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How to cite this article Benecke H, Perez-garrigues H, Sidek Db, Uloziene I, D K, Sondag E, Theeuwes A, et al. Betahistine is widely used in the management of vertigo but clinical research into this indication1-3 has not been accompanied by extensive investigation of its impact on health-related quality of life (HRQoL). Preliminary baseline data from this study have been the subject of a separate publication4. This was an international, multicentre, open-label, post-marketing surveillance (PMS) study of betahistine in patients with vertigo of peripheral vestibular origin, undertaken in the context of routine primary care.
Three well-established instruments - the DHI, HADS and SF-36v2 - were used to evaluate efficacy. For the DHI and HADS, if at least 50% of items were completed in any given subscale, any missing values were assumed to be equal to the mean of the relevant subscale. Missing data on the SF-36v2 Health Surveys was dealt with by substituting a person-specific estimate derived from the mean response to the answered items in the same scale when a respondent had answered at least one-half of the items on that scale; if fewer than half the items were completed the score was considered as missing.
Each of the efficacy parameters (DHI total score, HADS total score, SF-36v2 scores and scores on the different subscales) were summarized by descriptive statistics by visit, including last visit on-treatment. Subgroup analyses were performed to explore potential relations between a specific subgroup (gender, disease type, betahistine dosage, country, betahistine treatment at baseline) and the major efficacy variables.
Safety assessment was based on the safety population, which included all patients allocated to treatment who received a prescription of betahistine at baseline and who had at least one subsequent clinic visit.
Reports of adverse drug reactions (ADRs) that started during the study were obtained during the follow-up and final visits, and coded according to the Medical Dictionary of Regulatory Activities (MedDRA) classification version 9.0. The statistical analyses of the efficacy data were descriptive, and usually limited to mean ± standard deviation (SD). The study investigators were general practitioners and specialists based at 389 centres located in the following 13 countries: Brazil (3 centres), Canada (16 centres), Croatia (12 centres), Hungary (52 centres), India (23 centres), Latvia (42 centres), Lithuania (45 centres), Malaysia (17 centres), Poland (39 centres), Romania (88 centres), Russia (24 centres), Slovenia (11 centres) and Spain (17 centres).
Data management and statistical analysis were the responsibility of FOVEA Group (Rueil Malmaison, France). The study was designed and conducted in accordance with the international principles of Good Clinical Practice and the provisions of the Declaration of Helsinki and later amendments.
Informed consent was obtained from each patient in accordance with local regulatory requirements before they were enrolled in the study. A safety population of 2032 patients was recruited, from which an efficacy population of 1898 persons was derived.
A full listing of correlations between DHI, SF-36v2 and HADS scores with a Pearson coefficient > 0.60 (regardless of sign) is presented in Table 3.
The most frequently reported ADRs were gastrointestinal disorders (33 events in 27 patients, principally abdominal pain upper, nausea or dyspepsia) and nervous system disorders (14 events in 13 patients, principally headaches). Forty-three ADRs in 28 patients were classified as "possibly" and 11 events in 9 patients were classified as "probably" related to use of study medication; the remaining 22 events were regarded as either unlikely (n = 19) or were unknown (n = 3). OSVaLD is the largest study of its kind in patients with vertigo, in terms both of the total number of patients enrolled and their geographic and ethno-cultural diversity. Recent exercises in the use of outcomes such as HRQoL to examine the effects of vertigo15-18 originate from the recognition that diseases of the peripheral vestibular system can have wide-ranging physical and psychological effects on the lives of patients19,20.
The primary efficacy criterion evaluated was the absolute change from baseline in mean total DHI score between the baseline and final (3-month) visits.
This study is the first of its kind to use both the SF- 36v2 and the HADS to evaluate the effect of betahistine on vertigo patients. All the correlations identified were compatible with a priori expectations: so, for example, the more the SF-36v2 PCS signified improvement in clinical condition, the more the DHI total score did also.
