Wan Tian-Ju, Yu Yi-Chuan, Zhao Xiao-Gang, Tang Ping, Gong Yong-Shu
Department of Emergency, Yongchuan Hospital of Chongqing Medical University, Chongqing, China.
Department of Pediatrics, Yongchuan Hospital of Chongqing Medical University, Chongqing, China,
Neuropsychiatr Dis Treat. 2018 Nov 5;14:2965-2971. doi: 10.2147/NDT.S182809. eCollection 2018.
Some patients still complain of residual dizziness after successful canalith repositioning procedure (CRP) for benign paroxysmal positional vertigo (BPPV). Previous study found that compared to the low-dose betahistine, the high-dose betahistine could yield better efficacy in treating residual dizziness. Therefore, this study was conducted to assess whether the addition of cognitive behavioral therapy (CBT) could make low-dose betahistine produce similar results to high-dose betahistine in treating residual dizziness.
The recruited patients were randomly assigned to receive either low-dose betahistine (6 mg/time, three times/day) or high-dose betahistine (12 mg/time, three times/day). Patients in the low-dose group also received CBT (twice a week, 1 hour per time). The treatment was continued for 4 weeks. The duration of residual dizziness, 25-item Dizziness Handicap Inventory (DHI), Hamilton Anxiety Rating Scale (HARS), and Hamilton Depression Rating Scale (HDRS) were recorded and analyzed. The duration of residual dizziness and DHI score were the primary outcomes, and the HARS and HDRS scores were the secondary outcomes.
Each group had 50 patients. After treatment, the average DHI scores, HDRS scores, and HARS scores were significantly decreased in both groups. The duration of residual dizziness and average DHI score were nonsignificantly different (=0.08; =0.06) between the two groups, although they were lower in the low-dose group. Compared to the high-dose group, the low-dose group had the significantly lower average HDRS score (=0.007) and HARS score (=0.02). Meanwhile, four patients in the high-dose group experienced intolerable stomach upset.
These results demonstrated that the addition of CBT could make low-dose beta-histine produce similar results to high-dose betahistine in treating residual dizziness. Moreover, the low-dose betahistine plus CBT showed some advantages over high-dose betahistine in relieving depressive and anxiety symptoms and should be further explored.
对于一些良性阵发性位置性眩晕（BPPV）患者，在成功进行耳石复位治疗（CRP）后仍会抱怨残留头晕症状。先前的研究发现，与低剂量倍他司汀相比，高剂量倍他司汀在治疗残留头晕方面疗效更佳。因此，本研究旨在评估添加认知行为疗法（CBT）能否使低剂量倍他司汀在治疗残留头晕方面产生与高剂量倍他司汀相似的效果。
招募的患者被随机分配接受低剂量倍他司汀（6毫克/次，每日三次）或高剂量倍他司汀（12毫克/次，每日三次）治疗。低剂量组的患者还接受CBT治疗（每周两次，每次1小时）。治疗持续4周。记录并分析残留头晕的持续时间、25项头晕残障量表（DHI）、汉密尔顿焦虑量表（HARS）和汉密尔顿抑郁量表（HDRS）。残留头晕的持续时间和DHI评分是主要结局指标，HARS和HDRS评分是次要结局指标。
每组有50名患者。治疗后，两组的平均DHI评分、HDRS评分和HARS评分均显著降低。两组之间残留头晕的持续时间和平均DHI评分无显著差异（P=0.08；P=0.06），尽管低剂量组的数值较低。与高剂量组相比，低剂量组的平均HDRS评分（P=0.007）和HARS评分（P=0.02）显著更低。同时，高剂量组有4名患者出现难以忍受的胃部不适。
这些结果表明，添加CBT可使低剂量倍他司汀在治疗残留头晕方面产生与高剂量倍他司汀相似的效果。此外，低剂量倍他司汀加CBT在缓解抑郁和焦虑症状方面比高剂量倍他司汀具有一些优势，值得进一步探索。
