Неврология, нейропсихиатрия, психосоматика (Mar 2019)
Efficiency of long-term vinpocetine administration in the treatment of dizziness and associated statodynamic disorders in patients with chronic cerebrovascular insufficiency (EDELWEISS study)
Abstract
Complaints of dizziness are common in patients diagnosed with chronic cerebrovascular insufficiency (CCVI). Effective therapy of these patients is one of the most urgent problems of outpatient neurological practice.Objective: to evaluate the efficiency and safety of long-term administration of vinpocetine (Cavinton Comforte) in the treatment of dizziness in patients with CCVI.Patients and methods. A total of 139 patients took part in an open-label parallel-group clinical study. Vinpocetine (Cavinton Comforte) and vestibular exercises were prescribed in Group 1 (n=69); vestibular exercises were used in Group 2 (n=70). The efficiency of treatment was evaluated using a visual analog scale (VAS) in assessing vertigo and dizziness, the Dizziness Handicap Inventory (DHI), the Drug Attitude Inventory (DAI), the Montreal Cognitive Assessment (MoCA), the 5-point Likert scale, and videonystagmographic tests. Plasma brain-derived neurotrophic factor (BDNF) concentrations were analyzed before and after treatment. The total duration of the investigation was 8 months (6 months of therapy and 2 months of follow-up after therapy discontinuation).Results and discussion. The administration of vinpocetine significantly decreased the subjective intensity of vertigo and dizziness (on the VAS) and improved daily activities in patients (on the DHI) and a number of parameters according to the video nystagmographic tests: pursuit and saccadic eye movement tests. According to the DNI scores, the improvement changes in the patients' condition significantly correlated with increased plasma BDNF expression throughout the follow-up (Pearson's correlation coefficient>0.5). The use of vinpocetine could improve cognitive functions (on the MoCA and the 5-point Likert scale) and increase patient adherence to the therapy performed (on the DAI). The clinically significant effect in improving the statodynamic function was shown by vinpocetine at 2 months of its administration and was highest at 5 months; there was a significant improvement in cognitive function at 6 months. The long-term use of vinpocetine was not associated with the risk of serious adverse events.Conclusion. The findings allow vinpocetine to be recommended for long-term (at least 5 months) treatment of vertigo, dizziness, and cognitive impairment in patients with CCVI, in this case, the clinical effect is achieved through stimulating neuroplasticity, inducing BDNF synthesis in particular.
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