Effects of Acetyl-DL-Leucine in Vestibular Patients: A Clinical Study following Neurotomy and Labyrinthectomy
Effects of Acetyl-DL-Leucine in Vestibular Patients: A Clinical Study following Neurotomy and Labyrinthectomy
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DOI：
10.1159/000148206
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发表时间：
2009-01-01
影响因子：
1.6
通讯作者：
Vidal, P. P.
中科院分区：
文献类型：
--
作者：
Ferber-Viart, C.;Dubreuil, C.;Vidal, P. P.
40年来，氨基酸乙酰-DL-亮氨酸（或异亮氨酸-Tanganil（R））已被用于临床实践，以减少与急性眩晕危象相关的不平衡和自主神经症状。在动物模型中，乙酰-DL-亮氨酸加速单侧前庭切除术后的前庭补偿，并且对正常前庭功能仅具有微小的影响。我们在动物模型中的工作表明，乙酰-DL-亮氨酸主要作用于异常超极化和/或去极化前庭神经元，使其膜电位恢复到平均值-65至60 mV。急性前庭疾病与前庭神经元的不对称自发活动有关，因此先前的研究表明乙酰-DL-亮氨酸可能会减少人类中与前庭相关的急性失衡。为了验证这一假设，我们研究了乙酰-DL-亮氨酸在单侧前庭听神经鞘瘤手术或单侧难治性梅尼埃病患者神经切开术或前庭切除术后急性期的疗效。通过前庭功能的临床测试，患者在手术前根据前庭传入障碍的补偿程度进行分类。对于手术前已经达到接近完美补偿的患者，乙酰-DL-亮氨酸在手术后具有轻微或无影响。对于手术前显示残留前庭功能的患者，乙酰-DL-亮氨酸缓解了神经切断术后的静态前庭综合征。我们的研究结果倾向于证实这样的观点，即乙酰-DL亮氨酸主要作用于人类异常超极化和/或去极化前庭神经元，通过将其膜电位恢复到正常值;这与豚鼠单侧前庭神经节切除术后的研究结果一致。此外，它表明，神经切开术前的患者的热量轻瘫的程度是有用的预测神经切开术后的任何急性前庭综合征的结果，并评估乙酰-DL-亮氨酸的管理，以治疗任何这样的综合征的潜在价值。版权所有（C）2008 S. Karger AG，巴塞尔
For 40 years, the amino acid acetyl-DL-leucine (or isoleucine-Tanganil (R)) has been used in clinical practice to reduce imbalance and autonomic manifestations associated with acute vertigo crises. In animal models, acetyl-DL-leucine accelerates vestibular compensation following unilateral labyrinthectomy, and has only minor effects on normal vestibular function. Our work in animal models suggested that acetyl-DL-leucine acted mainly on abnormally hyperpolarized and/or depolarized vestibular neurons by restoring their membrane potential towards a mean value of-65 to-60 mV. Acute vestibular disorders are associated with asymmetrical spontaneous activities of vestibular neurons, so this previous study suggested that acetyl-DL-leucine may reduce acute, vestibular-related imbalances in humans. To test this hypothesis, we investigated the efficacy of acetyl-DL-leucine during the acute stage following neurotomy or labyrinthectomy in patients undergoing surgery for unilateral vestibular acoustic neurinoma, or suffering from unilateral and intractable Meniere's disease. By clinical testing of the vestibular function, patients were categorized according to the degree of compensation of the vestibular deafferentation prior to surgery. For patients who had achieved a close to perfect compensation before surgery, acetyl-DL-leucine had minor or no effect after surgery. For patients who displayed residual vestibular function before surgery, acetyl-DL-leucine eased the static vestibular syndromes, which followed neurotomy. Our findings tend to confirm the view that acetyl-DL leucine mainly acts, in humans, on abnormally hyperpolarized and/or depolarized vestibular neurons by restoring their membrane potential towards normal values; this is consistent with findings in guinea pigs following unilateral labyrinthectomy. Moreover, it suggests that the degree of caloric paresis of the patients before neurotomy is useful both to predict the outcome of any acute vestibular syndrome following neurotomy and to assess the potential value of the administration of acetyl-DL-leucine to treat any such syndrome. Copyright (C) 2008 S. Karger AG, Basel