r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2020-25-3-04-10r-n-j-81Research ArticleОБЗОРЫREVIEWSСовременные подходы к медикаментозному лечению головокруженияModern Concepts of Pharmacological Treatment of Vertigo and Dizzinesshttps://orcid.org/0000-0002-7988-4229ГусеваА. Л.GusevaA. L.

Москва

alexandra.guseva@gmail.comhttps://orcid.org/0000-0002-0193-2243ЗамерградМ. В.ZamergradM. V.

Москва

zamergrad@gmail.comФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава РоссииРоссияPirogov Russian National Research Medical UniversityRussian FederationФГБОУ ДПО РМАНПО Минздрава РоссииРоссияRussian Medical Academy of Continuous Professional EducationRussian Federation202014082020253410Copyright © Гусева А.Л., Замерград М.В., 20202020Гусева А.Л., Замерград М.В.Guseva A.L., Zamergrad M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/81

Цель — обзор основных заболеваний, сопровождающихся головокружением, и современных подходов к их медикаментозной терапии. В статье приведены современные представления об этиологии, патогенезе, методах диагностики доброкачественного пароксизмального позиционного головокружения, болезни Меньера, вестибулярного нейронита, функционального головокружения, вестибулярной мигрени, двусторонней вестибулопатии, вестибулярной пароксизмии и др. Обсуждаются диагностические критерии и основные принципы лечения этих заболеваний.

The aim of the article is to review the main conditions associated with vertigo and dizziness, modern approaches to their diagnosis and medical treatment. The review presents the update approach to etiology, pathogenesis, diagnostic strategies of benign paroxysmal positional vertigo, Meniere’s disease, vestibular neuritis, functional dizziness, vestibular migraine, bilateral vestibylopathy, vestibular paroxysmia and etc. Diagnostic criteria and basic treatment of these conditions are discussed.

головокружениедоброкачественное пароксизмальное позиционное головокружениевестибулярный нейронитвестибулярная мигреньболезнь Меньераvertigodizzinessbenign paroxysmal positional vertigovestibular neuritisvestibular migraineMeniere’s diseaseReferencesBergmann M., Viniol A., Becker A., Haasenritter J. Prevalence, aetiologies and prognosis of the symptom dizziness in primary care — a systematic review. BMC Fam. Pract. 2018;19(1):33. https://doi.org/10.1186/s12875-017-0695-0.Bergmann M., Viniol A., Becker A., Haasenritter J. Prevalence, aetiologies and prognosis of the symptom dizziness in primary care — a systematic review. BMC Fam. Pract. 2018;19(1):33. https://doi.org/10.1186/s12875-017-0695-0.Neuhauser H.K. The epidemiology of dizziness and vertigo. Handb. Clin. Neurol. 2016;137:67–82. https://doi.org/10.1016/B978-0-444-63437-5.00005-4.Neuhauser H.K. The epidemiology of dizziness and vertigo. Handb. Clin. Neurol. 2016;137:67–82. https://doi.org/10.1016/B978-0-444-63437-5.00005-4.Замерград М.В., Парфенов В.А., Яхно Н.Н., Мельников О.А., Морозова С.В. Диагностика системного головокружения в амбулаторной практике. Неврологический журнал. 2014;2:23–29. [Zamergrad M.V., Parfenov V.A., Yakhno N.N., Melnikov O.A., Morozova S.V. The diagnosis of systemic vertigo in out-patient practice. Neurological Journal. 2014;2:23–29. (In Russian)].Замерград М.В., Парфенов В.А., Яхно Н.Н., Мельников О.А., Морозова С.В. Диагностика системного головокружения в амбулаторной практике. Неврологический журнал. 2014;2:23–29. [Zamergrad M.V., Parfenov V.A., Yakhno N.N., Melnikov O.A., Morozova S.V. The diagnosis of systemic vertigo in out-patient practice. Neurological Journal. 2014;2:23–29. (In Russian)].Парфенов В.А., Замерград М.В., Мельников О.А. Головокружение. Диагностика и лечение, распространенные диагностические ошибки. МИА, Москва. 2019. [Parfenov V.A., Zamergrad M.V., Mel’nikov O.A. Golovokruzhenie. Diagnostika i lechenie, rasprostranennye diagnosticheskie oshibki. MIA, Moskva. 2019. (In Russian)].Парфенов В.А., Замерград М.В., Мельников О.А. Головокружение. Диагностика и лечение, распространенные диагностические ошибки. МИА, Москва. 2019. [Parfenov V.A., Zamergrad M.V., Mel’nikov O.A. Golovokruzhenie. Diagnostika i lechenie, rasprostranennye diagnosticheskie oshibki. MIA, Moskva. 2019. (In Russian)].Пальчун В.Т., Гусева А.Л., Чистов С.Д., Левина Ю.В. Отоневрологическое обследование пациента с головокружением. Вестник оториноларингологии. 2015;5:60–66. [Pal’chun V.T., Guseva A.L., Chistov S.D., Levina Yu.V. The otoneurological examination of a patient suffering from dizziness. Vestnik otorinolaringologii. 2015;80(5):60–66. (In Russian)]. https://doi.org/10.17116/otorino201580560-66.Пальчун В.Т., Гусева А.Л., Чистов С.