Efficacy of Yokukansan, a traditional Japanese herbal medicine, in patients with dizziness and irritability.

OBJECTIVE: Irritability is an emotional stress symptom that causes or exacerbates dizziness. Antidepressants may be helpful for some conditions that are accompanied by irritability; however, they do not completely inhibit irritability. Yokukansan (YKS), a traditional Japanese herbal medicine, has been used for neurosis, insomnia, and children's irritability and night crying. The study investigated the efficacy of YKS in nystagmus in patients with chronic dizziness and irritability. METHODS: Twenty-two cases with chronic dizziness and irritability were reviewed retrospectively. The patients were divided into two groups: control patients (0-7 days of treatment) and YKS-treated patients (YKS cases; >7 days of treatment). Dizziness before and during (after, in the controls) YKS treatment was evaluated by scoring the nystagmus intensity on a 5-point scale. The average scores were calculated within a maximum of 6 months before and during or after treatment. The normalized scores were also calculated. The optimal treatment regimen was calculated via receiver operating characteristic (ROC) curve analysis. RESULTS: There were six control cases (1 male, 5 females; mean age: 59.5 years). There were 16 YKS cases (3 males, 13 females; mean age: 61.8 years). While the group mean nystagmus intensity scores significantly decreased from 1.18 to 0.73 in the YKS cases, it did not change in the control cases. The group mean of the normalized nystagmus intensity scores during treatment was 0.73 in the YKS cases. The results of the ROC curve analysis indicated the optimal cut-off period of the YKS treatment was 10 days. CONCLUSION: The oral administration of YKS for more than 10 days was optimal. The treatments with YKS could be a good option for the treatments of vertigo.

Combined exercise training reduces climacteric symptoms without the additive effects of isoflavone supplementation: A clinical, controlled, randomised, double-blind study.

BACKGROUND: Exercise and supplementation with isoflavones are therapies used to prevent and treat climacteric symptoms. AIM: To verify the effects of 10 weeks of combined aerobic and resistance training and isoflavone supplementation on climacteric symptoms in postmenopausal women. METHODS: A randomised, double-blind, controlled clinical trial was performed. A total of 32 postmenopausal women, aged 54.4 ± 5.4 years, with a body mass index of 26.6 ± 3.0 kg/m2 and 5.6 ± 4.6 years after menopause, were randomly assigned to groups: placebo and exercise (PLA + EXE, n = 15) or 100 mg of isoflavone and exercise (ISO + EXE, n = 17). At the beginning and after 10 weeks of aerobic + resistance (20 min each, moderate intensity) training, climacteric symptoms were evaluated using the Blatt-Kupperman Menopausal Index, Cervantes Scale and Menopause Rating Scale. ANCOVA was used for analysis between groups and at different times, with the covariate adjusted by the pre-value. The level of significance considered was p < 0.05. RESULTS: A reduction in climacteric symptoms was observed in both groups, without differences between the interventions. The reductions were 45% and 50% for the Blatt-Kupperman Menopausal Index, 41% and 52% for the MRS and 39% and 39% for the Cervantes Scale in the ISO + EXE and PLA + EXE groups, respectively. In the descriptive analysis of the Blatt-Kupperman Menopausal Index values, there was an increase in the absence of symptoms from 48-77% in the ISO + EXE group and 24-58% in the PLA + EXE group. CONCLUSIONS: A period of 10 weeks of combined training was effective in improving climacteric symptoms in post-menopausal women. However, isoflavone supplementation did not promote additional effects in improving symptoms.

Outbreak of Mysterious Illness Among Hospital Staff: Poisoning or Iatrogenic Reinforced Mass Psychogenic Illness?

BACKGROUND: Hospitals are rarely reported as settings for mass psychogenic illness (MPI). The present report scrutinizes an outbreak of probable MPI among hospital staff, with medical intervention reinforcing the course of the illness. CASE REPORT: Four of seven staff members in an emergency department became acutely ill with nonspecific symptoms. After uneventful observation they were discharged, but symptoms worsened at reassembly for debriefing. Poisoning with hydrogen sulfide was suspected, and the victims were transferred by helicopter for hyperbaric oxygen (HBO) treatment. During the following 9 days, 14 possible poisoning victims were identified, 6 of whom were transferred for HBO. After hospital stays with repeated HBO treatment and examinations without identification of significant physical disease, the majority of the 10 HBO-treated victims remained symptomatic, some on prolonged sick leave. The ward was closed for several weeks during comprehensive but negative investigations for toxic chemicals. Clinical data and lack of indication of chemical exposure, together with an attack pattern with only some individuals becoming ill in a shared environment, suggest MPI. Iatrogenic influence from dramatic intervention was probably a strong driving force in the outbreak. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Awareness of MPI may prevent unnecessary and potentially harmful treatment as well as improve health care resilience, particularly with respect to preparedness. Outbreaks of illness in a group of symptomatic victims without indication of significant physical disease should be managed by observation and limited intervention.

