Motion Sickness Definition: Motion sickness is an unpleasant condition that occurs when persons are subjected to motion or the

the perception of motion. It results in the common symptoms of nausea, nonvertiginous dizziness, and general feelings of un-wellness. It is generally considered to be of physiological origin and nearly all individuals experience it if exposed to enough motion stimuli. Although the motion associated with travel is the most commonly reported form of the syndrome, it has other names with slightly different characteristics. These similar conditions have been called kinetosis, sea sickness, space sickness

Pathophysiology: The brain estimates motion based on the combined input from vestibular, visual, and proprioceptive receptors. Some have hypothesized that motion sickness occurs when the stimuli applied to these receptors appear to be in conflict. This apparent conflict causes more severe symptoms when the patient is passively moved at certain frequencies. It is much less common during active movements such as walking or swimming. The resulting nausea of motion sickness results from links between the vestibular system and the emetic centers in the brain. Symptoms: Preceding symptoms: generalized feeling of unwellness, drowsiness, fatigue, and irritability. An early sensation of stomach awareness, described as a fullness and discomfort in the epigastrium, is frequently the first reported symptom Nausea and vomiting hallmark symptoms and signs of motion sickness and can be quite severe. Sopite syndrome apathy, depression, disinclination for work, and decreased participation in group activities Neurophysiologic symptoms: malaise, lethargy, and agitation The sensation of movement frequently persists after the cessation of motion (ie, after disembarking from a ship that has been at sea) called mal de debarque, is considered worrisome if it lasts for longer than 3 days.

Physical examination: Facial pallor Increased salivation Diaphoresis Postural sway

Differential diagnosis: BPV Hypoglucemia Anxiety Dehydration Pregnancy Treatment: Non pharmacological: Tips for helping minimize motion are as follows: Pick a stable vehicle. Choose a location near the midline or front of the vehicle. Choose a location at the ground floor or waterline. Tips for reducing vestibular symptoms are as follows: Support the head. Recline head back 30. Visual tips for minimizing motion sickness are as follows: Try to see a wide horizon. Look toward motion. Do not do any close work or read. Wear sunglasses. Close your eyes. Proprioceptive tips for minimizing motion sickness are as follows: Avoid neck torsion Pharmacological Goal to prevent motion sickness,/relieve the symptoms of motion sickness (nausea) a. Anticholinergic Agents Function: the prevention of motion sickness rather than acute treatment. Effect: central anti-cholinergic properties reduce activity in the vestibular nuclei. b. Piperazine Antihistamines Efect: anti-cholinergic properties reduce activity in the vestibular nuclei. The non-sedating antihistamines do not cross the blood brain barrier do not appear to be effective in either preventing or treating motion sickness.

Contoh: 1. Cinnarizine 50mg PO r before a rough voyage. 2. Dimenhydrinate MOA: Diminishes vestibular stimulation and depresses labyrinthine function through central anticholinergic effects Dose: 50-100mg PO 30 min before motion 3. Meclizine MOA : Decreases excitability of middle ear labyrinth and blocks conduction in middle ear vestibular-cerebellar pathway Dose : 25-50mg 1 hour befor motion 4. Promethazine is prescribed for treating nausea or vomiting, motion sickness, and allergic reactions, but causes more sedation than other antihistamines. c. Antiemetics are taken to relieve nausea, but have not been shown to prevent motion sickness. Example : Domperidone, Ondansetron, Metoclorpamide