Further perspective on the effects of betahistine in this study may be extracted from reference to the fact that the overall result of the study was replicated in the large subset of patients with an initial diagnosis of BPPV (n = 417). OSVaLD was an open-label observational study; this is a format with recognized limitations30, but it was appropriate for an international study in the context of routine care and addressed certain limitations of controlled trials, such as strict limitations on patient eligibility and the use of co-medications. Preparation of this report was assisted by staff of Hughes associates, 3 Collins Street, Oxford OX4 1XS, UK. Brazil (3 centres): Boari L (Sao Paulo), Chaves AG (Sao Paulo), Dorigueto RS (Sao Paulo), Gananca FF (Sao Paulo), Goncalves DU (Belo Horizonte), Hyppolito MA (Ribeirao Preto), Korn GP (Sao Paulo), Munhoz MSL (Sao Paulo), Oliveira JAA (Ribeirao Preto). Croatia (12 centres): Aras I (Zagreb), Bencic I (Rijeka), Bonifacic M (Omisalj), Branica S (Zagreb), Dovzak-Kokic D (Split), Drvis P (Zagreb), Gortan D (Zagreb), Grdinic B (Pula), Grigic J (Osijec), Handzic I (Zagreb), Ivkovic M (Zagreb), Juros V (Sibenik), Kovacic J (Zagreb), Krstic E (Zadar), Lucin Z (Split), Maksimovic Z (Osijek), Maslovara S (Osijek), Rak I (Zagreb), Resler Seks A (Zagreb), Ries M (Zagreb), Trotic R (Zagreb).
Hungary (52 centres): Rosenberg A (Budapest), Gaal A (Szentendre), Badacsonyi M (Balmazujvaros), Balogh G (Budapest), Bandula M (Szigetszentmiklos), Baranya E (Szolnok), Jeges B (Veszprem), Brajnovits T (Budapest), Bucsai A (Szeged), Tubony Cs (Veszprem), Csill R (Budapest), Czegledi I (Szolnok), Olah L (Debrecen), Draveczky E (Pecs), Vaszkun L (Dunaujvaros), Siro E (Balatonfured), Fain A (Tatabanya), Foth A (Budapest), Gerlinger I (Pecs), Gestelyi Gy (Debrecen), Getachen K (Nagykanizsa), Ghayada R (Budapest), Gilincsek L (Kaposvar), Guth I (Hatvan), Hegedus E (Zalaegerszeg), Hegyi I (Mezobereny), Jofeju E (Siofok), Kerepesi L (Cegled), Krisan I (Bekescsaba), Laszlo K (Budapest), Lorincz T (Szekesfehervar), Marisch I (Rackeve), Mihalecz K (Nagykanizsa), Breznyan M (Dunaujvaros), Mori I (Budapest), Nagy L (Budapest), Manhalter N (Budapest), Pal A (Budapest), Papp M (Budapest), Peter J (Zalaegerszeg), Prunk Eger F (Nagykata), Radai F (Kaposvar), Szihalmy I (Eger), Torma E (Bekescsaba), Torok K (Szeged), Trencsenyi Gy (Vac), Varga E (Budapest), Vincze A (Szeged), Vogel R (Budapest), Szakolczay Z (Gyor), Zsilinszky Z (Budapest), Fain A (Tatabanya), Rovo Zs (Budapest), Tamas L (Budapest), Mester B (Papa), Hudak I (Mateszalka), Toth L (Debrecen), Merczel A (Gyor).