Histamine Antagonists for Treatment of Peripheral Vertigo: A Meta-Analysis.

OBJECTIVE: Vertigo, the hallucination of movement of oneself or one's surroundings, can have substantial adverse effects on the quality of life of affected patients. It is essential to decrease the frequency, severity, and duration of vertigo attacks using effective medications with minimal debilitating adverse effects. We performed a meta-analysis of available clinical trials to evaluate the efficacy of histamine antagonists in the treatment of vertigo compared to the rate of resolution in untreated control groups. MATERIALS AND METHODS: A systematic search of articles in any language from January 1970 to March 2015 was performed through the following databases: the Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online, the Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, Allied and Complementary Medicine Database, Web of Science, ClinicalTrials.gov, and Google. Randomized controlled trials comparing each kind of antihistamine to untreated control participants in the treatment of vertigo (blinded/unblinded) were screened for inclusion. Three reviewers separately performed data extraction from the included trials using a standard data abstraction form. Three other researchers read the final list of all articles retained. Discrepancies were settled by mutual consensus between the authors. Random effects models were applied to estimate the pooled odds ratio (OR) and 95% confidence interval (CI) using the Review Manager software. The evaluation of publication bias was performed by Egger's test and Begg's funnel plot. RESULTS: We identified 13 eligible citations. The pooled OR was 5.370, 95% CI (3.263-8.839), and I2=56.0%, with no obvious evidence of publication bias. CONCLUSION: Our results provide clarification of the effectiveness of several categories of histamine antagonists compared with placebos in controlling peripheral vertigo.

The quantity-effect relationship and physiological mechanisms of different acupuncture manipulations on posterior circulation ischemia with vertigo: study protocol for a randomized controlled trial.

BACKGROUND: Recent experiments have demonstrated that different needling manipulations may induce variable effects via diverse physiological mechanisms. A previous study indicated that needling at Fengchi (GB 20) improved cerebral blood flow in patients with vertigo induced by posterior circulation ischemia (PCI). In this study, we aim to explore the quantity-effect relationship and the physiological mechanisms underlying different acupuncture manipulations in PCI patients with vertigo. METHODS/DESIGN: We propose a pragmatic randomized and controlled trial. All participants, outcome assessors, and statisticians will be blinded. A total of 144 eligible participants will be randomized into one of four treatment groups receiving acupuncture at Fengchi (GB 20) with different one-minute manipulation parameters. Group 1 will receive twirling at a frequency of 60 times per minute toward the contralateral outer canthus at a depth of 0.5 to 0.8 cun. Group 2 will receive twirling at a frequency of 60 times per minute toward the Adam's apple at a depth of 0.5 to 0.8 cun. Group 3 will receive twirling at a frequency of 120 times per minute toward the contralateral outer canthus at a depth of 0.5 to 0.8 cun. Group 4 will receive twirling at a frequency of120 times per minute toward the Adam's apple at a depth of 0.5 to 0.8 cun. Additional points will be added based on individualized pattern diagnoses. The participants will receive 14 acupuncture sessions over 3 to 4 weeks. The subjects will be assessed at two time points: baseline and post-treatment. The primary outcome measurements will include subjective measurements (Vertebrobasilar System Ischemic Neurological Impairment Scale, UCLA Dizziness Questionnaire, Activities of Daily Living Scale, and Psychological and Social Adaptation Scale) and objective measurements (Transcranial Doppler, carotid ultrasonography and changes in cerebral oxygenation) to reduce bias arising from the placebo effect. We will use metabolomics to investigate the mechanisms underlying the different manipulation parameters. DISCUSSION: This trial aims to explore the quantity-effect relationship between different acupuncture manipulations and their clinical effects. The results from this study may help explain the contradictory results found in acupuncture studies that practice different manipulations. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR-RTRCC-12002675 (registered on 14 November 2012).

Subjective visual vertical before and after treatment of a BPPV episode.

