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Zhang LL, Wang JQ, Qi RR, Pan LL, Li M, Cai YL. Motion Sickness: Current Knowledge and Recent Advance. CNS Neurosci Ther 2015; 22:15-24. [PMID: 26452639 DOI: 10.1111/cns.12468] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/10/2015] [Accepted: 09/10/2015] [Indexed: 01/02/2023] Open
Abstract
Motion sickness (MS) is a common physiological response to real or virtual motion. Numerous studies have investigated the neurobiological mechanism and the control measures of MS. This review summarizes the current knowledge about pathogenesis and pathophysiology, prediction, evaluation, and countermeasures of MS. The sensory conflict hypothesis is the most widely accepted theory for MS. Both the hippocampus and vestibular cortex might play a role in forming internal model. The pathophysiology focuses on the visceral afference, thermoregulation and MS-related neuroendocrine. Single-nucleotide polymorphisms (SNPs) in some genes and epigenetic modulation might contribute to MS susceptibility and habituation. Questionnaires, heart rate variability (HRV) and electrogastrogram (EGG) are useful for diagnosing and evaluating MS. We also list MS medications to guide clinical practice. Repeated real motion exposure and combined visual-vestibular interaction training accelerate the progress of habituation. Behavioral and dietary countermeasures, as well as physiotherapy, are also effective in alleviating MS symptoms.
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Affiliation(s)
- Li-Li Zhang
- Department of Pharmacology, Second Military Medical University, Shanghai, China
| | - Jun-Qin Wang
- Department of Nautical Injury Prevention, Faculty of Navy Medicine, Second Military Medical University, Shanghai, China
| | - Rui-Rui Qi
- Department of Nautical Injury Prevention, Faculty of Navy Medicine, Second Military Medical University, Shanghai, China
| | - Lei-Lei Pan
- Department of Nautical Injury Prevention, Faculty of Navy Medicine, Second Military Medical University, Shanghai, China
| | - Min Li
- Department of Nautical Injury Prevention, Faculty of Navy Medicine, Second Military Medical University, Shanghai, China
| | - Yi-Ling Cai
- Department of Nautical Injury Prevention, Faculty of Navy Medicine, Second Military Medical University, Shanghai, China
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Abstract
INTRODUCTION The substance P (SP)/neurokinin (NK)-1 receptor system is involved in many pathological processes. NK-1 receptor antagonists have many promising therapeutic indications. However, the only NK-1 receptor antagonist used in clinical practice is the drug aprepitant and its intravenously administered prodrug, fosaprepitant. In general, NK-1 receptor antagonists are safe and well tolerated. AREAS COVERED A search was carried out in Medline using the following terms: adverse events, aprepitant, casopitant, clinical trials, CP-122,721, ezlopitant, fosaprepitant, NK-1 receptor antagonists, randomized, safety, side effects, tolerability and vofopitant. EXPERT OPINION Most clinical trials have focused on the antiemetic action of aprepitant in cancer patients treated with chemotherapy. However, the efficacy and safety of aprepitant have not been fully tested in other diseases in which the SP/NK-1 receptor system is involved (e.g., cancer, HIV, alcoholism); thus, clinical trials are required. The use of NK-1 receptor antagonists in oncology therapy is quite promising, but to date pharmacological therapy has not exploited the many possible therapies offered by such antagonists.
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Affiliation(s)
- Miguel Muñoz
- Virgen del Rocío University Hospital, Research Laboratory on Neuropeptides, Sevilla, Spain.
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Huang SC, Korlipara VL. Neurokinin-1 receptor antagonists: a comprehensive patent survey. Expert Opin Ther Pat 2010; 20:1019-45. [DOI: 10.1517/13543776.2010.495121] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Quartara L, Altamura M, Evangelista S, Maggi CA. Tachykinin receptor antagonists in clinical trials. Expert Opin Investig Drugs 2009; 18:1843-64. [DOI: 10.1517/13543780903379530] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Darmani NA, Ray AP. Evidence for a re-evaluation of the neurochemical and anatomical bases of chemotherapy-induced vomiting. Chem Rev 2009; 109:3158-99. [PMID: 19522506 DOI: 10.1021/cr900117p] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Nissar A Darmani
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California 91766-1854, USA.