India (23 centres): Agarwal VK (Varanasi), Bhatia R (Lucknow), Bhimani B (Rajkot), Biswal RN (Cuttack), Biswas A (Kolkata), Chowdary VS (Hyderabad), Dhond P (Mumbai), Dube TN (Bhopal), Gopakumar G (Calicut), Kansara A (Ahmedabad), Khound G (Guwahati), Kirtane MV (Mumbai), Mukherjee A (Kolkata), Nagpal T (Jabalpur), Ravikumar A (Chennai), Reddy V (Hyderabad), Sampat N (Mumbai), Shaikh S (Pune), Sinha S (Midnapur), Vaid N (Pune), Valsangkar S (Solapur), Vasnoi S (Dehradoon), Vishwanathan A (Coimbatore). Latvia (42 centres): Blumberga I (Riga), Bucina B (Jelgava), Cakule G (Renda), Demidova L (Riga), Dolge A (Riga), Dzirgause M (Riga), Freimane A (Valmiera), Fricbergs J (Riga), Frolova V (Riga), Ganus I (Incukalns), Gavare I (Aizkraukle), Grigs V (Aizkraukle), Grusle M (Rujiena), Levins E (Ogre), Veidule I (Talsi), Indrane M (Carnikava), Saihulova I (Jelgava), Jeca A (Riga), Jegere D (Riga), Ivanova A (Ventspils), Kalitas N (Riga), Kalnina Z (Riga), Kanepe K (Riga), Karlovska M (Riga), Kokina I (Pampali), Krigere R (Riga), Krisjane D (Aizkraukle), Kukurane S (Olaine), Kundrate G (Aloja), Kukaine S (Ligatne), Kukute I (Bauska), Lagzdina L (Kuldiga), Lapsa-Arenta S (Bauska), Madre S (Liepaja), Matusevica A (Riga), Mezale I (Riga), Melnika V (Riga), Mickevica S (Riga), Morlata N (Riga), Naudina MS (Riga), Nimroda L (Riga), Norina D (Limbazi), Opelte V (Saldus), Pavlovska I (Aizpute), Priede Z (Riga), Proskurna T (Riga), Purina J (Riga), Kamsa I (Riga), Raumane D (Riga), Kenina V (Riga), Roska-Levina D (Ogre), Rozenbaha A (Riga), Rozkalne A (Riga), Ruta A (Riga), Sendze G (Ventspils), Silins A (Jelgava), Skrupska D (Olaine), Skurule I (Incukalns), Sokalska A (Riga), Stepko Z (Liepaja), Supe I (Riga), Telezenko I (Riga), Tretjaka N (Riga), Turlaja V (Riga), Uzbeka I (Valka), Valucka T (Riga), Vancans J (Balvi), Vasilevskis U (Skujene), Veinberga V (Riga), Viba Z (Riga), Vitkovska M (Riga), Vitolina A (Riga), Voitovica L (Riga), Zigure I (Alukse), Zilite I (Bauska). Lithuania (45 centres): Bakstiene J (Gargzdai), Balkaitiene R (Utena), Basinskiene V (Kaunas), Beinaraviciene R (Vilnius), Bertasiene Z (Klaipeda), Bieliauskiene I (Marijampole), Budrikiene N (Vilnius), Butkus A (Kaunas), Butkus E (Siauliai), Butkus R (Sakiai), Cholomskiene V (Taurage), Dainius K (Radviliskis), Degteriova R (Vilnius), Deveikyte A (Vilnius), Dirzauskiene J (Klaipeda), Einoriene D (Birzai), Gadeikis E (Siauliai), Gircys P (Klaipeda), Grazeviciute L (Vilnius), Ivaskevicius A (Moletai), Janciute J (Kaunas), Jankauskiene D (Jurbarkas), Jersova J (Vilnius), Jociene I (Vilnius), Jokimaitiene J (Vilnius), Jukneliene R (Alytus), Kanapeckiene V (Radviliskis), Karaliene V (Kaunas), Kazlauskas A (Siauliai), Kicas R (Sakiai), Kiskuniene I (Vilnius), Kiudelis A (Taurage), Kizlaitiene R (Vilnius), Kuriene A (Jurbarkas), Lukaseviciene N (Klaipeda), Lukosaitis A (Siauliai), Malikeniene T (Kilnius), Markeleviciene R (Vilnius), Mazonyte S (Klaipeda), Nadusauskiene M (Kedainiai), Narkeviciene V (Vilnius), Naumcik J (Elektrenai), Navickiene E (Vilnius), Pancyreva I (Vilnius), Pavydyte J (Svencionys), Persidskaja O (Vilnius), Petkiniene V-R (Jubarkas), Petrileviciene R (Kedainiai), Petrosiute B (Kelme), Pliopliene I (Kaunas), Puckiene Z (Siauliai), Razukiene J (Vilnius), Remeikiene S (Grigiskes-Vilnius), Rudzeviciene E (Kaunas), Sceponaviciute