Д., Левина Ю.В. Отоневрологическое обследование пациента с головокружением. Вестник оториноларингологии. 2015;5:60–66. [Pal’chun V.T., Guseva A.L., Chistov S.D., Levina Yu.V. The otoneurological examination of a patient suffering from dizziness. Vestnik otorinolaringologii. 2015;80(5):60–66. (In Russian)]. https://doi.org/10.17116/otorino201580560-66.Кунельская Н.Л., Мельников О.А., Гусева А.Л., Байбакова Е.В. Этиология, патофизиология и дифференциальная диагностика доброкачественного пароксизмального позиционного головокружения. Журнал неврологии и психиатрии им. С.С. Корсакова. 2016;116(4):79–84. [Kunelskaya N.L., Melnikov O.A., Guseva A.L., Baybakova E.V. The etiology, pathophysiology and differential diagnosis of benign paroxysmal positional vertigo. Zhurnal Nevrol i psikhiatrii imeni S.S. Korsakova. 2016;116(4):79. (In Russian)]. https://doi.org/10.17116/jnevro20161164179-84.Кунельская Н.Л., Мельников О.А., Гусева А.Л., Байбакова Е.В. Этиология, патофизиология и дифференциальная диагностика доброкачественного пароксизмального позиционного головокружения. Журнал неврологии и психиатрии им. С.С. Корсакова. 2016;116(4):79–84. [Kunelskaya N.L., Melnikov O.A., Guseva A.L., Baybakova E.V. The etiology, pathophysiology and differential diagnosis of benign paroxysmal positional vertigo. Zhurnal Nevrol i psikhiatrii imeni S.S. Korsakova. 2016;116(4):79. (In Russian)]. https://doi.org/10.17116/jnevro20161164179-84.Кунельская Н.Л., Мокрышева Н.Г., Гусева А.Л., Байбакова Е.В., Манаенкова Е.А. Доброкачественное пароксизмальное головокружение: современные представления об этиологии и патогенезе. Вестник оториноларингологии. 2017;82(3):75–79. [Kunel’skaya N.L., Mokrysheva N.G., Guseva A.L., Baibakova E.V., Manaenkova E.A. Benign paroxysmal positional vertigo: Modern concepts of its etiology and pathogenesis. Vestn. Otorinolaringol. 2017;82(3).] https://doi.org/10.17116/otorino201782375-79.Кунельская Н.Л., Мокрышева Н.Г., Гусева А.Л., Байбакова Е.В., Манаенкова Е.А. Доброкачественное пароксизмальное головокружение: современные представления об этиологии и патогенезе. Вестник оториноларингологии. 2017;82(3):75–79. [Kunel’skaya N.L., Mokrysheva N.G., Guseva A.L., Baibakova E.V., Manaenkova E.A. Benign paroxysmal positional vertigo: Modern concepts of its etiology and pathogenesis. Vestn. Otorinolaringol. 2017;82(3).] https://doi.org/10.17116/otorino201782375-79.Faralli M., Lapenna R., Giommetti G., Pellegrino C., Ricci G. Residual dizziness after the first BPPV episode: role of otolithic function and of a delayed diagnosis. Eur. Arch. Otorhinolaryngol. 2016;273(10):3157–3165. https://doi.org/10.1007/s00405-016-3947-z.Faralli M., Lapenna R., Giommetti G., Pellegrino C., Ricci G. Residual dizziness after the first BPPV episode: role of otolithic function and of a delayed diagnosis. Eur. Arch. Otorhinolaryngol. 2016;273(10):3157–3165. https://doi.org/10.1007/s00405-016-3947-z.Agus S., Benecke H., Thum C., Strupp M. Clinical and Demographic Features of Vertigo: Findings from the REVERT Registry. Front. Neurol. 2013;4. https://doi.org/10.3389/fneur.2013.00048.Agus S., Benecke H., Thum C., Strupp M. Clinical and Demographic Features of Vertigo: Findings from the REVERT Registry. Front. Neurol. 2013;4. https://doi.org/10.3389/fneur.2013.00048.Sokolova L., Hoerr R., Mishchenko T. Treatment of Vertigo: A Randomized, Double-Blind Trial Comparing Efficacy and Safety of Ginkgo biloba Extract EGb 761 and Betahistine. Int. J. Otolaryngol. 2014;2014:1–6. https://doi.org/10.1155/2014/682439.Sokolova L., Hoerr R., Mishchenko T. Treatment of Vertigo: A Randomized, Double-Blind Trial Comparing Efficacy and Safety of Ginkgo biloba Extract EGb 761 and Betahistine. Int. J. Otolaryngol. 2014;2014:1–6. https://doi.org/10.1155/2014/682439.Пальчун В.Т., Макоева А.А., Гусева А.Л. Головокружение при вестибулярном нейроните: подходы к диагностике и лечению. Вестник оториноларингологии. 2018;83(3):4– 10. [Pal’Chun V.T., Makoeva A.A., Guseva A.L. Dizziness and vertigo associated with vestibular neuronitis: The approaches to the diagnostics and treatment. Vestn. Otorinolaringol. 2018;83(3). (In Russian)]. https://doi.org/10.17116/otorino20188334.Пальчун В.Т., Макоева А.А., Гусева А.Л. Головокружение при вестибулярном нейроните: подходы к диагностике и лечению. Вестник оториноларингологии. 2018;83(3):4– 10. [Pal’Chun V.T., Makoeva A.A., Guseva A.L. Dizziness and vertigo associated with vestibular neuronitis: The approaches to the diagnostics and treatment. Vestn. Otorinolaringol. 2018;83(3). (In Russian)]. https://doi.org/10.17116/otorino20188334.Замерград М.