Medical Treatment and Therapy of Vertigo

      Because the causes of vertigo are varied, while patients often feel very annoyed with vertigo symptoms, often using symptomatic treatment. The duration of treatment are varied. Most cases of therapy can be stopped after a few weeks and here are some commonly used classes of drugs:
     Not all antihistamines have the ability to anti-vertigo. Antihistamines can relieve vertigo like drugs: dimenhydrinate and diphenhydramine, antihistamines which have anti-vertigo also have anticholinergic activity in the central nervous system. Perhaps anticholinergic properties is related to his ability as a drug antivertigo. Common side effects are sedation (sleepiness). In patients with severe vertigo, these side effects have a positive impact.
a. Betahistin
Betahistin compound (an analogue of histamine) that can improve circulation in the inner ear, can be given to treat symptoms of vertigo. Side effects Betahistin is impaired in the stomach, feeling nauseated, and the occasional "rash" on the skin. Betahistin mesylate (Merislon) With a dose of 6 mg (1 tablet) - 12 mg, 3 times a day orally.
b. Betahistin in Hcl (Betaserc). With a dose of 8 mg (1 tablet), 3 times a day. Maximum 6 tablets divided into several doses.
c. Dimenhydrinate (Dramamine). Duration of action of this drug is 4-6 hours. Can be given by oral or parenteral (intramuscular and intravenous injections). Can be administered at a dose of 25 mg - 50 mg (1 tablet), 4 times a day. Side effect is sedation.
d. Difhenhidramin Hcl (Benadryl). Long activity of this drug is 4-6 hours, given at a dose of 25 mg (1 capsule) - 50 mg, 4 times daily by mouth. These drugs can also be given parenterally. Side effect is sedation.
        It can also be efficacious in treating vertigo. Calcium antagonist drug such as Cinnarizine (Stugeron) and flunarizine (Sibelium) is often used. Is a vestibular suppressant drugs for vestibular hair cells contain a lot of calcium tunnels. However, calcium antagonists often have other benefits such as anticholinergic and antihistamine. The extent to which the nature of the other's role in overcoming vertigo unknown.
a. Cinnarizine (Stugerone). Have properties suppress vestibular function. May reduce the response to angular and linear acceleration. The dose usually is 15-30 mg, 3 times daily or 1 x 75 mg a day. The side effects are drowsiness (sedation), feeling tired, diarrhea or constipation, mouth dryness and a "rash" on the skin.

    This group of drugs has many anti emetic (anti-vomiting). But it does not all have anti vertigo. Chlorpromazine (Largactil) and prochlorperazine (Stemetil) is very effective for nausea caused by chemicals but less efficacious against vertigo.
a. Promethazine (Phenergan). Is the most effective class of Fenotiazine treating vertigo. Long activity of this drug is 4-6 hours. Given at a dose of 12.5 mg - 25 mg (1 draze), 4 times a day per oral or parenteral (intramuscular or intravenous injection). A common side effect is sedation (sleepiness), while fewer extrapyramidal side effects than other drugs Fenotiazine.
b. Chlorpromazine (Largactil). Can be given to patients with severe vertigo attacks and acute. These drugs can be administered orally or parenterally (intramuscular or intravenous injection). The usual dose is 25 mg (1 tablet) - 50 mg, 3-4 times a day. Side effect is sedation.

     Sympathomimetic drugs can also suppress vertigo. One of these sympathomimetic drug that can be used to suppress vertigo is ephedrine. Activity duration is 4-6 hours. The dose can be given 10 -25 mg, 4 times a day. Efficacy of these drugs can be synergistic when combined with other anti-vertigo. The side effects are insomnia, palpitations (palpitations) and became anxious - nervous.

Vertigo can be given to patients to reduce the anxiety that often accompanies suffered vertigo symptoms. side effects such as dry mouth and blurred vision.
a. Lorazepam dose may be given 0.5 mg - 1 mg
b. Diazepam dose may be administered 2 mg - 5 mg.

Anticholinergic drugs, which is active in the central vestibular system can suppress the activity and may reduce symptoms of vertigo.
- Scopolamine
Scopolamine may also be combined with ephedrine and fenotiazine or have synergistic efficacy. Scopolamine dose is 0.3 mg - 0.6 mg, 3-4 times a day

Central nervous system has the ability to compensate for balance disorders. But sometimes encountered several patients who have little or no ability to adapt well. This may be caused by other disorders in the central nervous system or acquired deficits in visual or proprioceptive. Sometimes drugs are not much help, so need vestibular physical exercise. Exercise aims to address vestibular disorders, adapting themselves to balance disorders. The objectives of the exercise are:
1. Trained trigger head movement vertigo or disequilibrium to improve gradually overcome.
2. Training the eye movements, eye fixation exercises.
3. Exercising improve balance
Examples of exercises:
1. Stand erect with eyes open, then with eyes closed.
2. Sports are moving the head (rotational motion, flexion, extension, tilt).
3. From the sitting posture was told to stand with eyes open, then with eyes closed.
4. Roads in the room or the room with eyes open and then with eyes closed.
5. Walking "tandem" (toe in a straight line position, the heel of the foot touching
 other toes stepped).
6. Way up and down the slope.
7. eyes glanced toward the horizontal and vertical.
8. Training the eye movements by following a moving object and a stationary fixation on objects.

Physical Therapy Brand-Darrof
 There are various kinds of physical exercises, one of which is the practice of Brand-Darrof

Specific Therapy
 a. BPPV     In these conditions are not recommended drug therapy. Vertigo can be improved with head rotation maneuver this will move the calcium deposits that are free to the rear vestibule,. This maneuver includes: canalith repositioning, with the Epley maneuver and modified Epley maneuver. Patients must remain upright for 24 hours after canalith repositioning to prevent calcium deposits back into the semicircular canals,
b. Vestibular neuronitis and Labirynthis
    Therapy focuses on the symptoms of drug therapy that suppress vestibular followed by vestibular exercises. Vestibular compensation occurs more rapidly and more completely if the patient begins to 2 times a day as soon as possible after exercise vestibular vertigo reduced with drug therapy.
c.  Meniere's diseaseTherapy by decreasing Endolymphatic pressure. Although the low-salt diet and a diuretic often reduce vertigo, it is less effective in treating deafness and tinnitus. In rare cases surgical interventions such as decompression of the endolymphatic shunt, or cochleosacculoctomy needed if the disease is resistant to diuretic treatment and diet.
 d. Ischemic VascularApplicable TIA and stroke include prevent repeat events through control blood pressure, lower cholesterol levels, reduce smoking, menginhibisi platelet function (eg, aspirin, clopidogrel) and sometimes anticoagulation (warfarin). Acute vertigo caused by a stroke in the brain stem or cerebellum treated with drugs that suppress vestibular and minimize movement of the head on the first day. As soon as possible if the complaint can be tolerated drugs should taper off and vestibular rehabilitation exercises should be started immediately. Vertebrobasilar stent placement is necessary in patients with vertebral artery stenosis and refractory to medical treatment. Bleeding in the cerebellum and brain stem compression posing necessitating decompression through neurosurgery.

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