Dizziness is one of the unpleasant side effects of aging. Usually, disorders in the vestibular system or balance perception are responsible. However, it may also be a result of declining brain function. Blood flow to the brain deteriorates with age.
It’s a feeling like the ground is starting to shake, like you’re losing your footing or riding a merry-go-round. Sometimes dizziness is also accompanied by nausea. Older people aged 65 and over in particular often suffer from pathological dizziness. Many of those affected no longer dare to leave the house unaccompanied, as the risk of falling increases with the symptoms. Dizziness can have a variety of causes. Basically, however, there is a disturbance in the vestibular system or balance perception. In old age, diseases of the vestibular organ in the inner ear, circulatory disorders in the brain, e.g. due to circulatory weakness and problems, signs of aging in the cervical spine, diseases of the long nerve fibers in the trunk and legs, or visual disturbances are often the triggers.
Dizziness is a warning signal of the body and should be medically clarified accordingly. If the dizziness symptomatology is related to circulatory disorders or decreasing adaptability of the brain, the ginkgo-premium extract EGb 761® (Tebokan®) is a treatment option. Several studies have already demonstrated the efficacy and safety of this substance. For example, a recent meta-analysis evaluated the effects of EGb 761® at a daily dose of 240 mg on tinnitus and vertigo associated with dementia [1]. Randomized, placebo-controlled clinical trials with G. biloba extract EGb 761® were included if they met all of the following selection criteria and were identified through a systematic database search:
- Diagnosis of dementia according to generally accepted criteria,
- Treatment duration of at least 20 weeks,
- Outcome measures that cover at least two of the three conventional assessment domains,
- Presence and severity of vertigo and tinnitus were assessed, and
- Assessment was performed before and after randomized treatment.
Five studies met these inclusion criteria. The risk of bias was considered low with Jadad values of 3 and 5. All studies used 11-point box scales to assess the severity of tinnitus and vertigo. EGb 761® was found to be superior to placebo. The researchers concluded that ginkgo-premium extract is also effective in patients with dementia with concurrent neurosensory symptoms.
Vestibular compensation possible
Exciting results are also shown by a study regarding vestibular compensation in acute vestibular loss [2]. For this, the dose-dependent therapeutic effect of Ginkgo biloba extract EGb 761 on vestibular compensation was investigated by behavioral testing and serial cerebral [18F]-fluorodeoxyglucose ([18F]-FDG)-μPET in a rat model of unilateral labyrinthectomy (UL). In summary, EGb 761® improves vestibulo-ocular motor, vestibulo-spinal compensation and mobility after UL. This rat study supports the translational approach to investigate EGb 761® at higher doses to accelerate vestibular compensation in acute vestibular loss.
Effect proven for a long time
As early as 1998, an open-label, controlled study demonstrated that EGb 761® can significantly improve oculomotor and visuovestibular function. 44 Patients complaining of dizziness caused by vascular vestibular disorders were treated with 80 mg Ginkgo biloba twice daily or 16 mg betahistine dihydrochloride (BI) twice daily for three months. In the first month of therapy, dizziness improved in 64.7% of patients treated with BI and in 65% of patients receiving EGb 761®. Ginkgo biloba also induced a slight decrease in saccade delay and significantly increased saccade velocities. BI improved saccade accuracy but did not change delay. EGb 761® also improved uniform tracking gain at 0.4 Hz and 40°/s three times more than BI. both drugs asymmetrically reduced the maximum velocity of nystagmus at 40°/s and asymmetrically enhanced the sinusoidal vestibulo-ocular reflex. BI significantly reduced the visuovestibular ocular reflex, while EGb 761® significantly improved it.
Literature:
- Spiegel R, Kalla R, Mantokoudis G, et al: Ginkgo biloba extract EGb 761® alleviates neurosensory symptoms in patients with dementia: a meta-analysis of treatment effects on tinnitus and dizziness in randomized, placebo-controlled trials. Clinical Interventions in Aging 2018; 13: 1121-1127.
- Lindner M, Gosewisch A, Ellies E, et al: Ginkgo biloba extract EGb 761 Improves Vestibular Compensation and Modulates Cerebral Vestibular Networks in the Rat. Front Neurol 2019; 10: 147.
- Cesarani A, Meloni F, Alpini D, et al: Ginko biloba (EGb 761) in the Treatment of Equilibrium Disorders. Adv Ther 1998; 15(5): 291.
InFo NEUROLOGY & PSYCHIATRY 2020; 18(3): 30.
HAUSARZT PRAXIS 2020; 15(5): 25