В. Практические подходы к вестибулярной реабилитации. Неврологический журнал. 2015;20(6):45–49. [Zamergrad M.V. Practical approach to vestibular rehabilitation. Neurological Journal. 2015;20(6):45–49. (In Russian)]. http://dx.doi.org/10.18821/1560-9545-2015-20-6-45-49.Замерград М.В. Практические подходы к вестибулярной реабилитации. Неврологический журнал. 2015;20(6):45–49. [Zamergrad M.V. Practical approach to vestibular rehabilitation. Neurological Journal. 2015;20(6):45–49. (In Russian)]. http://dx.doi.org/10.18821/1560-9545-2015-20-6-45-49.Пальчун В.Т., Гусева А.Л., Чистов С.Д. Вестибулярная реабилитация: обоснование, показания, применение. Consilium Medicum. 2015;17(9):113–120. [Pal’chun V.T., Guseva A.L., Chistov S.D. Vestibular rehabilitation: substantiation, indications, application. Consilium Medicum. 2015;17(9):113–120. (In Russian)].Пальчун В.Т., Гусева А.Л., Чистов С.Д. Вестибулярная реабилитация: обоснование, показания, применение. Consilium Medicum. 2015;17(9):113–120. [Pal’chun V.T., Guseva A.L., Chistov S.D. Vestibular rehabilitation: substantiation, indications, application. Consilium Medicum. 2015;17(9):113–120. (In Russian)].Hall C.D., Herdman S.J., Whitney S.L., Cass S.P., Clendaniel R.A., Fife T.D., Furman J.M., Getchius T.S., Goebel J.A., Shepard N.T., Woodhouse S.N. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: From the american physical therapy association neurology section. J. Neurol. Phys. Ther. 2016;40(2):124–55. http://dx.doi.org/10.1097/NPT.0000000000000120.Hall C.D., Herdman S.J., Whitney S.L., Cass S.P., Clendaniel R.A., Fife T.D., Furman J.M., Getchius T.S., Goebel J.A., Shepard N.T., Woodhouse S.N. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: From the american physical therapy association neurology section. J. Neurol. Phys. Ther. 2016;40(2):124–55. http://dx.doi.org/10.1097/NPT.0000000000000120.Strupp M., Zingler V.C., Arbusow V., Niklas D., Maag K.P., Dieterich M., Bense S., Theil D., Jahn K., Brandt T. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N. Engl. J. Med. 2004;351(4):354–361. https://doi.org/10.1056/NEJMoa033280.Strupp M., Zingler V.C., Arbusow V., Niklas D., Maag K.P., Dieterich M., Bense S., Theil D., Jahn K., Brandt T. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N. Engl. J. Med. 2004;351(4):354–361. https://doi.org/10.1056/NEJMoa033280.Fishman J.M., Burgess C., Waddell A. Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis). Cochrane Database Syst. Rev. 2011;(5):CD008607. http://dx.doi.org/10.1002/14651858.CD008607.pub2.Fishman J.M., Burgess C., Waddell A. Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis). Cochrane Database Syst. Rev. 2011;(5):CD008607. http://dx.doi.org/10.1002/14651858.CD008607.pub2.Sjögren J., Magnusson M., Tjernström F., Karlberg M. Steroids for Acute Vestibular Neuronitis-the Earlier the Treatment, the Better the Outcome? Otol. Neurotol. 2019;40(3):372–374. https://doi.org/10.1097/MAO.0000000000002106.Sjögren J., Magnusson M., Tjernström F., Karlberg M. Steroids for Acute Vestibular Neuronitis-the Earlier the Treatment, the Better the Outcome? Otol. Neurotol. 2019;40(3):372–374. https://doi.org/10.1097/MAO.0000000000002106.Ismail E.I., Morgan A.E., Abdel Rahman A.M. Corticosteroids versus vestibular rehabilitation in long-term outcomes in vestibular neuritis. J. Vestib. Res. 2018;28(5–6):417–424. https://doi.org/10.3233/VES-180645.Ismail E.I., Morgan A.E., Abdel Rahman A.M. Corticosteroids versus vestibular rehabilitation in long-term outcomes in vestibular neuritis. J. Vestib. Res. 2018;28(5–6):417–424. https://doi.org/10.3233/VES-180645.Hamann K-F. Ginkgo-Spezialextrakt bei Schwindel. HNO. 2007;55(4):258–263. https://doi.org/10.1007/s00106-006-1440-5.Hamann K-F. Ginkgo-Spezialextrakt bei Schwindel. HNO. 2007;55(4):258–263. https://doi.org/10.1007/s00106-006-1440-5.Lindner M., Gosewisch A., Eilles E., Branner C., Krämer A., Oos R., Wolf E., Ziegler S., Bartenstein P., Brandt T., Dieterich M., Zwergal A. Ginkgo biloba Extract EGb 761 Improves Vestibular Compensation and Modulates Cerebral Vestibular Networks in the Rat. Front. Neurol. 2019 Feb. 25;10:147. https://doi.org/10.3389/fneur.2019.00147.Lindner M., Gosewisch A., Eilles E., Branner C., Krämer A., Oos R., Wolf E., Ziegler S., Bartenstein P., Brandt T., Dieterich M., Zwergal A. Ginkgo biloba Extract EGb 761 Improves Vestibular Compensation and Modulates Cerebral Vestibular Networks in the Rat. Front. Neurol. 2019 Feb. 25;10:147. https://doi.org/10.3389/fneur.2019.00147.Lacour M., Ez-Zaher L., Raymond J. Plasticity mechanisms in vestibular compensation in the cat are improved by an extract of ginkgo biloba (EGb 761). Pharmacol. Biochem. Behav. 