S (Siauliai), Scerbickiene L (Rokiskis), Sersniova I (Vilnius), Sinkuniene N (Panevezys), Skerneviciute I (Telsiai), Snureviciute V (Kedainiai), Sostakiene N (Gargzdai), Tunkulas E (Vilnius), Vitkauskiene V (Telsiai), Zakarauskiene R (Kaunas), Zorjan N (Klaipeda), Zurauskiene R (Kaunas). Malaysia (17 centres): Abdullah Sani (Kuala Lumpur), Amran Mohamad (Kuala Terengganu), Asma Abdullah (Kuala Lumpur), Avatar Singh (Kuching), Baharudin Abdullah (Kota Bharu), Dinsuhaimi Sidek (Kota Bharu), Faridah Hassan (Selayang), Ganeshwaran Selvarajah (Klang), Goh Bee See (Kuala Lumpur), Gurdeep Singh Mann (Ipoh), Harvinder Singh (Ipoh), Hj Abdul Razak Hj Ahmad (Melaka), Iskandar Hailani (Kuala Lumpur), Izzuniddin Mohd Yusof (Melaka) , K Gopalan Nair (Seremban), KS Sathananthar (Kuantan), Kuljit Singh (Kuala Lumpur), Lokman Saim (Kuala Lumpur), Melati Hj Abdul Ghani (Johor Bharu), Michael Herg (Seremban), Mohd Amin Jalaludin (Kuala Lumpur), Mohd Khairi Md Daud (Kota Bharu), Mohamad Khir Abdullah (Johor Bharu), Nazim Hj Noor (Kota Bharu), Nezrean Radzana Mohamed (Johor Bahru), Nor Kamaruzaman Esa (Melaka), Noraffendie Mat Jusoh (Kuala Terengganu), Prepageran Narayanan (Kuala Lumpur), Pua Kin Choo (Penang), Raja Ahmad Al'Konee (Kuantan), Raman Rajagopalan (Kuala Lumpur), Rosmaliza Ismail (Kuantan), Siti Sabzah Mohd Hashim (Alor Star), Sivakumar Kumarasamy (Alor Star), Tan Lye Suan (Klang), Tengku Mohamed IzamTengku Kamalden (Johor Bharu), Tiong Tung Sang (Kuching), Valuyeetham Kamara Ambu (Seremban), Wan Islah Leman (Kuantan), Zainal Azmi Zainal Abidin (Selayang), Zulkiflee Salahuddin (Kuantan), Zulkifli Yusof (Alor Setar). Poland (39 centres): Burduk P (Bydgoszcz), Chmura H, Czecior E (Zabrze), Dabrowski P (Poznan), Diechota L (Wejherowo), Dietrich G (Gdansk), Domagata M (Raciborz), Durko M (Lodz), Frak W (Lublin), Franczuk-Gwiazda M (Pruszkow), Galbarczyk D (Ciechanow), Gaweowicz J (Lublin), Kabacinska A (Szczecin), Kadej GZ (Siedlce), Kapuscinski J (Wroclaw), Kolebacz B (Katowice), Korpus-Kaminska I (Lodz), Lachowicz M (Biatystok), Mielnik E (Ketrzyn), Mihutka S (Pruszkow), Nilewski J (Gdansk), Nouinska E (Zabrze), Obzebowska- Karszania Z (Suchylas), Oleksiak M (Katowice), Palasik W (Warsaw), Paradowski B (Wroclaw), Paskal J (Zary), Pospiech L (Wroclaw), Pres K (Wroclaw), Rynio E (Stargaro), Schneider K (Tarnow), Siger M (Lodz), Stoniewska-Piackus M (Gdansk), Szczuto J (Zielona Gora), Wilczynski K, Wojcicki P (Lublin), Woynowski W (Skorzewo), Zatonski T(Wroclaw), Ziolkowska-Kochan M (Bydgoszcz), Zygadlo EN. Russia (24 centres): Alekseeva N (Moscow), Amelin A (St Petersburg), Artemova I (Moscow), Batysheva T (Moscow), Bobyreva S (Moscow), Boyko A (Moscow), Buldakova N (Moscow), Ganzhula P(Moscow), Gaponova O (Moscow), Hanevich T (Moscow), Hozova A (Moscow), Isachenkova O (Moscow), Ismailov A (Moscow), Zhuravleva E (Moscow), Kostenko E (Moscow), Lilenko S (St Petersburg), Lisenker L (Moscow), Makarova G (Moscow), Manevich T (Moscow), Matsnev E (Moscow), Melnikov O (Moscow), Morozova S (Moscow), Nesterova O (Moscow), Nikulina I (Moscow), Otcheskaya O (Moscow), Pivovarova V (Moscow), Rotor L (Moscow), Rylskiy A (Moscow), Shalabanova I (Moscow) , Shinkarev S (Moscow), Sorokoumov V (St Petersburg), Vdovichenko T (Moscow), Vinetskiy Y (Moscow), Vostricova I (Moscow), Zadorozhnaya T (Moscow).
