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ProOtology
BalkanJournalofOtology&NeuroOtology,Vol.3,No1:43452003
Allrightsreserved.PublishedbyProOtologyAssociation

Piracetam*inPatientswithChronicVertigo
R.Benchev,Zl.Zhelyazkova
DepartmentofOtorhinolaryngology
MedicalInstituteofMinistryofInterior,Sofia,Bulgaria

ABSTRACT
Objective:ThepurposeofthisstudywastoobservetheeffectivenessofPiracetam*intreatingchronicvertigo.
StudyDesign:Thestudydesignwasaretrospectiveanalysis.
Setting: This study was performed at the Department of Otorhinolaryngology in the Medical Institute
MinistryofInterior,Sofia.
Patients:Thestudyincluded40patientswithchronicvertigo.
Intervention:ThepatientsweretreatedwithPiracetam/Nootropil/for8weeks2.4g/day(2x1.2g).
Main Outcome Measures: The patients passed precise otorhinolaryngological and neurotological
examinationincludingpuretoneaudiometry,observationfornystagmus,staticandkinetictests,posturography
beforeandafterthetreatment.
Results:Thefrequencyofthevertiginousattacksinpatientswiththewholeamountofthedifferentdiseases
decreasedthedurationofthevertigodiminishedinpatientswithdiabetesmellitusandclimax,butremained
thesameinpatientswithneuritisofthecochleovestibularnerveandbenignpositionalparoxysmalvertigo
the severity of the vertigo and the vegetative complaints decreased the intervals between the vertiginous
attacksincreased.
Conclusions:TheresultsofthetreatmentencourageustorecommendNootropilforcuringchronicvertigoof
bothperipheralandcentralorigininpatientswiththedifferentpreviouslymentioneddiseases.
Keywords:Chronicvertigo,Nootropil.
ProOtology1:4345,2003

INTRODUCTION
Vertigo is not a disease but a cardinal symptom of vestibular dysfunction. It may be
definedasanillusionofmovementoftheenvironmentorofoneself.Vertigoisasensationof
altered orientation in space and of motion without external stimuli. It is an unpleasant
symptomfrequentlyaccompaniedbynausea,vomiting,dysequillibrium,andunsteadiness(3).
Vertigo can result from a wide variety of diseases affecting either peripheral or central
vestibularsystem.Swaying,rocking,staggering,weakness,aswimmingorwavysensationis
associatedwithchronicvertigo.Classicallythedifferentiationbetweencentralandperipheral
causes of vertigo has been made by the duration of vertiginous attack, that is, episodic or
constant. Although constant vertigo is definitely associated with central etiology, many
central processesproduce episodic vertigo, especiallyintheearly stages (1,2). Some of the
patients have chronic vertigo characterized by almost continuous symptoms of variable
severitypunctuatedbyperiodicexacerbationsorepisodes(4,5).

Thequalitiesofvertigothatmustbedeterminedarethefollowing:
severityofvertiginousattacks
durationofassociatedincapacity
frequencyofepisodes
intervalsbetweenthevertiginousattacks
precipitatingfactorsasnausea,neurovegetativesymptoms
instability,imbalance.
Effective symptomatic treatment of chronic vertigo remains a difficult therapeutic
challenge.Pharmacotherapyisrequiredforthatkindoftreatment.Piracetamhasbeenshown
tobeeffectiveinvertigoofbothcentralandperipheralorigin.Thedosageweusedwas2.4
g/day (2x1.2g) for 8 weeks. Piracetam was well tolerated and free from serious adverse
events.
Table1.Characteristicsofvertigo,causedbydifferentdiseasesbeforethetreatment.

PATIENTSANDMETHODS
50patientsofeithergender(34femaleand16male),agedbetween30and75yearswith
chronic vertigo of at least 3 months duration and with 2 or more acute episode or
exacerbationseachmonth,wereenrolledinthestudy.Vertigowassevereenoughtointerfere
withsocialandprofessionallife.Thestudydesignincludedthefollowinggroups:
A.Patientswithvestibulardisordersofperipheralorigin,causedbythefollowingdiseases:
MorbusMeniere2patients
Vestibularneurinitiswithrecurrentvertigo4patients
Benignpositionalparoxysmalvertigo2patients.
B.Patientswithvestibulardisordersofcentralorigin,causedbythefollowingdiseases:
Vertebrobasilarinsufficiency12patients
Multiplesclerosis2patients.
C.Patientswithvestibulardisorders,causedbymetabolicderangementsas:
Diabetesmellitus10patients
Rheumatoidarthritis4patients
Hypothyreoidism6patients
Climax8patients.
Thediagnosiswasclinically,otorhinolaryngologicallyandneurotologicallyestablishedby
theexaminations.Thespecificotoneurologicalparameterswerestudiedincludingassessment
ofspontaneous,latentandpositionalnystagmusstatokinetictestsandposturographybefore
andafterthetreatment.

