Comparing the Effectiveness of Intravenous Diazepam and Methyl Prednisolone in Treatment of Acute Peripheral Vertigo; a Clinical Trial
Iranian Journal of Emergency Medicine,
Vol. 3 No. 3 (2016),
21 September 2016
,
Page 97-92
https://doi.org/10.22037/ijem.v3i3.13413
Abstract
Introduction: Although vertigo alone is not counted as a disease, it is one of the most common complaints of patients presenting to emergency departments (ED). Considering that in facing peripheral vertigo a single treatment has not been agreed upon, we decided to evaluate the effectiveness and side effects of intravenous (IV) methyl prednisolone and diazepam in treating acute peripheral vertigo in a clinical trial. Methods:This double blind clinical trial was done to compare the effectiveness of IV methyl prednisolone and diazepam in controlling acute peripheral vertigo in patients visiting ED. Patients were allocated to one of the 2 groups using simple randomization, and vertigo severity (based on VAS score), hemodynamic changes, level of consciousness, changes in blood sugar and the side effects were compared between the 2 groups 30, 60, and 120 minutes after injection. Results: The study was done on 113 patients with the mean age of 41.8 ± 10.4 years (20-60) (58.4 male). Patients were divided into 2 groups of IV diazepam (51 patients) and IV methyl prednisolone (62 patients). A significant difference was not found between the 2 groups regarding age (p = 0.83), sex (p = 0.339), vertigo severity (p = 0.337) and vital signs (p = 0.986) on arrival. Vertigo severity only showed significant difference between the groups after 120 minutes of drug administration (p = 0.003). No case of low blood pressure, loss of consciousness, or hemodynamic instability was seen in either group during 120 minutes. Dry mouth was significantly higher in the group receiving IV diazepam (p =0.007). Mean blood sugar for diazepam and methyl prednisolone groups after 60 and 120 minutes were 120.6 ± 36.2 and 143.1 ± 51.2 (p = 0.009) and 119.5 ± 35.1 and 162.9 ± 50.9 (p < 0.001). Conclusion: In conclusion, considering the higher effectiveness and non-significant side effects of IV diazepam, it seems to be better than IV methyl prednisolone for symptom control in patients presenting with acute peripheral vertigo.How to Cite
References
Brandt T. Benign paroxysmal positioning vertigo. Vertigo: Springer; 2003. p. 251-83.
Irving C, Richman P, Kaiafas C, Eskin B, Allegra J. Intramuscular droperidol versus intramuscular dimenhydrinate for the treatment of acute peripheral vertigo in the emergency department: a randomized clinical trial. Academic emergency medicine. 2002;9(6):650-3.
Calhoun AH, Ford S, Pruitt AP, Fisher KG. The point prevalence of dizziness or vertigo in migraine–and factors that influence presentation. Headache: The Journal of Head and Face Pain. 2011;51(9):1388-92.
Strickland C, Russell RG. What is the best way to manage benign paroxysmal positional vertigo? Clinical Inquiries, 2003 (MU). 2003.
Roceanu A, Bajenaru O, Muresan D, Popescu B, Anghel D, Georgescu M, et al. MANAGEMENT OF VERTIGO. Romanian Journal of Neurology. 2016;15(1).
Shahrami A, Norouzi M, Kariman H, Hatamabadi HR, Dolatabadi AA. True Vertigo Patients in Emergency Department; an Epidemiologic Study. Emergency. 2015;4.
Strupp M, Zingler VC, Arbusow V, Niklas D, Maag KP, Dieterich M, et al. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. New England Journal of Medicine. 2004;351(4):354-61.
Amini A, Heidari K, Kariman H, Taghizadeh M, Hatamabadi H, Shahrami A, et al. Histamine Antagonists for Treatment of Peripheral Vertigo: A Meta-Analysis. J Int Adv Otol. 2015;11(2):138-42.
Puskarich MA, Jones AE. Tintinalli's Emergency Medicine: A Comprehensive Study Guide>. Sepsis. 2015;2:16.
Karlberg ML-Å, Magnusson M. Treatment of acute vestibular neuronitis with glucocorticoids. Otology & Neurotology. 2011;32(7):1140-3.
Fishman JM, Burgess C, Waddell A. Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis). Cochrane Database Syst Rev. 2011;5.
Morales-Luckie E, Cornejo-Suarez A, Zaragoza-Contreras MA, Gonzalez-Perez O. Oral administration of prednisone to control refractory vertigo in Ménière's disease: a pilot study. Otology & Neurotology. 2005;26(5):1022-6.
Ariyasu L, Byl FM, Sprague MS, Adour KK. The beneficial effect of methylprednisolone in acute vestibular vertigo. Archives of Otolaryngology–Head & Neck Surgery. 1990;116(6):700-3.
Barrs DM. Intratympanic Injections of Dexamethasone for Long‐Term Control of Vertigo. The Laryngoscope. 2004;114(11):1910-4.
Lavigne P, Lavigne F, Saliba I. Intratympanic corticosteroids injections: a systematic review of literature. European Archives of Oto-Rhino-Laryngology. 2015:1-8.
Hain TC. Drug Treatment of Vertigo. Northwestern University Medical School. 2015.
Hain TC, Uddin M. Pharmacological treatment of vertigo. CNS drugs. 2003;17(2):85-100.
Malavasi M, Caovilla HH, Freitas F, Freitas C, Munhoz MSL, da Silva MLG, et al. Clonazepam in the pharmacological treatment of vertigo and tinnitus. International Tinnitus Journal. 2002;8(1):50-3.
Amini A, Heidari K, Asadollahi S, Habibi T, Shahrami A, Mansouri B, et al. Intravenous promethazine versus lorazepam for the treatment of peripheral vertigo in the emergency department: A double blind, randomized clinical trial of efficacy and safety. Journal of Vestibular Research. 2014;24(1):39-47.
Pollak L, Klein C, Rafael S, Vera K, Rabey JM. Anxiety in the first attack of vertigo. Otolaryngology--Head and Neck Surgery. 2003;128(6):829-34.
Rodríguez J, Crawford V. What Therapies Are Effective for Relief of Chronic Vertigo Symptoms? Evidence Based Practice. 2016;12(7).
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