1991;40(2):367–379. https://doi.org/10.1016/0091-3057(91)90568-M.Lacour M., Ez-Zaher L., Raymond J. Plasticity mechanisms in vestibular compensation in the cat are improved by an extract of ginkgo biloba (EGb 761). Pharmacol. Biochem. Behav. 1991;40(2):367–379. https://doi.org/10.1016/0091-3057(91)90568-M.Maclennan K., Smith P.F., Darlington C.L. The effects of ginkgolide B (BN52021) on guinea pig vestibular nucleus neurons in vitro: importance of controlling for effects of dimethylsulphoxide (DMSO) vehicles. Neurosci. Res. 1996;26(4):395-399. https://doi.org/10.1016/S0168-0102(96)01118-2.Maclennan K., Smith P.F., Darlington C.L. The effects of ginkgolide B (BN52021) on guinea pig vestibular nucleus neurons in vitro: importance of controlling for effects of dimethylsulphoxide (DMSO) vehicles. Neurosci. Res. 1996;26(4):395-399. https://doi.org/10.1016/S0168-0102(96)01118-2.Lopez-Escamez J.A., Carey J., Chung W.H., Goebel J.A., Magnusson M., Mandalà M., Newman-Toker D.E., Strupp M., Suzuki M., Trabalzini F., Bisdorff A. Classification Committee of the Barany Society; Japan Society for Equilibrium Research; European Academy of Otology and Neurotology (EAONO); Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS); Korean Balance Society. Diagnostic criteria for Menière’s disease. J. Vestib. Res. 2015;25(1):1–7. https://doi.org/10.3233/VES-150549.Lopez-Escamez J.A., Carey J., Chung W.H., Goebel J.A., Magnusson M., Mandalà M., Newman-Toker D.E., Strupp M., Suzuki M., Trabalzini F., Bisdorff A. Classification Committee of the Barany Society; Japan Society for Equilibrium Research; European Academy of Otology and Neurotology (EAONO); Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS); Korean Balance Society. Diagnostic criteria for Menière’s disease. J. Vestib. Res. 2015;25(1):1–7. https://doi.org/10.3233/VES-150549.Пальчун В.Т., Гусева А.Л., Левина Ю.В. Болезнь Меньера: эпидемиология, патогенез, диагностика, лечение. Consilium Medicum. 2016;18(3):107–116. [Palchun V.T., Guseva A.L., Levina Y.V. Ménière’s disease: epidemiology, etiology, diagnostics, management. Consilium Medicum. 2016;18(3):107–116. (In Russian)].Пальчун В.Т., Гусева А.Л., Левина Ю.В. Болезнь Меньера: эпидемиология, патогенез, диагностика, лечение. Consilium Medicum. 2016;18(3):107–116. [Palchun V.T., Guseva A.L., Levina Y.V. Ménière’s disease: epidemiology, etiology, diagnostics, management. Consilium Medicum. 2016;18(3):107–116. (In Russian)].Radunz C.L., Okuyama C.E., Branco-Barreiro F.C.A., Pereira R.M.S., Diniz S.N. Clinical randomized trial study of hearing aids effectiveness in association with Ginkgo biloba extract (EGb 761) on tinnitus improvement. Braz. J. Otorhinolaryngol. 2019;June. doi:10.1016/j.bjorl.2019.05.003.Radunz C.L., Okuyama C.E., Branco-Barreiro F.C.A., Pereira R.M.S., Diniz S.N. Clinical randomized trial study of hearing aids effectiveness in association with Ginkgo biloba extract (EGb 761) on tinnitus improvement. Braz. J. Otorhinolaryngol. 2019;June. doi:10.1016/j.bjorl.2019.05.003.Newman-Toker D.E., Curthoys I.S., Halmagyi G.M. Diagnosing Stroke in Acute Vertigo: The HINTS Family of Eye Movement Tests and the Future of the “eye ECG.” Semin. Neurol. 2015;35(5):506–521. https://doi.org/10.1055/s-0035-1564298.Newman-Toker D.E., Curthoys I.S., Halmagyi G.M. Diagnosing Stroke in Acute Vertigo: The HINTS Family of Eye Movement Tests and the Future of the “eye ECG.” Semin. Neurol. 2015;35(5):506–521. https://doi.org/10.1055/s-0035-1564298.Spiegel R., Kirsch M., Rosin C., Rust H., Baumann T., Sutter R., Friedrich H., Göldlin M., Müri R., Kalla R, Bingisser R., Mantokoudis G. Dizziness in the emergency department: an update on diagnosis. Swiss Med. Wkly. 2017;147:w14565. https://doi.org/10.4414/smw.2017.14565.Spiegel R., Kirsch M., Rosin C., Rust H., Baumann T., Sutter R., Friedrich H., Göldlin M., Müri R., Kalla R, Bingisser R., Mantokoudis G. Dizziness in the emergency department: an update on diagnosis. Swiss Med. Wkly. 2017;147:w14565. https://doi.org/10.4414/smw.2017.14565.Powers W.J., Rabinstein A.A., Ackerson T., Adeoye O.M., Bambakidis N.C., Becker K., Biller J., Brown M., Demaerschalk B.M., Hoh B., Jauch E.C., Kidwell C.S., Leslie-Mazwi T.M., Ovbiagele B., Scott P.A., Sheth K.N., Southerland A.M., Summers D.V., Tirschwell D.L. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke. 2019;50(12):e344–e418. https://doi.org/10.1161/STR.0000000000000211.Powers W.J., Rabinstein A.A., Ackerson T., Adeoye O.M., Bambakidis N.C., Becker K., Biller J., Brown M., Demaerschalk B.M., Hoh B., Jauch E.C., Kidwell C.S., Leslie-Mazwi T.M., Ovbiagele B., Scott P.A., Sheth K.N., Southerland A.M., Summers D.V., Tirschwell D.L. