Ginkgo biloba contributes to central vestibular compensation

In central vestibular vertigo, errors occur in processing information to maintain balance and stabilize gaze due to lesions in the brainstem or cerebellum. The treatment includes, among others, physiotherapeutic and medicinal measures. An exploratory clinical trial published in 2022 demonstrated that the use of a special Ginkgo extract in combination with balance training significantly improved symptoms.

The most common causes of central vestibular dizziness are strokes, neurodegenerative diseases or tumors. Common consequences are gait instability and increased risk of falls [1–3]. This can be explained by the fact that vestibular disorders lead to sensory conflict. However, symptoms can be relieved by central vestibular compensation. This compensation is associated with CNS plasticity [4].

The ginkgo special extract EGb ^761® has been shown to be effective in the treatment of various forms of vertigo [5,6]. The various constituents of Ginkgo biloba exert multimodal efficacy, including improving mitochondrial function, which has a beneficial effect on ATP production, and this in turn stimulates neuroplasticity [7]. In addition, EGb ^761® has blood circulation-enhancing effects in the brain, which contributes to better microcirculation.

In a study published in the journal Neuroscience and Medicine , the effects of a combination of balance training with EGb ^761® were investigated in patients with central vertebral dizziness.

Greater improvement in vertigo symptoms in ginkgo group

The randomized, placebo-controlled, double-blind study conducted at the University Hospital of Lübeck (D) included 40 patients aged 30-75 years [6]. Patients suffered from central vestibular vertigo due to ischemic lesions in the brainstem or cerebellum. Vertigo symptoms were quantified on a scale of 0 to 35 in terms of intensity, frequency, and duration. The inclusion criterion was a score of at least 5. Patients were treated with 2× 120 mg EGb ^761®/d or placebo for 180 days and performed a standardized program of vestibular exercises daily. The primary endpoint was patient assessment of the severity of vertigo symptoms. A visual analog scale (VAS) was used for this purpose, with scores ranging from 0 (=no complaints) to 100 (= most severe complaints). In addition, the assessment of vertigo symptoms from the physician’s point of view was surveyed, using a scale with values from 1 (=return to normal) to 6 (=significant worsening). Eye movement parameters and patient-rated intensity, duration, and frequency of vertigo symptoms were chosen as secondary endpoints (using the 0 to 35 scale for participant selection).

Analyses showed that at day 180 after baseline, patient-assessed vertigo severity (VAS) (Fig. 1) improved by 46% in the EGb ^761® group, compared with 19% in the placebo group [6]. A significant difference between the two groups was evident by day 60. Regarding physician assessment, there was a trend toward greater improvement under EGb ^761® vs. placebo. For the secondary endpoints, the dizziness score at day 180 showed a statistically significant benefit (p=0.04) for the EGb ^761® group. Throughout the study period, EGb ^761® proved to be well tolerated.

Literature:

Kammerlind AS, Håkansson JK, Skogsberg MC: Effects of balance training in elderly people with nonperipheral vertigo and unsteadiness. Clin Rehabil 2001; 15(5): 463-470.
Schlick C, et al: Falls and fear of falling in vertigo and balance disorders: A controlled cross-sectional study. Journal of Vestibular Research 2016; 25(5-6): 241-251.
Alyono JC: Vertigo and dizziness. Otolaryngologic Clinics of North America 2018; 51(4): 725-740.
“Vertigo in Family Practice,” www.arztakademie.at/fileadmin/template/main/
geriatrics/publications19/Sakho-Brehm_Svertigo_in_family_physician_practice_FINAL.pdf, (last accessed Oct 04, 2023).
Drug Information, www.swissmedicinfo.ch,(last accessed Oct. 04, 2023).
Heide W, et al: Ginkgo biloba Extract EGb 761® Improves Central Vestibular Vertigo in Patients Undergoing Vestibular Exercises: A Randomised Placebo-Controlled Trial. Neuroscience and Medicine 2022, www.scirp.org/journal/paperinformation,(last accessed Oct. 04, 2023).
Müller WE, Heiser J, Leuner K: Effects of the standardized Ginkgo biloba extract ^EGb761® on neuroplasticity. Int Psychogeriatr 2012; 24(Suppl 1): S21-24.