OBJECTIVE: The study analyses the behavior of subjective visual vertical (SVV) in benign paroxysmal positional vertigo (BPPV) before and after treatment, and offers a clinical-pathogenic interpretation. METHODS: We studied 30 consecutive patients with BPPV of the posterior semicircular canal treated with the Epley repositioning maneuver. SVV was determined at three different stages: at the time of diagnosis (1st test), after the repositioning maneuver (2nd test), and then 7 days after the resolution of the clinical picture (3rd test). The main study parameter was represented by the mean of 6 consecutive measurements (SVV(0)) for each patient. SVV was also examined in 20 healthy subjects, who represented the control group. The comparison between mean values and standard deviations showed a statistical significance of p<0.05. RESULTS: During the first test, the degree of deviation of SVV was significantly higher in the patient group than in the control group. Tilting towards the affected side was observed in all cases. The 2nd test showed an inversion in the orientation of SVV in 16 patients, and as a result of the Epley maneuver there was a statistically significant variation in SVV(0) values in 20 patients with respect to the previous test (2nd test vs. 1st test). This involved 87% (23 patients) of those who then had a negative Dix-Hallpike test, and none of the ones in whom paroxysmal positional nystagmus persisted. Lastly, no differences emerged in the behavior of the patient group vs. the control group during the third test. CONCLUSIONS: SVV is often altered during active BPPV. The degree of otolithic dysfunction is never high and, in all cases, it is brief in duration. Tilting towards the dysfunctional side is essentially a constant in untreated BPPV. This could be due to a substantial loss of otoconia, with a decrease in the density and specific weight of the macula, and thus hypofunction of the receptor. The observation of a significant variation in SVV after therapeutic maneuvers has a favorable predictive value, as it probably reflects the migration of otoliths to the utricle, where saturation mechanisms can often have irritative effects leading to the inversion of SVV.

Treatment of tinnitus needs a combined neurootological and psychosomatic approach.

In this study the results of the examination of 100 successive patients with Tinnitus, M. Menière or vertigo, who were referred to a specialised neurootological and psychosomatic centre, are presented. The study focuses on the results of the audiological tests and the question of the related hearing impairment as well as on psychological diagnosis and the possible connection between biographical details and symptom development.

Cognitions associated with anxiety in Ménière's disease.

OBJECTIVES: The purpose of this longitudinal study was to identify cognitions associated with anxiety and maintenance of anxiety in people with Ménière's disease. METHOD: At baseline, participants completed the Hospital Anxiety and Depression Scale (HADS), the Revised Illness Perception Questionnaire, the Dizziness Beliefs Scale, the Fear-Avoidance Beliefs Questionnaire, the Intolerance of Uncertainty Scale, and measures of demographic and illness characteristics. Participants were then randomized to a no-treatment group or to receive one of two self-help booklets, and completed the HADS again at 3-month follow-up. RESULTS: After symptom severity had been controlled for, baseline anxiety was found to be associated with intolerance of uncertainty, fear-avoidance of physical activity, belief that dizziness would develop into a severe attack of vertigo, and several illness perception subscales (emotional representations, consequences, psychological causes, and perceived treatment effectiveness). Anxiety on follow-up was predicted by higher baseline levels of autonomic/somatic symptoms and intolerance of uncertainty, and by reporting less understanding of the illness. These longitudinal relationships were found in those who did and who did not receive self-help booklets. CONCLUSIONS: Our findings suggest that intolerance of uncertainty is associated with anxiety in Ménière's disease. A controlled trial is needed to see whether anxiety might be reduced in Ménière's disease by helping patients tolerate and cope with uncertainty.

Body balance in patients with systemic vertigo after rehabilitation exercise.

The aim of this paper was to characterize structural balance of the body in people with systemic vertigo after applying rehabilitation exercise, such as motor-visual coordination on a posturographic platform and balance exercise. Physiotherapeutic procedures were carried out in a group of 12 people, aged 25-60 years suffering from vertigo. The evaluation of body balance in the standing position was performed by means of recording of postural sways based on force-plate posturography. The examination was performed before and after the rehabilitation program. Standard tests were done, with eyes open, eyes closed, and with conscious visual control-biofeedback. Patients with vertigo underwent a month-long therapy, which included: exercise of motor-visual coordination on a posturographic platform and balance exercise, which consisted of repeated visual, vestibular, and somatosensory stimulation for conscious postural control. The rehabilitation program resulted in a decrease of the range of sways, improved visuomotor coordination and thus also improved balance.