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke. 2019;50(12):e344–e418. https://doi.org/10.1161/STR.0000000000000211.Whitney S.L., Alghwiri A.A., Alghadir A. An Overview of Vestibular Rehabilitation. Vol. 137. 1st ed. Elsevier BV. 2016. https://doi.org/10.1016/B978-0-444-63437-5.00013-3.Whitney S.L., Alghwiri A.A., Alghadir A. An Overview of Vestibular Rehabilitation. Vol. 137. 1st ed. Elsevier BV. 2016. https://doi.org/10.1016/B978-0-444-63437-5.00013-3.Парфенов В.А., Вербицкая С.В. Вторичная профилактика ишемического инсульта: международные рекомендации и клиническая практика. Неврологический журнал. 2014;2:4– 10. [Parfenov V.А., Verbitskaya S.V. Secondary prevention of ischemic stroke: international recommendations and clinical practice. Neurological Journal. 2014;2:4–10. (In Russian)].Парфенов В.А., Вербицкая С.В. Вторичная профилактика ишемического инсульта: международные рекомендации и клиническая практика. Неврологический журнал. 2014;2:4– 10. [Parfenov V.А., Verbitskaya S.V. Secondary prevention of ischemic stroke: international recommendations and clinical practice. Neurological Journal. 2014;2:4–10. (In Russian)].Иванова Т.А., Гусева А.Л., Филатова Е.Г. Головокружения при мигрени. РМЖ. 2017;9:602–606. [Ivanova TA, Guseva AL, Filatova EG. Migraine vertigo. RMJ. 2017;9:602–606. (In Russian)].Иванова Т.А., Гусева А.Л., Филатова Е.Г. Головокружения при мигрени. РМЖ. 2017;9:602–606. [Ivanova TA, Guseva AL, Filatova EG. Migraine vertigo. RMJ. 2017;9:602–606. (In Russian)].Lempert T., Olesen J., Furman J., Waterston J., Seemungal B., Carey J., Bisdorff A., Versino M., Evers S., Newman-Toker D. Vestibular migraine: diagnostic criteria. J. Vestib. Res. 2012;22(4):167–72. https://doi.org/10.3233/VES-2012-0453.Lempert T., Olesen J., Furman J., Waterston J., Seemungal B., Carey J., Bisdorff A., Versino M., Evers S., Newman-Toker D. Vestibular migraine: diagnostic criteria. J. Vestib. Res. 2012;22(4):167–72. https://doi.org/10.3233/VES-2012-0453.Furman J.M., Marcus D.A., Balaban C.D. Rizatriptan reduces vestibular-induced motion sickness in migraineurs. J. Headache Pain. 2011;12(1):81–88. https://doi.org/10.1007/s10194-010-0250-z.Furman J.M., Marcus D.A., Balaban C.D. Rizatriptan reduces vestibular-induced motion sickness in migraineurs. J. Headache Pain. 2011;12(1):81–88. https://doi.org/10.1007/s10194-010-0250-z.Neuhauser H., Radtke A., von Brevern M., Lempert T. Zolmitriptan for treatment of migrainous vertigo: A pilot randomized placebocontrolled trial. Neurology. 2003;60(5):882–883. https://doi.org/10.1212/01.WNL.0000049476.40047.A3.Neuhauser H., Radtke A., von Brevern M., Lempert T. Zolmitriptan for treatment of migrainous vertigo: A pilot randomized placebocontrolled trial. Neurology. 2003;60(5):882–883. https://doi.org/10.1212/01.WNL.0000049476.40047.A3.Tabet P., Saliba I. Meniere’s Disease and Vestibular Migraine: Updates and Review of the Literature. J. Clin. Med. Res. 2017;9(9):733–744. https://doi.org/10.14740/jocmr3126w.Tabet P., Saliba I. Meniere’s Disease and Vestibular Migraine: Updates and Review of the Literature. J. Clin. Med. Res. 2017;9(9):733–744. https://doi.org/10.14740/jocmr3126w.Dieterich M., Obermann M., Celebisoy N. Vestibular migraine: the most frequent entity of episodic vertigo. J. Neurol. 2016;263(1):82–89. https://doi.org/10.1007/s00415-015-7905-2.Dieterich M., Obermann M., Celebisoy N. Vestibular migraine: the most frequent entity of episodic vertigo. J. Neurol. 2016;263(1):82–89. https://doi.org/10.1007/s00415-015-7905-2.Strupp M., Kim J.S., Murofushi T., Straumann D., Jen J.C., Rosengren S.M., Della Santina C.C., Kingma H. Bilateral vestibulopathy: Diagnostic criteria Consensus document of the Classification Committee of the Bárány Society. J. Vestib. Res. 2017;27(4):177–189. https://doi.org/10.3233/VES-170619.Strupp M., Kim J.S., Murofushi T., Straumann D., Jen J.C., Rosengren S.M., Della Santina C.C., Kingma H. Bilateral vestibulopathy: Diagnostic criteria Consensus document of the Classification Committee of the Bárány Society. J. Vestib. Res. 2017;27(4):177–189. https://doi.org/10.3233/VES-170619.Kattah J.C. Clinical Characteristics and Etiology of Bilateral Vestibular Loss in a Cohort from Central Illinois. Front Neurol. 2018;9. https://doi.org/10.3389/fneur.2018.00046.Kattah J.C. Clinical Characteristics and Etiology of Bilateral Vestibular Loss in a Cohort from Central Illinois. Front Neurol. 