Dizziness: treatment

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

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

• In disorders of cerebral circulation, effective control of blood pressure, the use of nootropics, antiaggregants, vasodilators or venotonic drugs, and if necessary - antiepileptic drugs is mandatory.
• Patients with Meniere's disease show a restriction of salt intake, the use of diuretics, in the absence of effect and frequent severe attacks of dizziness, consider the question of surgical treatment.
• With vestibular neuronitis, antiviral drugs may be required.
• The basis of treatment of a patient with RAPP is non-drug therapy.
  • The essence of the method consists in committing sick head movements that facilitate the displacement of the otoliths from the semicircular canal to the vestibule. The most effective manipulation is the reception of Epley. The patient is laid on the couch on his back with his head, deployed in the direction of the stricken labyrinth and a little overturned back. Produce a slow (for 1 min) turn of the head in the opposite direction, which causes displacement of the otoliths. As the reversal occurs, a sensation of systemic dizziness arises, intensifying toward the end of its execution. Simultaneously, the patient can identify a horizontal or horizontal-rotator binocular nystagmus. Intensive dizziness can be associated with the displacement of the otoliths in an elliptical sac, which is the goal of manipulation. Supporting the patient, you should sit him on the couch and manipulate with a turn of the head in the opposite direction. Displaced otoliths are able for several hours to cause irritation of the receptors, which is accompanied by dizziness (iatrogenic instability of the otolith apparatus). After the reposition of the otoliths, it is desirable to stay in the position with the head raised for a day.
  • The use of drugs that suppress the activity of the vestibular analyzer, with benign paroxysmal positional vertigo is considered impractical.

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Symptomatic treatment of dizziness

Symptomatic therapy for dizziness involves the use of vestibulitics, which inhibit the activity of the vestibular receptors and conductive ascending systems. The timing of their admission should not be excessively long, since some drugs, inhibiting the activity of the corresponding nerve formations, hinder the development of compensatory changes. For treatment and prevention of vertigo attacks widely used betahistine, an effect which is realized through histamine H ₂ - and H ₃ receptors of the inner ear and vestibular nuclei. The drug is usually administered at 48 mg per day (tablets of 24 mg - 2 times a day), the effectiveness increases with the simultaneous carrying out of medical gymnastics. With non-systemic dizziness (imbalance, pre-memory states, psychogenic dizziness), the appointment of betagistine as the main therapy is not appropriate.

With the primary lesion of the vestibular analyzer, the effect is provided by antihistamines - meclosin (12.5-25 mg 3-4 times a day), promethazine (25-50 mg 4 times a day).

Widely used drugs that limit the intake of calcium ions in the cell, which in this situation have a variety of clinical effects (cinnarizine 25 mg 3 times a day).

Traditionally widely used are combined preparations of vestibulolytic and sedative action, which help to reduce the severity of both dizziness and accompanying vegetative manifestations. The composition of such drugs include alkaloids belladonna, sedative, vasoactive components (for example, alkaloids belladonna + phenobarbital + ergotamine-bellataminal). The expediency of their application is established empirically, clinically significant effects include the reduction of nausea, hyperhidrosis, hypersalivation, bradycardia, as a result of which episodes of dizziness are transferred much easier.

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

In the overwhelming majority of cases with dizziness systematic training in physiotherapy is advisable, allowing not only to reduce subjective unpleasant manifestations, but also to ensure the maximum possible independence of the patient in everyday life, as well as reduce the risk of falls in the elderly.

Treatment of patients with psychogenic dizziness is advisable to conduct with the participation of a psychotherapist (psychiatrist). Along with non-pharmacological treatment in most cases, the use of antidepressants, anxiolytics. In some cases, a positive effect can be achieved by the appointment of anticonvulsants (carbamazepine, gabapentin). It should be borne in mind that most of these drugs themselves in a certain situation (with inadequate dosing, rapid increase in dose) can cause dizziness. To avoid self-termination of treatment, the patient must be informed of possible side effects.

In many patients with dizziness caused by organic damage to the vestibular apparatus or other sensory systems, recovery may not be complete, and therefore, rehabilitation methods aimed at compensating for the defect and providing the patient with a certain level of independence in everyday life are of exceptional importance.