Randomized trial of betahistine mesilate tablets as augmentation for oxcarbazepine and carbamazepine in treating vestibular paroxysmia

Abstract

BackgroundVestibular paroxysmia (VP) is a rare episodic peripheral vestibular disorder. This study was conducted to compare the efficacy and acceptability of carbamazepine (CBZ) plus betahistine mesilate tablets (BMT) (CBZ+BMT) and oxcarbazepine (OXC) plus BMT (OXC+BMT) in treating VP, and investigated whether the synergistic effect could be increased along with the increased dose of BMT.MethodsVP patients were recruited and randomly assigned to receive CBZ+BMT or OXC+BMT. The doses of CBZ and OXC were set to 200 and 300 mg/time, twice daily, respectively. The doses of BMT were set to 12 and 18 mg/time, twice daily. Half of the patients in each group received BMT 12 mg/time and the other half received BMT 18 mg/time. The treatment was continued for 12 weeks. The vertigo frequency, vertigo score, vertigo duration, response rate, and drug-related side effects were analyzed.ResultsIn total, 92 patients in the CBZ+BMT group and 93 patients in the OXC+BMT group completed this trial. After 12 weeks of treatment, the two groups had similar average vertigo frequency, average vertigo score, average vertigo duration, and response rate. But the incidence of side effects was significantly higher in the CBZ+BMT group than in the OXC+BMT group (p=0.04). Subgroup analysis found that patients receiving BMT (18 mg) had greater reductions in average vertigo frequency, average vertigo duration, and average vertigo score, and higher response rates than patients receiving BMT (12 mg).ConclusionThese results demonstrated that OXC+BMT may be suitable as an alternative method in VP patients with CBZ hypersensitivity, and the synergistic effect could be increased along with the increased dose of BMT.

Long-term Prognosis of Vertigo Attacks and Health-related Quality of Life Limitations in Patients With Vestibular Paroxysmia

“…Bayer et al found a relative risk of 0.67 ( p = 0.025) for experiencing one or more VP attacks with oxcarbazepine treatment compared to placebo (7). Other studies have shown that betahistine mesilate tablets may improve the effectiveness and acceptability of carbamazepine and oxcarbazepine treatment in patients with VP (10,11). In our study we only looked at the effect of carbamazepine as experienced by patients and found that a slight majority (58%) of those that (had) used this medication reported a positive perceived effect.…”

Literature review and two study cases of vestibular paroxysmia from an otorhinolaryngology centre

“…A study of the course of the disease in 32 patients over 3 years showed a significant and consistent reduction in episode frequency, which fell to 10% of the initial value, as well as a reduction in the intensity and duration of episodes [44]. Xue et al conducted a clinical study using OXC together with betahistine mesylate (BMT) in patients with hypersensitivity to CBZ; the results showed increased efficacy of this combination compared to monotherapy with OXCs [54]. Yi et al in a retrospective study on the support of BMT therapy with OXC in patients with paroxysmia also demonstrated the greater efficacy of this regimen [55].…”