Slovenia (11 centres): Breznik Farkas B (Murska Sobota), Felbabic J (Novo Hesto), Geczy Buljovcic B (Ljubljana), Grad A (Ljubljana), Hoenigman B (Sempeter), Kurent Z (Ljubljana), Krek BP (Kranj), Rok B (Ljubljana), Spindler M (Maribor), Vatovec J (Ljubljana), Zorn A (Izola), Zupan L (Celje). Spain (17 centres): Aguila Artal A (Sabadell), Caballero Borrego M (Barcelona), Garcia Vazquez C (Pontevedra), Cruellas Taishiv F (Hospitalet de Llobregat), Munoz Pinto C (Alicante), Domenech Juan I (Hospitalet de Llobregat), Donderis Sala J (Valencia), Estevez Garcia M (Vigo), Pallas Pallas E (Vigo), Grani Martinez F (Lleida), Gonzalez Compta FX (Hospitalet de Llobregat), Galindo Ortega J (Lleida), Garcia Arumi AM (Barcelona), Garcia Gonzalez B (Lleida), Gonzalez Guijarro I (Vigo), Hernandez Agelet de Saracibar A (Lleida), Hijano Esque R (Barcelona), Lopez Escamez JA (El Ejido), Saiz Arnaiz JM (Sabadell), Izquierdo Luzon J (Alicante), Perez Lopez L (Valencia), Paya Perez LM (Alicante), Mesa Marrero M (Viladecans), Molina Palma MI (El Ejido), Navarrete Alvaro LM (Barcelona), Marti Gomar L (Valencia), Melgarejo Moreno F (Lleida), Orts Alborch M (Valencia), Suarez Granda PI (Valencia), Perez Monteagudo P (Alzira), Perez Garrigues H (Valencia), Perez Guillen V (Valencia), Rodriguez Rondon S (Valencia), Santos Perez S (Santiago de Compostela), Soto Varela A (Santiago de Compostela), Malluguiza Calvo JR (Alicante), Ramirez Llorens R (Alzira), Jimenez Montoya R (Hospitalet de Llobregat), Barona de Guzman R (Valencia), Escamilla Carpintero Y (Sabadell), Saiz Monfort V (Alzira), Gisbert Aguilar FJ (Alzira), Provedo Poza C (Vigo), Pardo Salgado E (Vigo), Aleman Lopez O (Alicante), Martin Sanz E (Valencia), Marco Algarra J (Valencia). If there are no complications due to measles, the symptoms will usually disappear within 7-10 days.

Patients should be kept in a closed and darkened room to ease the sensitivity to light and reduce eye discomfort that is common in children with measles. In severe cases of measles, especially with complications, hospital treatment may be required. Vitamin A supplements may prevent some of the serious complications arising from a measles infection. This site complies with the HONcode standard for trustworthy health information: verify here. Effects of Betahistine on Patient-Reported Outcomes in Routine Practice in Patients with Vestibular Vertigo and Appraisal of Tolerability: Experience in the OSVaLD Study. In order to obtain a wider perspective on this matter, we undertook an observational study to gather patientreported outcome information about dizziness, generic HRQoL and symptoms of anxiety and depression in a diverse population of patients suffering from peripheral vestibular vertigo.
The only exclusion condition was the presence of contraindications to betahistine, as identified in the relevant summary of product characteristics.
