Negative Effects of Betahistine on Recovery of Brainstem Oculo motor Integration after Vestibular Rehabilitation of Benign Paroxysmal Positional Vertigo (BPPV) Patients
Keywords:vestibular rehabilitation, physical therapy, benign paroxysmal positional vertigo, vestibulo-ocular reflex, betahistine
Objectives: To evaluate effects of betahistine, an antihistamine, on recovery of vestibulo-ocular functions in patients with BPPV after vestibular rehabilitation (VR) therapy.
Study design: Retrospective study.
Setting: Vestibular Rehabilitation Clinic, Division of Physical Therapy, Department of Rehabilitation Medicine, Trang Hospital, Ministry of Public Health, Trang, Thailand.
Subjects: Patients with BPPV who were referred for VR; assessed with global BPPV symptom severity visual analog scale (VAS), Dix-Hallpike test (DHT), roll test (RT), head thrust test (HTT), and gaze evoked nystagmus test (GENT) before once a week of VR and one week after completing three sessions; and performed a daily home-based VR exercises (VREs) for 3 or 4 weeks.
Methods: Data of all assessments mentioned above were extracted from case record forms, and divided into two groups: those taking betahistine (81 patients) and those not taking any antihistamine (84 patients). Data from the two groups were compared and analyzed.
Results: After completing all three sessions of VR therapy, every assessment score significantly decreased (p < 0.001) in both groups. Before the first therapy, mean VAS scores (SD) of the betahistine and the no antihistamine groups were 9.12 (0.73) and 9.22 (0.70), respectively (p = 0.38); in the second assessment, were 4.17 (0.86) and 5.15 (1.21) respectively (p < 0.001); in the third assessment, were 3.53 (0.63) and 2.57 (3.32) (p < 0.001), and in the last assessment, were 1.84 (0.64) and 0.03 (0.18) respectively (p < 0.001). Regarding the baseline assessment of the DHT, the RT, the GENT, and the HTT, there were no significant differences (p > 0.01) between the two groups. However, in all subsequent assessments there were significant differences in the GENT and the HTT scores between the two groups, favoring to the no antihistamine group over the betahistine group (p < 0.01). The DHT and the RT scores did not reach significant differences between the two groups in the last two weeks of assessments.
Conclusion: Once a week of VR therapy and a daily home-based VREs for three or four weeks significantly decreased the BPPV symptoms. Recovery of vestibulo-ocular reflex function seemed less and not as complete in those taking betahistine.
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