Betahistine treatment in managing vertigo and improving vestibular compensation: Clarification

Issue title: ARO 2012 Symposium on Vestibular Neuropharmacology, New Insights on Vestibular Neuropharmacology: From Bench to Bedside - San Diego, CA, USA, February 28, 2012

Guest editors: Christian Chabbert

Article type: Research Article

Authors: Lacour, Michel^{; *}

Affiliations: UMR 7420, CNRS/Université Aix-Marseille, Marseille, France | INSERM U1051 Montpellier and UMR 7260 CNRS Aix-Marseille University, Marseille, France

Correspondence: [*] Corresponding author: Michel Lacour, 21 Impasse des Vertus, 13710 FUVEAU, France. Tel.: +33 612 471 247; E-mail: michel. [email protected]

Abstract: Betahistine dihydrochloride (betahistine) is currently used in the management of vertigo and vestibular pathologies with different aetiologies. The main goal of this review is to clarify the mechanisms of action of this drug, responsible for the symptomatic relief of vertigo and the improvement of vestibular compensation. The review starts with a brief summary recalling the role of histamine as a neuromodulator/neurotransmitter in the control of the vestibular functions, and the role of the histaminergic system in vestibular compensation. Then are presented data recorded in animal models demonstrating that betahistine efficacy can be explained by mechanisms targeting the histamine receptors (HRs) at three different levels: the vascular tree, with an increase of cochlear and vestibular blood flow involving the H1R; the central nervous system, with an increase of histamine turnover implicating the H3R, and the peripheral labyrinth, with a decrease of vestibular input implying the H3R/H4R. Clinical data from vestibular loss patients show the impact of betahistine treatment for the long-term control of vertigo, improvement of balance and quality of life that can be explained by these mechanisms of action. However, two conditions, at least, are required for reaching the betahistine therapeutic effect: the dose and the duration of treatment. Experimental and clinical data supporting these requirements are exposed in the last part of this review.

Keywords: Vertigo, vestibular compensation, histamine receptors, betahistine

DOI: 10.3233/VES-130496

Journal: Journal of Vestibular Research, vol. 23, no. 3, pp. 139-151, 2013