1. VertigoA slide kit Picture adapted from Borg E, Counter A. Pour la Science 1989;144:65. Pour la scienceGPSRC PCP 058 PROM 0608 PIR_Nootropil Slide Kit Vertigo UCB PHARMA S.A. 2008. All rights reserved

2. What is vertigo? Vertigo is: A type of dizziness A sensation of movement typically characterised byfeelings of rotation or spinning Baloh RW. Lancet 1998;352:18416. Mukherjee A et al. JAPI 2003;51:1095101. Sloane PD et al. Ann Intern Med 2001;134:82332.2GPSRC PCP 058 PROM 0608 PIR_Nootropil Slide Kit Vertigo UCB PHARMA S.A. 2008. All rights reserved 3. Vertigo can be objective or subjective Objective vertigo: the patient perceives that the environment ismoving around him/her Subjective vertigo: the patient feels himself/herself moving in a staticenvironment Mukherjee A et al. JAPI 2003;51:1095101. Salvinelli F et al. Clin Ter 2003;154:3418.3GPSRC PCP 058 PROM 0608 PIR_Nootropil Slide Kit Vertigo UCB PHARMA S.A. 2008. All rights reserved 4. Vertigo is one of four types of dizziness Dizziness OtherVertigoPresyncopeDisequilibrium subtypes An illusion of A feeling of A sense of Swimming ormovement,faintness orunsteadiness in the floatingusuallyloss of lower bodysensationsrotation consciousness No effect on feelings Feelings of in head dissociation Relieved when Difficult to sitting downdescribe Drachman DA, Hart CW. Neurology 1972;22:3234. Sloane PD et al. Ann Intern Med 2001;134:82332.4GPSRC PCP 058 PROM 0608 PIR_Nootropil Slide Kit Vertigo UCB PHARMA S.A. 2008. All rights reserved 5. Etiology of vertigo Vertigo related to inner earBenign paroxysmal positional vertigo (BPPV)Menieres diseaseLabyrinthitisTrauma (labyrinthine concussion)Aminoglycoside toxicity Vertigo related to the vestibular nerveVestibular neuritisNerve compression due to meningioma or schwannoma Vertigo related to brain stemPhysiological (visual-vestibular mismatch)Demyelination (multiple sclerosis)MigraineVertebrobasilar insufficiency (as in stroke or TIA)Drug toxicities (with anticonvulsants, aspirin, alcohol) Allen CMC, Lueck CJ. Neurological disease. In: Christopher H, Edwin RC, Nicholas AB, eds. Davidsons Principles and Practice of Medicine. 19th ed. Edinburgh: Churchill Livingstone;2002:1103-12310. 5GPSRC PCP 058 PROM 0608 PIR_Nootropil Slide Kit Vertigo UCB PHARMA S.A. 2008. All rights reserved 6. Vertigo: Pathophysiological Pathways Endolymph movement, depending on the direction of flow and deflection of otoliths by gravity, either stimulates or inhibits neuronal output from the attached hair cells Nerve impulses from the vestibular system are transmitted to the vestibular nuclei in the brain stem and cerebellum through the eighth cranial nerve From there, connections are made to the oculomotor system, spinal cord, and cerebral cortex, which integrate the information to produce the perception of motion Vertigo results from lesions or disturbances along this pathway Robert BD, Mark DC. Syncope, Faintness, Dizziness, And vertigo. In: Dennis LK, Eugene B, Anthony SF et al, eds. Harrisons Principles of Internal Medicine.16th ed. New York:McGraw-Hill;2005:126-133. 6GPSRC PCP 058 PROM 0608 PIR_Nootropil Slide Kit Vertigo UCB PHARMA S.A. 2008. All rights reserved 7. Vertigo: Role of Neurotransmitters Neurotransmitters that work centrally and peripherally include: Acetylcholine: Functions as an excitatoryneurotransmitter in central and peripheral pathways Glutamate: Maintains the resting discharge of thecentral vestibular neurons; may modulate synaptictransmission in the VOR arc GABA: Thought to be inhibitory for commissures ofthe medial vestibular nucleus McLean MJ. Principles of neuropharmacology and therapeutics. In: Bradley WG, Daroff RB, Fenichel GM, Marsden CD, eds. Neurology in Clinical Practice. 3rd ed. Boston: Butterworth Heinemann;2000:867-898. 7GPSRC PCP 058 PROM 0608 PIR_Nootropil Slide Kit Vertigo UCB PHARMA S.A. 2008. All rights reserved 8. Vertigo: Presentation Sensation of motion either of the person or the environment In addition, the following may be present: Nausea or vomiting Abnormal eye movements Sweating Duration of symptoms can vary from a few minutes to hours and can be constant or episodic May also be associated with visual disturbances, weakness, decreased level of consciousness, difficulty in speaking Troost BT. Dizziness and vertigo. In: Bradley WG, Daroff RB, Fenichel GM, Marsden CD, eds. Neurology in Clinical Practice. 3rd ed. Boston: Butterworth Heinemann;2000:239-240.8GPSRC PCP 058 PROM 0608 PIR_Nootropil Slide Kit Vertigo UCB PHARMA S.A. 2008. All rights reserved 9. Vertigo episodes are debilitating and are more than just a sensation of movement Vertigo episodes: are characterised by a sensation of movement, usually spinningor rotating vary in intensity and duration are usually unpredictable are often accompanied by: nausea vomiting imbalance anxiety sweating nystagmus Baloh RW. Lancet 1998;352:18416. Mukherjee A et al. JAPI 2003;51:1095101. Salvinelli F, Firrisi L, Casale M, et al. Clin Ter 2003;154:3418.9GPSRC PCP 058 PROM 0608 PIR_Nootropil Slide Kit Vertigo UCB PHARMA S.A. 2008. All rights reserved 10. Vertigo is a continuous burden Between vertigo episodes there may be:HeadachesInstabilityGeneral malaiseAnxiety and depressionFear over recurrence of episodes These symptoms may have a negative effect on quality of life Fielder H et al. Clin Otolaryngol 1996;21:1246. Hgnebo C et al. Scand Audiol 1997;26:6976. Lopez-Escamez JA, Lopez-Nevot A. Acta Otorrinolaringol Esp 2000;51:37782. Mendel B et al. Clin Otolaryngol Allied Sci 1999;24:28693. Monzani D et al. J Psychosom Res 2001;50:31923. Salvinelli F et al. Clin Ter 2003;154:3418.10GPSRC PCP 058 PROM 0608 PIR_Nootropil Slide Kit Vertigo UCB PHARMA S.A. 2008. All rights reserved 11. Vertigo can have a negative impact on quality of lifeWomen with vertigo Weighted population mean Men with vertigoMean score (scale of 0-100) Mean score (scale of 0-100)QoL parameter (SF-36) Physical functioning Limitations due to emotions Limitations due p