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Van Sassenbroeck DK, Hemelsoet DMR, Vanwalleghem P, Verstraete AG, Santens P, Monsieurs KG, Buylaert WA. Three Cases of Substitution Errors Leading to Hyoscine Hydrobromide Overdose. Clin Toxicol (Phila) 2009; 43:861-5. [PMID: 16440514 DOI: 10.1080/15563650500357560] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report three patients with anticholinergic poisoning caused by the substitution of hyoscine hydrobromide for hyoscine butylbromide in preparations compounded by two different pharmacists. The patients took the preparations for gastrointes tinal discomfort and presented with altered mental status tachycardia, facial flushing, dilated pupils, and dry skin shortly after the ingestion. In one patient the intoxication was initially not recognized and he was treated as suffering from an acute cerebrovascular accident. Two patients experienced long-lasting effects such as decreased ability to concentrate, memory dis turbances, tremor, and photo- and phonophobia. It was obviously impossible to elucidate the exact nature of the relationship between the intoxication and these long-lasting complaints. Information from the Belgian poison control center revealed that cases of substitution error with hyoscine hydrobromide are not unique The Belgian authorities issued a warning to all pharmacists.
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Holmes AM, Rudd JA, Tattersall FD, Aziz Q, Andrews PLR. Opportunities for the replacement of animals in the study of nausea and vomiting. Br J Pharmacol 2009; 157:865-80. [PMID: 19371333 PMCID: PMC2737646 DOI: 10.1111/j.1476-5381.2009.00176.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 11/17/2008] [Accepted: 01/08/2009] [Indexed: 12/24/2022] Open
Abstract
Nausea and vomiting are among the most common symptoms encountered in medicine as either symptoms of disease or side effects of treatments. Developing novel anti-emetics and identifying emetic liability in novel chemical entities rely on models that can recreate the complexity of these multi-system reflexes. Animal models (especially the ferret and dog) are the current gold standard; however, the selection of appropriate models is still a matter of debate, especially when studying the subjective human sensation of nausea. Furthermore, these studies are associated with animal suffering. Here, following a recent workshop held to review the utility of animal models in nausea and vomiting research, we discuss the limitations of some of the current models in the context of basic research, anti-emetic development and emetic liability detection. We provide suggestions for how these limitations may be overcome using non-animal alternatives, including greater use of human volunteers, in silico and in vitro techniques and lower organisms.
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Affiliation(s)
- A M Holmes
- National Centre for the Replacement, Refinement and Reduction of Animals in Research, London, W1B 1AL, UK.
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Diemunsch P, Joshi G, Brichant JF. Neurokinin-1 receptor antagonists in the prevention of postoperative nausea and vomiting. Br J Anaesth 2009; 103:7-13. [DOI: 10.1093/bja/aep125] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Motion sickness can be caused by a variety of motion environments (e.g., cars, boats, planes, tilting trains, funfair rides, space, virtual reality) and given a sufficiently provocative motion stimulus almost anyone with a functioning vestibular system can be made motion sick. Current hypotheses of the 'Why?' of motion sickness are still under investigation, the two most important being 'toxin detector' and the 'vestibular-cardiovascular reflex'. By contrast, the 'How?' of motion sickness is better understood in terms of mechanisms (e.g., 'sensory conflict' or similar) and stimulus properties (e.g., acceleration, frequency, duration, visual-vestibular time-lag). Factors governing motion sickness susceptibility may be divided broadly into two groups: (i) those related to the stimulus (motion type and provocative property of stimulus); and (ii) those related to the individual person (habituation or sensitisation, individual differences, protective behaviours, administration of anti-motion sickness drugs). The aim of this paper is to review some of the more important factors governing motion sickness susceptibility, with an emphasis on the personal rather than physical stimulus factors.
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Affiliation(s)
- John F Golding
- Department of Psychology, University of Westminster, 309 Regent Street, London W1B 2UW, U.K.
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Zajonc TP, Roland PS. Vertigo and Motion Sickness. Part II: Pharmacologic Treatment. EAR, NOSE & THROAT JOURNAL 2006. [DOI: 10.1177/014556130608500110] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Vertigo is a sensation of movement when no movement is actually occurring. It is often accompanied by visceral autonomic symptoms including pallor, diaphoresis, nausea, and vomiting. Vertigo is similar to motion sickness in that both may be caused by vestibular stimulation that does not match an internal model of expected environmental stimuli. Indeed, a functioning vestibular system is necessary for the perception of motion sickness. For this reason, many of the same drugs are used to treat both conditions. The investigation of drugs that treat motion sickness helps to discover medications that may treat vertigo caused by disease of the vestibular system. In this article, we discuss the pharmacologic agents that are now available for the treatment of vertigo and those agents that are still under study.
