 to 36 mg and with a period of treatment of 3-8 weeks. The present meta-analysis confirms the benefit of drug treatment with betahistine for the vertiginous symptomatology related to cupulo-canalolithiasis and vertebro-basilar arterial insufficiency.
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Affiliation(s)
- C Della Pepa
- Department of Anatomy, Pharmacology and Forensic Medicine, University of Turin, Italy.
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Cavaliere M, Mottola G, Iemma M. Benign paroxysmal positional vertigo: a study of two manoeuvres with and without betahistine. Acta Otorhinolaryngol Ital 2005; 25:107-12. [PMID: 16116833 PMCID: PMC2639876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Efficacy of the liberatory manoeuvre and of gradual otolitis dispersion technique, with or without associated drug therapy, have been compared. Included in this prospective study were 103 patients with benign paroxysmal positional vertigo seen in the Outpatient Department. Patients were classified into 4 groups according to treatment: Liberatory Manoeuvre according to methods described by Semont et al., with and without betahistine, Gradual Otolitis Dispersion Technique according to Brandt and Daroff, with and without betahistine. Evaluation was performed at baseline and at 3, 7, 14, 30, 60 and 90 days after start of treatment. Response to treatment was evaluated using criteria of Epley. At day 14, liberatory manoeuvre-betahistine and Brandt and Daroff-betahistine groups did significantly better than liberatory manoeuvre and Brandt and Daroff groups (p < 0.05). Improvement reached at day 30 was: 100% in liberatory manoeuvre-betahistine group; 96.30% (p > 0.05) in Brandt and Daroff-betahistine group; these results were significantly better (p < 0.05) than those of liberatory manoeuvre (54.17%) and Brandt and Daroff (25%) groups. As far as concerns differences between disease onset and start of therapy (less and more than 2 weeks), and age (< or =60 years and > or =60 years), response to treatment was similar. In conclusion, both liberatory manoeuvre and Brandt and Daroff, when associated with betahistine, were significantly more effective than manoeuvres alone (p < 0.05). Improvement in liberatory manoeuvre-betahistine group, in the initial phase, was greater that in Brandt and Daroff-betahistine group, albeit, differences were not significant (p > 0.05). Age-related effects of manoeuvres were compared in 71 patients < 60 years and 32 patients > or =60 years, showing a similar improvement rate at the end of the investigation in both groups. In our opinion, liberatory manoeuvre and Brandt and Daroff associated with betahistamine produces faster recovery compared to liberatory manoeuvre and Brandt and Daroff alone. Nevertheless, 3 months after onset of treatment, all patients showed complete recovery due to spontaneous evolution of paroxysmal positional vertigo, in other words, treatment does not appear to influence the final improvement rate and its role should be accepted as a significant reduction in persistence of symptoms.
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Affiliation(s)
- M Cavaliere
- Otorhinolaryngology Department, Moscati Hospital, Avellino, Italy.
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