Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2022; 10(20): 6811-6824
Published online Jul 16, 2022. doi: 10.12998/wjcc.v10.i20.6811
Effects of Kampo medicine hangebyakujutsutemmato on persistent postural-perceptual dizziness: A retrospective pilot study
Toru Miwa, Shin-ichi Kanemaru
Toru Miwa, Department of Otolaryngology-Head and Neck Surgery, Osaka Metropolitan University, Osaka 5458585, Japan
Toru Miwa, Shin-ichi Kanemaru, Department of Otolaryngology-Head and Neck Surgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka 5308480, Japan
Toru Miwa, Shin-ichi Kanemaru, Department of Otolaryngology-Head and Neck Surgery, Kyoto University, Kyoto 7507501, Japan
Author contributions: Miwa T contributed to the investigation, project administration, methodology, software, resources, visualization, writing–original draft, data curation, formal analysis, supervision, conceptualization, validation, writing–review and editing; Kanemaru SI contributed to the methodology, supervision, conceptualization; All authors approved the final version of the manuscript.
Institutional review board statement: The study was conducted in accordance with the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of Kitano Hospital (protocol code 2104002 for the approval).
Informed consent statement: Written informed consent was obtained from all participants prior to study inclusion.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: The data are available upon reasonable request from the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Toru Miwa, MD, PhD, Neurosurgeon, Research Scientist, Department of Otolaryngology-Head and Neck Surgery, Osaka Metropolitan University, 1-4-3 Asahi-cho, Abeno-ku, Osaka 5458585, Japan. miw.com1101@gmail.com
Received: January 13, 2022
Peer-review started: January 13, 2022
First decision: March 16, 2022
Revised: March 17, 2022
Accepted: April 22, 2022
Article in press: April 22, 2022
Published online: July 16, 2022
Processing time: 172 Days and 20.3 Hours
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.

Keywords: Hangebyakujutsutemmato; Kampo medicine; Persistent postural-perceptual dizziness; Niigata persistent postural-perceptual dizziness questionnaire score; Sensory reweighting; Treatment responder

Core Tip: Persistent postural-perceptual dizziness (PPPD) is characterized by a shift in processing spatial orientation information to favor visual or somatosensory information over vestibular inputs, as well as failure of higher cortical mechanisms. Our retrospective study showed that Kampo medicine Hangebyakujutsutemmato (HBT) was effective as an adjunctive therapy for PPPD. Additionally, HBT responders had baseline autonomic dysfunction, unstable balance, semicircular canal paresis, anxiety, and poor sleep quality. According to our results, and previous reports, several herbal ingredients in HBT might improve autonomic function and the cyclic AMP response element binding protein/the brain-derived neurotrophic factor pathway, resulting in sensory reweighting to establish a balance between the systems involved in PPPD.