These visits were to be incorporated into the treating physician's usual pattern of follow-up consultations. The efficacy population of this study was defined as all patients allocated to treatment who (a) received a prescription of betahistine at baseline and who had at least one subsequent clinic visit (follow-up, final or endpoint visit) and (b) had a score calculated for at least one of the three specified outcomes scales (DHI total, SF-36v2 [both summary scores] or HADS [both anxiety and depression scales]) at the baseline visit and at least one post-baseline visit. If fewer than 50% of items were completed, the subscale and scale scores were not calculated.
Changes from baseline for all efficacy parameters were presented by descriptive statistics, including 95% confidence intervals and one-sample t-test. Pearson correlation analyses were undertaken to explore the associations between the different efficacy variables.
These events were also described according to their severity and their relationship to the study drug as judged by the investigator. Based on previous observations on the use of the DHI to evaluate drug therapy in patients with recurrent vestibular vertigo and published evidence that a difference in the total DHI score of 14 points is indicative of a clinically meaningful effect2,5, and allowing for 25% premature departure from the study, a recruitment target was set of 200 patients per country. Patients were advised that they were free to withdraw from the study at any time, for any reason and without offering any explanation for their decision, and that any such withdrawal could be made without prejudicing normal standards of clinical care. Demographic data for these populations are presented in Table 1 and affirm that the profiles of both populations are congruent with the previously published preliminary baseline data4. In accordance with the norm-based criteria outlined in the Methods section, both these scores were below the U.S.
Forty-nine patients were reported as having experienced at least one ADR (one patient experienced an event at both betahistine dosages).
The majority of ADRs were characterized as mild (47 events in 33 patients) or moderate (28 events in 19 patients). Thirty-one of the gastrointestinal disorders events were considered possibly (24 events) or probably (7 events) related to use of study medication, whereas 8 of the nervous system events were considered possibly (n = 7) or probably (n = 1) related. These ADRs were predominantly gastrointestinal (11 events in 9 patients) or nervous system disorders (6 events in 6 patients).
Secondary analyses of results from individual participating countries may be expected to provide insights about the subjective circumstances of vertigo patients in a wider than usual range of national and cultural situations. Baseline data from OSVaLD provided corroboration of that premise, with consistent indications of diminished functional capacity and high prevalence of anxiety and depression at baseline4.
Substantial improvements were registered in this measure, with a 37-point reduction in the mean total score and double-digit reductions in the three domains (physical, emotional and functional) of the DHI. Comparison of DHI improvements in OSVaLD with published data from other clinical trials of betahistine.
These values are relatively high compared with data from various other types of illness21-23 and may be indicative of the impact of vertigo on HRQoL. Additional analysis of the trial database will be needed to establish whether and how the use of multiple instruments provided information beyond what may be obtained from individual questionnaires. These numerous demonstrations of interrelations between different instruments lend credibility to - but cannot prove - the likelihood of a causal relation between the use of betahistine and the response of the various efficacy measures.
Assessments were conducted in accordance with practitioners' standard clinical practice and the requirements of a PMS study. Albera R, Ciuffolotti R, Di Cicco M, De Benedittis G, Grazioli I, Melzi G, Mira E, Pallestrini E, Passali D, Serra A, Vicini C.
Michopoulos I, Douzenis A, Kalkavoura C, Christodoulou C, Michalopoulou P, Kalemi G, Fineti K, Patapis P, Protopapas K, Lykouras L. Once the rash starts, only rest and isolation along with treatment of symptoms can be undertaken to let the episode pass off on its own. Most physicians would watch out for complications of measles during the course of the disease. Cough medications, however, are of little or no help and usually not advised in children under the age of six.
These may be recommended for children under two years old especially those with vitamin A deficiency. Study endpoints comprised on-treatment changes in the Dizziness Handicap Index (DHI), Hospital Anxiety and Depression Score (HADS) and the Short-Form (SF)-36v2. For each question, a "Yes" response scored four points, a "No" response scored zero points and a "Sometimes" response scored two points. The same categories were applied to both subscale scores: 0-7 points = normal, 8-10 points = mild, 11-14 points = moderate and 15-21 points = severe. Most of these events were recorded in participants in Brazil (10 events in 7 patients) or Slovenia (9 events in 6 patients).