Evaluation of booklet-based self-management of symptoms in Ménière disease: a randomized controlled trial.

OBJECTIVE: This study examined the effectiveness of booklet-based education in vestibular rehabilitation (VR) and symptom control (SC) techniques to manage vertigo and dizziness in Ménière disease. METHODS: Participants (n = 360) were randomized to a waiting list control group or to receive either a VR or an SC self-management booklet. VR involved provoking dizziness in a controlled manner by making repeated head movements in order to promote neurological and psychological habituation. SC involved using applied relaxation, challenging negative beliefs, and lifestyle modification to reduce amplification of dizziness by anxiety. Subjective improvement in health, enablement (ability to understand and cope with symptoms), and adherence were measured at 3 and 6 months. Symptoms, handicap, anxiety and depression, and negative beliefs about symptoms were assessed pretreatment and at 3 and 6 months. RESULTS: At 6-month follow-up, 45 (37.5%) of the VR group and 47 (39.2%) of the SC group reported improvement compared with 19 (15.8%) controls; the relative probability of improvement compared with controls was 2.37 (95% confidence interval [CI], 1.48-3.80) for VR and 2.47 (95% CI, 1.55-3.95) for SC. Both intervention groups reported greater enablement than controls (p < .001, d > 0.70). At 3 months, the VR group had reduced symptoms, anxiety, handicap, and negative beliefs about dizziness; the SC group had reduced handicap; but the control group showed no improvement. Reported adherence levels were low and strongly related to outcome. CONCLUSIONS: Self-management booklets offer an inexpensive and easily disseminated means of helping people with Ménière disease to cope with dizziness symptoms.

Audiological and psychological characteristics of a group of tinnitus sufferers, prior to tinnitus management training.

A profile of audiological and psychological characteristics, obtained before starting tinnitus management training, is presented for 96 subjects with tinnitus. Variability was marked in all measures. A history of headaches, neck or back pain, or balance problems was not related to the ability to cope with tinnitus. The coping strategies used to manage tinnitus were influenced by the beliefs held about tinnitus, but the coping strategies chosen were not necessarily effective. No gender differences were found in coping ability or overall stress levels, although there were gender differences on some psychological measures and stress influences. Subjects who had previously sought assistance differed from those who had not in the complexity of the tinnitus sounds, the level of emotional reaction and the use of coping behaviours.

La dinámica motriz, la psique y el vértigo / Motor dynamics, psyche and vertigo

Cien pacientes con vértigo de diferente etiología se dividieron en dos grupos aleatorios para valorar la eficacia de dos diferentes tratamientos sintomáticos. El grupo A se trató con alcalosis y rehabilitación con técnica de Cawthorne Cooksey, y el grupo B, con diversos medicamentos. En el grupo A se observó reducción en la intensidad y frecuencia del vértigo, a partir de los primeros 60 días en el 56 por ciento en comparación con 16 por ciento del grupo B. Se identificaron factores psicógenos en el 67 por ciento de los pacientes y 47 por ciento tenían diagnósticos previos de padecimientos psicosomáticos. Se postula que el estres reduce la eficacia del sistema eferente vestibular en su aspecto supresor, ocasionando un mal funcionamiento del vestíbulo.

Behavioral treatment of dizziness secondary to benign positional vertigo following head trauma.

Benign positional vertigo (BPV) represents a challenge to rehabilitation due to the subjective nature of the complaint of dizziness, frequent failure of pharmacologic intervention, and complicating psychologic factors. Behavioral therapy was used to treat a 26-year-old woman who complained of debilitating dizzy spells after mild head injury sustained in a motor vehicle accident. During a three-week baseline period before treatment, the patient reported a weekly average of 48 dizzy spells, which prevented participation in independent activities and kept her homebound and psychologically distressed. Nine-week behavioral treatment included biofeedback-assisted relaxation training, psychologic counseling, gaze-fixation practice, desensitization exercise, and generalization training. This protocol has been used successfully to train aviators to combat vertigo and nausea in flight. Our regimen included hourly recording of physical activity, notation of frequency of dizzy spells, and use of behavioral methods during nine weeks. The patient reported 90% reduction in dizzy spells and full resumption of independent activities including driving and athletics. Results are discussed in the context of behavioral problems associated with BPV and application of behavioral methods to the complaint of dizziness.