A reduction of vestibulo-visual integration during transdermally administered scopolamine and dimenhydrinate. A presentation of gain control theory in motion sickness.

The effect of transdermally administered scopolamine (TTS scopolamine) (release rate 5 micrograms/h) and dimenhydrinate (100 mg) was examined on optovestibular nystagmus in 16 volunteers in a randomized double-blind trial. A statistically significant decrease in the optokinetic part of nystagmus was observed during all treatments. Most profound reduction was found during treatment with two TTS scopolamine. The vestibular part was reduced by treatment with two TTS scopolamine, only. The results indicate that scopolamine and dimenhydrinate exert their effect in motion sickness by reducing the vestibular and visual influx and by partly inhibiting the integrative functioning of the vestibular nuclei. In their action, the motion sickness drugs seem to assist the cerebellum by diminishing impulses from various orientation reflexes in order to preserve the functional capacity of the central nervous system. Different symptoms in motion sickness seem to arise when the vestibular gain operates beyond the normal range of the cerebellar control mechanisms.