The primary results of OSVaLD, reported here, add to experience with HRQoL instruments in vertigo and provide original data on the response of those indices to therapy delivered in the context of routine clinical care.

The improvement in the total DHI score considerably exceeded the numerical threshold for a clinically meaningful response.
The possible contribution of non-vertigo factors to these scores must be acknowledged, although in the sphere of neurological conditions, differentiating cause and effect can be especially difficult24,25.
An extensive series of correlations has already been identified between responses in the DHI, HADS and SF-36v2 (Table 3). This qualification may be especially relevant to depression, which is often the product of multiple influences and likely to be beyond the scope of a single medical intervention. A 3-month follow-up was chosen as a length of time sufficient to generate useful safety and tolerability data. Fixed combination of cinnarizine and dimenhydrinate versus betahistine dimesylate in the treatment of Meniere's disease: a randomized, double-blind, parallel group clinical study. Double-blind, randomized, multicenter study comparing the effect of betahistine and flunarizine on the dizziness handicap in patients with recurrent vestibular vertigo. Patient baseline characteristics in a multinational study of betahistine in recurrent peripheral vestibular vertigo: the OSVaLD study.
Evaluation of health-related quality of life in individuals with vestibular disease using disease-specific and general outcome measures. Test of reliability of the dizziness handicap inventory and the activities-specific balance confidence scale for use in Sweden. Reliability of clinical balance tests and subjective ratings in dizziness and disequilibrium. Long-term outcome and health-related quality of life in benign paroxysmal positional vertigo. Impact of treatment on health-related quality of life in patients with posterior canal benign paroxysmal positional vertigo.
Health-related quality of life in patients over sixty years old with benign paroxysmal positional vertigo.
Hospital Anxiety and Depression Scale (HADS): validation in a Greek general hospital sample. Assessment of the structure of the Hospital Anxiety and Depression Scale in musculoskeletal patients. Antidepressant treatment of chronic tension-type headache: a comparison between fluoxetine and desipramine.
Correlated physical and mental health summary scores for the SF-36 and SF-12 Health Survey, V.I. Benign paroxysmal positional vertigo: a study of two manoeuvres with and without betahistine. Division of Otoneurology, Department of Otorhinolaryngology, Hospital Universitario La Fe, Passeig de la Sequia 12, 46111 Rocafort, Valencia, Spain. Department of Otolaryngology-Head and Neck, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia. Solvay Pharmaceuticals BV, Postbus 900, CJ van Houtenlaan 36, Weesp, NL-1380 DA, The Netherlands. Aspirin in children with viral ailments carries a risk of a severe liver damage called Reye’s syndrome. Children over 12 months old may benefit from a teaspoon of lemon juice and two teaspoons of honey in a glass of warm water. Total DHI score improved 37.2 points (of a 100-point scale) following betahistine treatment. Statistical analysis was performed using SAS version 8.2 and SF Health OutcomesTM Scoring Software of Quality Metric Incorporated. The baseline SF-36v2 data for the OSVaLD population would also appear to support the view that this was a group with a low HRQoL26. The observed reduction in HADS-assessed depression severity and distribution seen in this study is perhaps the more noteworthy for that reason. Issues of differential diagnosis were considered in an earlier report4; there is currently no reason to think that our database has been affected by major variations in, or errors of, diagnosis. Psychometric and clinical tests of validity in measuring physical and mental health constructs.
Within the total score, individual scores were generated for the three subscales "physical" (seven questions), "emotional" (nine questions) and "functional" (nine questions).
The effects of betahistine on these indices of HRQoL should be considered in this context of marked baseline HRQoL deficits. Correlations between the DHI and SF-36v2 domains have been reported previously18, but we believe this to be the first demonstration of correlations between the HADS and DHI in a large-scale vertigo study. The original objective of recruiting 200 patients per country was not achieved, but the statistical findings remain robust and the trend of responses was consistent in all countries, suggesting that the efficacy findings are a reliable indication of a true effect.
Honey should not be given to babies under the age of 12 months for risk of a severe form of paralysis. Further it can be demonstrated that the effect seen in OSVaLD on the DHI was similar to that seen in double-blind, placebo controlled clinical studies with betahistine (Figure 4).

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