MANAGEMENT syndrome

Vertigo
The management of patients with vertigo include symptomatic therapy, causal
therapy, and subsequent rehabilitative therapy. Most cases of vertigo of unknown
cause, if the cause is found, then the causal therapy is the main option. Symptomatic
therapy aimed at two main things: a sense of vertigo and autonomic symptoms
(nausea, vomiting). The central compensation mechanisms will lead to reduced
symptoms, but in the acute phase of symptomatic treatment is very necessary for
comfort, tranquility and the patient can immediately mobilize patients in
rehabilitation. Symptomatic therapy must not be overstated that the compensation
mechanism is not obstructed. Vertigo drug selection depends on the point of catching
drug action, severe vertigo, phases and types of vertigo. Here's mechanism of action
of anti-vertigo drug:
a. Ca entry blocker works by reducing the excitatory CNS by pressing glutamate
release and work directly as a depressor maze. Be used for cases of central or
peripheral vertigo, ie flunarizine.
b. Antihistamines have anticholinergic effects and stimulate inhibitory
monoaminergic causing inhibition of the vestibular nuclei, for example:
cinnarizine, dimenhidrinat, promethazine.
c. Anticholinergic work to reduce the excitability of neurons by inhibiting -
cholinergic excitatory pathways to the vestibular nuclei that are cholinergic
reduce the vestibular nucleus response to stimuli, eg, scopolamine and
atropine.
d. Monoaminergic have a stimulating effect on the monoaminergic inhibitory
pathways vestibular nucleus, resulting in reducing the excitability of neurons,
eg amphetamine and ephedrine.
e. Dopaminergic work on chemoreseptor trigger zone and the vomiting center in
medulla oblongata, for example: klorpromazine and haloperidol.
f. Benzodiazepines will lower resting the activity of neurons in the vestibular
nuclei by pressing fascilitatory reticular system, eg diazepam.
g. Histaminik polisinaptik inhibit neurons in the vestibular nucleus lateralis,
example: betahistine mesylate
h. Antiepileptic works by increasing the threshold, especially on vertigo due
Temporal lobe epilepsy, eg, carbamazepine and phenytoin.
Rehabilitative therapies aimed at improving the central compensation and habituation
of patients with vestibular disorders. The working mechanism through:
a. The central substitution by visual and somatosensory system for the vestibular
function disrupted.
b. Activate tone control by the vestibular nuclei of the cerebellum, the visual
system, and somatosensory.
c. Cause habituation, ie reduced response to sensory stimuli repeatedly. Therapy
(vestibular exercise) given in the form: Brandt-Daroff methods, methods
HallpikeEpley maneuver, visual vestibular exercises, and practice runs.

Ref :
Joesoef, AU, 2002. Clinical Neurootologi - Vertigo, Airlangga University Press,
PERDOSSI Joesoef, AA 2003. Molecular Neurobiology review of Vertigo. Papers
Konas V Perdossi, Bali