Effects of Kampo medicine hangebyakujutsutemmato on persistent postural-perceptual dizziness: A retrospective pilot study

Abstract

BACKGROUND Persistent postural-perceptual dizziness (PPPD) is a functional disorder, typically preceded by acute vestibular disorders. It is characterized by a shift in processing spatial orientation information, to favor visual over vestibular and somatosensory inputs, and a failure of higher cortical mechanisms. To date, no therapies for PPPD have been approved. Kampo medicine hangebyakujutsutemmato (HBT) has been reported to alleviate disturbances of equilibrium. We hypothesized that HBT would be a beneficial treatment for PPPD. AIM To examine the efficacy of HBT for the treatment of PPPD. METHODS Patients with PPPD were enrolled and divided into two groups: The HBT group ( n = 24) and the non-HBT group ( n = 14). The participants completed questionnaire surveys [Niigata PPPD questionnaire (NPQ), dizziness handicap inventory, hospital anxiety and depression scale (HADS), orthostatic dysregulation questionnaire, pittsburg sleep quality index (PSQI), and motion sickness scores] before and after HBT treatment. Additionally, to identify HBT responders, multivariate regression analysis was performed using the results of the questionnaire surveys and equilibrium tests; including stabilometry, and caloric, vestibular evoked myogenic response, and head-up tilt tests. RESULTS Thirty-eight outpatients were included in this study, of which 14 patients (3 men, 11 women; mean age, 63.5 ± 15.9 years) received treatment without HBT, and 24 (1 man, 23 women; mean age, 58.2 ± 18.7 years) received combination treatment with HBT. Following HBT treatment, NPQ scores decreased significantly (baseline 40.1 ± 10.0 vs 2 mo 24.6 ± 17.7, P < 0.001). No statistically significant changes were observed in the NPQ scores in the non-HBT group (baseline 38.6 ± 12.2 vs 2 mo 39.4 ± 14.4, P = 0.92). Multivariable regression analysis revealed that the results of stabilometry ( P = 0.02) and the caloric ( P = 0.03), and head-up tilt tests ( P < 0.001), HADS ( P = 0.003), and PSQI ( P = 0.01) were associated with HBT responsiveness in PPPD patients. CONCLUSION HBT may be an effective adjunct therapy for PPPD. Patients with autonomic dysfunction, unstable balance, semicircular canal paresis, anxiety, and poor sleep quality may be high responders to HBT.

Validity and reliability of the Niigata PPPD Questionnaire in a Western population

“…In addition to the study of Kitazawa [ 30 ] previously mentioned, Yamaguchi et al used the NPQ to assess the effects of a treatment based on virtual reality in participants with PPPD, determining that participants improved their symptoms [ 31 ]. Similarly, Miwa and Kanemaru observed 15.5 points of improvement in the NPQ using traditional medicine in PPPD patients [ 32 ], which is greater than the MDC obtained by our study. Thus, these authors and future authors would benefit from our study, as we calculated the MDC for the NPQ, allowing a better and more precise interpretation of the results of every study that uses the NPQ.…”

Repetitive transcranial magnetic stimulation as add-on therapy in persistent postural-perceptual dizziness

“…The tolerability of rTMS treatment in PPPD is well. To date, SSRIs and SNRIs, VRT and CBT or their combination have been proved to be useful to the treatment for PPPD with limited e cacy [15], our study provided clinical evidence that rTMS may provide further improvement, thus warrant further investigation in the treatment of PPPD.…”

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“…However, a comparison of their effective rate indicates that the first prescription and the second prescription should be swapped. The first prescription for lower back pain (33) was Hachimi-jio-gan with an effective rate of 72.4% and the second prescription was Gosha-jinkii-gan with an effective rate of 78.4%, but this effective rate indicates that the precedence of these two formulations should also be switched. As a result, Hachimi-jio-gan could be the first prescription for both lower back pain and knee pain.…”