2018;9. https://doi.org/10.3389/fneur.2018.00046.Girasoli L., Cazzador D., Padoan R., Nardello E., Felicetti M., Zanoletti E., Schiavon F., Bovo R. Update on Vertigo in Autoimmune Disorders, from Diagnosis to Treatment.J. Immunol. Res. 2018;2018:5072582. https://doi.org/10.1155/2018/5072582.Girasoli L., Cazzador D., Padoan R., Nardello E., Felicetti M., Zanoletti E., Schiavon F., Bovo R. Update on Vertigo in Autoimmune Disorders, from Diagnosis to Treatment.J. Immunol. Res. 2018;2018:5072582. https://doi.org/10.1155/2018/5072582.Kingma H., Felipe L., Gerards M.C., Gerits P., Guinand N., Perez-Fornos A., Demkin V., van de Berg R. Vibrotactile feedback improves balance and mobility in patients with severe bilateral vestibular loss. J. Neurol. 2019;266(1):19–26. https://doi.org/10.1007/s00415-018-9133-z.Kingma H., Felipe L., Gerards M.C., Gerits P., Guinand N., Perez-Fornos A., Demkin V., van de Berg R. Vibrotactile feedback improves balance and mobility in patients with severe bilateral vestibular loss. J. Neurol. 2019;266(1):19–26. https://doi.org/10.1007/s00415-018-9133-z.Clendaniel R.A., Fife T.D., Furman J.M., Getchius T.S., Goebel J.A., Shepard N.T., Woodhouse S.N. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: From the American physical therapy association neurology section. J. Neurol. Phys. Ther. 2016;40(2):124–55. https://doi.org/10.1097/NPT.0000000000000120.Clendaniel R.A., Fife T.D., Furman J.M., Getchius T.S., Goebel J.A., Shepard N.T., Woodhouse S.N. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: From the American physical therapy association neurology section. J. Neurol. Phys. Ther. 2016;40(2):124–55. https://doi.org/10.1097/NPT.0000000000000120.Boutros P.J., Schoo D.P., Rahman M., Valentin N.S., Chow M.R., Ayiotis A.I., Morris B.J., Hofner A., Rascon A.M., Marx A, Deas R., Fridman G.Y., Davidovics N.S., Ward B.K., Treviño C., Bowditch S.P., Roberts D.C., Lane K.E., Gimmon Y., Schubert M.C., Carey J.P., Jaeger A., Della Santina C.C. Continuous vestibular implant stimulation partially restores eyestabilizing reflexes. JCI Insight. 2019;4(22):e128397. https://doi.org/10.1172/jci.insight.128397.Boutros P.J., Schoo D.P., Rahman M., Valentin N.S., Chow M.R., Ayiotis A.I., Morris B.J., Hofner A., Rascon A.M., Marx A, Deas R., Fridman G.Y., Davidovics N.S., Ward B.K., Treviño C., Bowditch S.P., Roberts D.C., Lane K.E., Gimmon Y., Schubert M.C., Carey J.P., Jaeger A., Della Santina C.C. Continuous vestibular implant stimulation partially restores eyestabilizing reflexes. JCI Insight. 2019;4(22):e128397. https://doi.org/10.1172/jci.insight.128397.Hüfner K., Barresi D., Glaser M., Linn J., Adrion C., Mansmann U., Brandt T., Strupp M. Vestibular paroxysmia: diagnostic features and medical treatment. Neurology. 2008;71(13):1006–1014. https://doi.org/10.1212/01.wnl.0000326594.91291.f8.Hüfner K., Barresi D., Glaser M., Linn J., Adrion C., Mansmann U., Brandt T., Strupp M. Vestibular paroxysmia: diagnostic features and medical treatment. Neurology. 2008;71(13):1006–1014. https://doi.org/10.1212/01.wnl.0000326594.91291.f8.Замерград М.В., Балязина Е.В. Вестибулярная пароксизмия. Неврологический журнал. 2016;21(2):68–73. [Zamergrad M.V., Balyazina E.V. Vestibular paroxysmia. Neurological Journal. 2016;21(2):68–73. (In Russian)]. https://doi.org/10.18821/1560-9545-2016-21-2-68-73.Замерград М.В., Балязина Е.В. Вестибулярная пароксизмия. Неврологический журнал. 2016;21(2):68–73. [Zamergrad M.V., Balyazina E.V. Vestibular paroxysmia. Neurological Journal. 2016;21(2):68–73. (In Russian)]. https://doi.org/10.18821/1560-9545-2016-21-2-68-73.Strupp M., Lopez-Escamez J.A., Kim J.S., Straumann D., Jen J.C., Carey J., Bisdorff A., Brandt T. Vestibular paroxysmia: Diagnostic criteria. J. Vestib. Res. 2016;26(5–6):409–415. https://doi.org/10.3233/VES-160589.Strupp M., Lopez-Escamez J.A., Kim J.S., Straumann D., Jen J.C., Carey J., Bisdorff A., Brandt T. Vestibular paroxysmia: Diagnostic criteria. J. Vestib. Res. 2016;26(5–6):409–415. https://doi.org/10.3233/VES-160589.Rommer P.S., Wiest G., Kronnerwetter C., Zach H., Loader B., Elwischger K., Trattnig S. 7-Tesla MRI demonstrates absence of structural lesions in patients with vestibular paroxysmia. Front Neuroanat. 2015;9:81. https://doi.org/10.3389/fnana.2015.00081.Rommer P.S., Wiest G., Kronnerwetter C., Zach H., Loader B., Elwischger K., Trattnig S. 7-Tesla MRI demonstrates absence of structural lesions in patients with vestibular paroxysmia. Front Neuroanat. 2015;9:81. https://doi.org/10.3389/fnana.2015.00081.Brandt T., Strupp M., Dieterich M. Vestibular paroxysmia: a treatable neurovascular cross-compression syndrome. J. Neurol. 2016;263(S1):90–96. https://doi.org/10.1007/s00415-015-7973-3.Brandt T., Strupp M., Dieterich M. Vestibular paroxysmia: a treatable neurovascular cross-compression syndrome. J. Neurol. 