By using propensity-score matching, which controls for potential heterogeneity in patient baseline characteristics and small patient numbers, the results of this analysis suggest that combined betahistine and piracetam may be more effective than betahistine alone in patients with peripheral vestibular vertigo.

Introduction. The demonstrative example of unilateral peripheral vestibulopathy is vestibular neuronitis. This disease of infectious-toxic origin has the involvement of vestibular ganglia neurons or vestibular nerve fibers. The overwhelming moment in topic diagnostics of vestibular impairments is within-patient comparison anamnesis data and vestibulometry results. In cases of vestibular neuronitis exception of central vestibular system pathology is mandatory.Objective. To attain objectification of disequilibrium in vestibular neuronitis by means of registration and assessment of oculogyric and postural reactions.Materials and methods. Vestibular passport trials are recommended in the examination of patients with acute vertiginous complaints. Special attention has been given to the revelation of impairments of command eye movements, disturbances of ocular pursuit, spontaneous nystagmus, and catch-up saccades in Halmagyi – Curthoys test. Possible impairments of static and dynamic balance control are assessed in modified Romberg test and Unterberger test. Gaze tests with registration of saccadic and pursuit eye movements, spontaneous and optokinetic nystagmus reactions as well bithermal caloric test are carried out in computerized electrooculography and videooculography. Deviations of body gravity center are analyzed with the help of sensory organization test in computerized dynamic posturography.Results and discussion. The results of screening and computerized vestibular testing of 24 patients are presented. High diagnostic value of registration and analysis of oculogyric reactions as well as postural control signs is demonstrated in cases of acute vestibular neuronitis and acerbation of its chronic recurrent variant. The key objective symptom, which confirms peripheral level of vestibular dysfunction, is spontaneous nystagmus registration in elimination of gaze fixation. Unsteadiness in static and dynamic trials confirms the vestibular decompensation extent in acute phase of vestibular ganglia / neurons pathology in cases of vestibular neuronitis. Decompensation signs revelation of this peripheral vestibular dysfunction needs urgent medicine: possible etiotropic and obligate symptomatic therapy as well as spare vestibular rehabilitation exercises.Conclusion. Combination of oculogyric impairments and disturbances of postural control enables to improve accuracy of diagnostics in decompensated stage of vestibular neuronitis.

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BackgroundWe 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.MethodsThe 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.ResultsTotal 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.ConclusionBetahistine 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.