RESULTS
After8weeksoftreatment,theseverityofthevertigoandtheneurovegetativecomplaints
such as nausea, vomiting and paleness decreased the intervals between the vertiginous
attacksincreasedthedurationofvertigocrisisdiminishedthefrequencyofthevertiginous
attacksalsodecreased.Therewasnoimbalanceandinstabilitybetweentheepisodes.
Table2.ThecharacteristicsofvertigoafterthetreatmentwithPiracetam/Nootropil/.

Table3.ThecharacteristicsofvertigoafterthetreatmentwithPiracetam/Nootropil/.

DISCUSSION
The pathophysiology of vertigo and the ability to compensate in the presence of this
disorder are dependent on central nervous function. The whole vestibular system, including
theoculomotorsystem,isservedbymorethan50nucleiinthecentralnervoussystemand,as
suchisthemostcomplexstructureinthebrain.
The nootropic agent Piracetam exerts effects through actions on cerebral
neurotransmission. It acts by restoring both the number and function of cholinergic
(muscarinic) and excitatory amine (NmethylDaspartate) receptors in aged rats and mice
and the release of dopamine after hypoxia (7). Thus, during the excitatory phase of
neurotransmissionofimpulsesalongthevestibularnerveinthetimeofthevestibularattack,
nootropicagentstopsthetransmissionandinhibitinginputfromthevestibularapparatus.The
drugreducesnerveactionpotentialsfromthevestibularsensoryorganstothebrainstem.The
effectofPiracetamonvertigoappearstobeprophylacticinthatitdiminishesthenumberof
episodesorexacerbationsandimprovesbackgroundsymptomsbetweenepisodes.
There is a nonspecific modulation of the neurotransmission due as well to the ability of
piracetam to restore neuronal membrane fluidity (7). The increase in neuronal membrane
fluidityobservedafterPiracetamadministrationinagingmayexplainboththeimprovement
invariousmembraneboundcellfunctionsandwhyclinicalbenefitusuallyoccurswhencell
function is compromised (6). Piracetam improves higher cerebral integrative functions but
doesnotpossesssedativeorpsychostimulantproperties.
Possessinganticholinergeticactivity,thedrugdiminishestheexcitabilityofneuronsinthe

vestibularnuclei.Itsuppressesboththespontaneousfiringrateandtheresponsetovestibular
nerve stimulation. Piracetam acts on the vestibular nuclei, which project to oculomotor,
spinal,cerebellarandcerebralareasinthebrainstem.Thusitappearstoenhancethenormal
processesofvestibularcompensationandhabituationrecoveryofoculomotorandpostural
function in patients with both peripheral and central vertigo. The drug accelerates
spontaneousrecovery,reinforcesandstabilizesadaptationandrestorationofbalance(7).
Piracetamhasapositiveeffectinpresbyvertigo.Theischemiainpatients,sufferingfrom
vertebrobasilar insuffeciency is a result of arterosclerosis and generally occurs in the older
age group. Piracetam increases intralabyrinthine blood flow and oxyganation of sensory
tissue. It stimulates the sinthesis of AMP and ATP and thus prevents the neural cells of
hypoxiaandimprovesthemetabolisminthecellsofthevestibularsystem.
CONCLUSIONS
ClinicaltrialshaveshownPiracetamtobeofparticularvalueinthetreatmentofchronicor
recurrent vertigo. The drug in a dose of 2.4 g/day (2x1.2g) diminishes the frequency of
exacerbations of vertiginous attacks reduces the severity of the vestibular disorders and
durationofassociatedincapacity.Theresultsofthetreatmentencourageustorecommendthe
Nootropilforcuringchronicvertigoofbothperipheralandcentralorigininpatientswiththe
differentpreviouslymentioneddiseases.
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DisabilitiesandHandicapinVertiginousPatients.ClinOtolaryngol199924(1):318.
3. JacklerR,BrackmannD.Neurotology.Mosby1994:1457.
4. Ishikawa K, Cao ZW, Wang Y, et al. Dynamic Locomotor Function in Normals and Patients with Vertigo. Acta
Otolaryngol2001121(2):2414.
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SufferingfromPeripheralVestibularDisorder.ClinOtolaryngol199924(4):28693.
6. OosterveldWJ.TheEffectivenessofPiracetaminVertigo.Pharmacopsychiatry199932(Suppl.):5460.
7. Rosenhall U, Deberdt W, Friberg U, ET AL. Piracetam in Patients with Chronic Vertigo. Clin Drug Invest
199611(5):25160.

*NootropilregisteredtrademarkofUCBPharma
ProOtology
Copyright2003,ProOtologyAssociation.
ISSN13118633

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