2016;263(S1):90–96. https://doi.org/10.1007/s00415-015-7973-3.Кунельская Н.Л., Гусева А.Л., Байбакова Е.В., Левина Ю.В., Макоева А.А. Головокружение в пожилом возрасте: особенности течения и возможности реабилитации. Consilium Medicum. 2017;19(2.1):94–97. [Kunelskaia N.L., Guseva A.L., Baibakova E.V., Levina Yu.V., Makoeva A.A. Vertigo in the elderly age: the features of the course and the possibility of rehabilitation. Consilium Medicum. 2017;19(2.1):94–97. (In Russian)].Кунельская Н.Л., Гусева А.Л., Байбакова Е.В., Левина Ю.В., Макоева А.А. Головокружение в пожилом возрасте: особенности течения и возможности реабилитации. Consilium Medicum. 2017;19(2.1):94–97. [Kunelskaia N.L., Guseva A.L., Baibakova E.V., Levina Yu.V., Makoeva A.A. Vertigo in the elderly age: the features of the course and the possibility of rehabilitation. Consilium Medicum. 2017;19(2.1):94–97. (In Russian)].Замерград М.В. Возрастные аспекты головокружений. Неврологический журнал. 2014;3:21–28. [Zamergrad MV. Age aspects of dizziness. Neurological Journal. 2014;3:21–28. (In Russian)].Замерград М.В. Возрастные аспекты головокружений. Неврологический журнал. 2014;3:21–28. [Zamergrad MV. Age aspects of dizziness. Neurological Journal. 2014;3:21–28. (In Russian)].Ihl R., Bachinskaya N., Korczyn A.D., Vakhapova V., Tribanek M., Hoerr R., Napryeyenko O. GOTADAY Study Group. Efficacy and safety of a once-daily formulation of Ginkgo biloba extract EGb 761 in dementia with neuropsychiatric features: a randomized controlled trial. Int. J. Geriatr Psychiatry. 2011;26(11):1186–1194. https://doi.org/10.1002/gps.2662.Ihl R., Bachinskaya N., Korczyn A.D., Vakhapova V., Tribanek M., Hoerr R., Napryeyenko O. GOTADAY Study Group. Efficacy and safety of a once-daily formulation of Ginkgo biloba extract EGb 761 in dementia with neuropsychiatric features: a randomized controlled trial. Int. J. Geriatr Psychiatry. 2011;26(11):1186–1194. https://doi.org/10.1002/gps.2662.Spiegel R., Kalla R., Mantokoudis G., Maire R., Mueller H., Hoerr R., Ihl R. Ginkgo biloba extract EGb 761® alleviates neurosensory symptoms in patients with dementia: a metaanalysis of treatment effects on tinnitus and dizziness in randomized, placebo-controlled trials. Clin. Interv. Aging. 2018;13:1121–1127. https://doi.org/10.2147/CIA.S157877.Spiegel R., Kalla R., Mantokoudis G., Maire R., Mueller H., Hoerr R., Ihl R. Ginkgo biloba extract EGb 761® alleviates neurosensory symptoms in patients with dementia: a metaanalysis of treatment effects on tinnitus and dizziness in randomized, placebo-controlled trials. Clin. Interv. Aging. 2018;13:1121–1127. https://doi.org/10.2147/CIA.S157877.Massieu L., Morán J., Christen Y. Effect of Ginkgo biloba (EGb 761) on staurosporine-induced neuronal death and caspase activity in cortical cultured neurons. Brain Res. 2004;1002(1–2):76–85. https://doi.org/10.1016/j.brainres.2003.12.018.Massieu L., Morán J., Christen Y. Effect of Ginkgo biloba (EGb 761) on staurosporine-induced neuronal death and caspase activity in cortical cultured neurons. Brain Res. 2004;1002(1–2):76–85. https://doi.org/10.1016/j.brainres.2003.12.018.Yang T.H., Young Y.H., Liu S.H. EGb 761 (Ginkgo biloba) protects cochlear hair cells against ototoxicity induced by gentamicin via reducing reactive oxygen species and nitric oxide-related apoptosis. J. Nutr. Biochem. 2011;22(9):886–894. https://doi.org/10.1016/j.jnutbio.2010.08.009.Yang T.H., Young Y.H., Liu S.H. EGb 761 (Ginkgo biloba) protects cochlear hair cells against ototoxicity induced by gentamicin via reducing reactive oxygen species and nitric oxide-related apoptosis. J. Nutr. Biochem. 2011;22(9):886–894. https://doi.org/10.1016/j.jnutbio.2010.08.009.Дюкова Г.М., Замерград М.В., Голубев В.Л., Адилова С.М., Макаров С.А. Функциональное (психогенное) головокружение. Журнал неврологии и психиатрии им. С.С. Корсакова. 2017;117(6):91–98. [Diukova G.M., Zamergrad M.V., Golubev V.L., Adilova S.M., Makarov S.A. Functional (psychogenic) vertigo. Zhurnal Nevrol i psikhiatrii imeni S.S. Korsakova. 2017;117(6):91–98. (In Russian)]. https://doi.org/10.17116/jnevro20171176191-98.Дюкова Г.М., Замерград М.В., Голубев В.Л., Адилова С.М., Макаров С.А. Функциональное (психогенное) головокружение. Журнал неврологии и психиатрии им. С.С. Корсакова. 2017;117(6):91–98. [Diukova G.M., Zamergrad M.V., Golubev V.L., Adilova S.M., Makarov S.A. Functional (psychogenic) vertigo. Zhurnal Nevrol i psikhiatrii imeni S.S. Korsakova. 