Wibble Tobias, Engström Johanna, Verrecchia Luca, Pansell Tony
Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Marianne Bernadotte Centre, Karolinska Institutet, Stockholm, Sweden.
St Erik Eye Hospital, Stockholm, Sweden.
Br J Clin Pharmacol. 2020 Aug;86(8):1510-1518. doi: 10.1111/bcp.14257. Epub 2020 Mar 3.
Antihistamines make up the first line of treatments against motion-sickness. Still, their efficacy and specific mechanism have come into question. The aim of this study was to investigate the effect of meclizine on motion-sensitivity.
This study was carried out as a triple-blinded randomized trial involving 12 healthy subjects who were exposed to (i) vestibular (VES), (ii) visual (VIS) and (iii) visual-vestibular (VIS+VES) stimulations in the roll plane. Subjects were divided into 2 groups by stratified randomization, receiving either meclizine or a placebo. Stimulations were carried out before, and after, drug administration, presented at 2 intensity levels of 14 and 28°/s . Eye movements were tracked, and torsional slow-phase velocities, amplitudes and nystagmus beats were retrieved. Subjects initially graded for their motion-sickness susceptibility.
Susceptibility had no effect on intervention outcome. Despite large variations, repeated ANOVAS showed that meclizine led to a relative increase in torsional velocity compared to placebo during vestibular stimulation for both intensities: 2.36 (7.65) from -0.01 (4.17) during low intensities, and 2.61 (6.67) from -3.49 (4.76) during high. The visual-vestibular stimuli yielded a decrease during low acceleration, -0.40 (3.87) from 3.75 (5.62), but increased during high, 3.88 (6.51) from -3.88 (8.55).
Meclizine had an inhibitory effect on eye movement reflexes for low accelerations during VIS+VES trials. This indicates that meclizine may not primarily work through sensory-specific mechanisms, but rather on a more central level. Practically, meclizine shows promise in targeting motion-sickness evoked by everyday activities, but its use may be counterproductive in high-acceleration environments.
抗组胺药是治疗晕动病的一线药物。然而，其疗效和具体作用机制仍存在疑问。本研究旨在探讨美克洛嗪对运动敏感性的影响。
本研究采用三盲随机试验，纳入12名健康受试者，使其暴露于（i）前庭（VES）、（ii）视觉（VIS）和（iii）视觉 - 前庭（VIS + VES）在翻滚平面的刺激。受试者通过分层随机化分为两组，分别接受美克洛嗪或安慰剂。在给药前和给药后进行刺激，刺激以14和28°/秒的两种强度水平呈现。跟踪眼动，并获取扭转慢相速度、幅度和眼球震颤搏动。受试者最初对其晕动病易感性进行分级。
易感性对干预结果没有影响。尽管存在较大差异，但重复方差分析表明，在前庭刺激期间，与安慰剂相比，美克洛嗪在两种强度下均导致扭转速度相对增加：低强度时从 -0.01（4.17）增加到2.36（7.65），高强度时从 -3.49（4.76）增加到2.61（6.67）。视觉 - 前庭刺激在低加速度时降低，从3.75（5.62）降至 -0.40（3.87），但在高加速度时增加，从 -3.88（8.55）增至3.88（6.51）。
在VIS + VES试验中，美克洛嗪对低加速度时的眼动反射有抑制作用。这表明美克洛嗪可能并非主要通过感觉特异性机制起作用，而是在更中枢的水平上发挥作用。实际上，美克洛嗪在针对日常活动引起的晕动病方面显示出前景，但其在高加速度环境中的使用可能会适得其反。