2017;117(6):91–98. (In Russian)]. https://doi.org/10.17116/jnevro20171176191-98.Dieterich M., Staab J.P. Functional dizziness: from phobic postural vertigo and chronic subjective dizziness to persistent posturalperceptual dizziness. Curr. Opin. Neurol. 2017;30(1):107–113. https://doi.org/10.1097/WCO.0000000000000417.Dieterich M., Staab J.P. Functional dizziness: from phobic postural vertigo and chronic subjective dizziness to persistent posturalperceptual dizziness. Curr. Opin. Neurol. 2017;30(1):107–113. https://doi.org/10.1097/WCO.0000000000000417.Staab J.P., Eckhardt-Henn A., Horii A., Jacob R., Strupp M., Brandt T., Bronstein A. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. J. Vestib. Res. 2017;27(4):191–208. https://doi.org/10.3233/VES-170622.Staab J.P., Eckhardt-Henn A., Horii A., Jacob R., Strupp M., Brandt T., Bronstein A. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. J. Vestib. Res. 2017;27(4):191–208. https://doi.org/10.3233/VES-170622.Müller W.E., Heiser J., Leuner K. Effects of the standardized Ginkgo biloba extract EGb 761 ® on neuroplasticity. Int. Psychogeriatrics. 2012;24(S1):S21–S24. doi:10.1017/S1041610212000592.Müller W.E., Heiser J., Leuner K. Effects of the standardized Ginkgo biloba extract EGb 761 ® on neuroplasticity. Int. Psychogeriatrics. 2012;24(S1):S21–S24. doi:10.1017/S1041610212000592.Maclennan K. The CNS effects of Ginkgo biloba extracts and ginkgolide B. Prog. Neurobiol. 2002;67(3):235–257. https://doi.org/10.1016/S0301-0082(02)00015-1.Maclennan K. The CNS effects of Ginkgo biloba extracts and ginkgolide B. Prog. Neurobiol. 2002;67(3):235–257. https://doi.org/10.1016/S0301-0082(02)00015-1.Islam M.T., da Silva C.B., de Alencar MVOB, Paz MFCJ, Almeida F.R. de C., Melo-Cavalcante A.A. de C. Diterpenes: Advances in Neurobiological Drug Research. Phyther Res. 2016;30(6):915–928. https://doi.org/10.1002/ptr.5609.Islam M.T., da Silva C.B., de Alencar MVOB, Paz MFCJ, Almeida F.R. de C., Melo-Cavalcante A.A. de C. Diterpenes: Advances in Neurobiological Drug Research. Phyther Res. 2016;30(6):915–928. https://doi.org/10.1002/ptr.5609.Duverger D., Defeudis F.V., Drieu K. Effects of repeated treatments with an extract of Ginkgo biloba (EGb 761) on cerebral glucose utilization in the rat: an autoradiographic study. Gen. Pharmacol. Vasc. Syst. 1995;26(6):1375–1383. https://doi.org/10.1016/0306-3623(94)00309-B.Duverger D., Defeudis F.V., Drieu K. Effects of repeated treatments with an extract of Ginkgo biloba (EGb 761) on cerebral glucose utilization in the rat: an autoradiographic study. Gen. Pharmacol. Vasc. Syst. 1995;26(6):1375–1383. https://doi.org/10.1016/0306-3623(94)00309-B.Eckert A. Stabilization of Mitochondrial Membrane Potential and Improvement of Neuronal Energy Metabolism by Ginkgo Biloba Extract EGb 761. Ann NY Acad. Sci. 2005;1056(1):474– 485. https://doi.org/10.1196/annals.1352.023.Eckert A. Stabilization of Mitochondrial Membrane Potential and Improvement of Neuronal Energy Metabolism by Ginkgo Biloba Extract EGb 761. Ann NY Acad. Sci. 2005;1056(1):474– 485. https://doi.org/10.1196/annals.1352.023.Крюков А.И., Кунельская Н.Л., Янюшкина Е.С., Байбакова Е.В., Чугунова М.А., Тардов М.В., Заоева З.О., Изотова Г.Н. Влияние препарата Мемоплант в режиме монотерапии на головокружение. Вестник оториноларингологии. 2017;82(4):56–59. [Kryukov A.I., Kunel’skaya N.L., Yanyushkina E.S., Baybakova E.V., Chugunova M.A., Tardov M.V., Zaoeva Z.O., Izotova G.N. The influence of Memoplant monotherapy on the dizziness. Vestnik otorinolaringologii. 2017;82(4):56–59. (In Russian)]. https://doi.org/10.17116/otorino201782456-59.Крюков А.И., Кунельская Н.Л., Янюшкина Е.С., Байбакова Е.В., Чугунова М.А., Тардов М.В., Заоева З.О., Изотова Г.Н. Влияние препарата Мемоплант в режиме монотерапии на головокружение. Вестник оториноларингологии. 2017;82(4):56–59. [Kryukov A.I., Kunel’skaya N.L., Yanyushkina E.S., Baybakova E.V., Chugunova M.A., Tardov M.V., Zaoeva Z.O., Izotova G.N. The influence of Memoplant monotherapy on the dizziness. Vestnik otorinolaringologii. 2017;82(4):56–59. (In Russian)]. https://doi.org/10.17116/otorino201782456-59.Пизова Н.В. Безопасность терапии EGb 761® у коморбидных пациентов. Медицинский совет. 2019;1:19–23. [Pisova N.V. Safety of EGb 761® therapy in comorbid patients. Meditsinsky Sovet. 2019;1:19–23. (In Russian)]. https://doi.org/10.21518/2079-701X-2019-1-19-23.Пизова Н.В. Безопасность терапии EGb 761® у коморбидных пациентов. Медицинский совет. 2019;1:19–23. [Pisova N.V. Safety of EGb 761® therapy in comorbid patients. Meditsinsky Sovet. 2019;1:19–23. (In Russian)]. https://doi.org/10.21518/2079-701X-2019-1-19-23.

The authors declare that there are no conflicts of interest present.