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Affiliation(s)
| | - Peter S. Roland
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center at Dallas
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Lau AHY, Rudd JA, Yew DTW. Action of ondansetron and CP-99,994 on cisplatin-induced emesis and locomotor activity in Suncus murinus (house musk shrew). Behav Pharmacol 2005; 16:605-12. [PMID: 16286811 DOI: 10.1097/00008877-200512000-00002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Species possessing the emetic reflex are useful for anti-emetic screening. Assessing the potential of novel drugs to simultaneously reduce nausea and emesis in animals is problematic, however. In the present studies, therefore, the behavioural repertoire of Suncus murinus in response to the emetic chemotherapeutic drug cisplatin was studied in an attempt to characterize behaviours (including spontaneous locomotor activity) that may be relevant to nausea status. Cisplatin at 30 mg/kg, intraperitoneal, induced a robust emetic response but did not induce novel behaviour and failed to affect spontaneous locomotor activity. Ondansetron at 3 mg/kg, subcutaneous, and CP-99,994 at 10 mg/kg, subcutaneous, reduced emesis by 98% and 40.7%, respectively. Both ondansetron and CP-99,994, however, were inactive in modifying spontaneous locomotor activity in either cisplatin-treated or normal animals. Results are discussed in relation to other animal models of nausea and emesis.
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Affiliation(s)
- Angie H Y Lau
- Emesis Research Group, Department of Pharmacology, Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
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12
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Abstract
PURPOSE OF REVIEW The public's longstanding resigned tolerance to motion sickness threatens to change, due to the widespread introduction of nauseogenic tilting trains and the increasing use of virtual reality immersion. RECENT FINDINGS Scientific effort over the last 5 years has focused on precise evaluation of the stimuli that provoke sickness and on the development of behavioural and new pharmacological interventions to suppress sickness. SUMMARY The precise mechanical ride characteristics of vehicles that provoke sickness have been identified and this will lead to guidelines for future engineering design, especially for suspension systems that compensate for inertial tilt, and recommendations for passengers at risk. The frequency characteristics of motion provoking sickness have been defined with greater precision and identified with shifts in perception of motion versus orientation, and changes in the quality of reflex eye movements. Ability to modify readily the time constant of vestibular 'velocity store' has emerged as a potential candidate marker of successful motion sickness habituation. Behavioural 'autogenic' countermeasures to the development of sickness, such as controlled breathing, which can be implemented readily, are shown to have significant ameliorating effects on nausea and are of value for short term moderate exposures. New classes of pharmacological agents such as N-methyl-D-aspartate antagonists and 5HT1a receptor agonists show promise in animals but await trials in humans.
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Affiliation(s)
- John F Golding
- Department of Psychology, University of Westminster, London, UK
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Lau AHY, Ngan MP, Rudd JA, Yew DTW. Differential action of domperidone to modify emesis and behaviour induced by apomorphine in the ferret. Eur J Pharmacol 2005; 516:247-52. [PMID: 15963978 DOI: 10.1016/j.ejphar.2005.05.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2005] [Accepted: 05/24/2005] [Indexed: 11/29/2022]
Abstract
The action of domperidone (1 mg/kg, i.p.) on spontaneous behaviour and the emesis and behavioural change induced by apomorphine (0.25 mg/kg, s.c.) were studied in the ferret. Domperidone was inactive to modify spontaneous behaviour but apomorphine-induced emesis and increased locomotor activity (distance travelled and velocity of movement; P<0.05); the emesis, but not the modification of locomotor activity was antagonized significantly (P<0.01) by domperidone. However, apomorphine did not modify significantly other behavioural measures (i.e. lip licking, rearing, burrowing, backward walking, curling-up activity, or defecatory frequency; P>0.05). The action of apomorphine to modify behaviour and its interaction with domperidone in this species is discussed in relation to animal models of nausea.
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Affiliation(s)
- Angie H Y Lau
- Emesis Research Group, Department of Pharmacology and Department of Anatomy, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, PR China
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Gale JD, O’Neill BT, Humphrey JM. Tachykinin NK1receptor antagonists for the control of chemotherapy-induced nausea and vomiting. Expert Opin Ther Pat 2005. [DOI: 10.1517/13543776.11.12.1837] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lau AHY, Kan KKW, Lai HW, Ngan MP, Rudd JA, Wai MK, Yew DTW. Action of ondansetron and CP-99,994 to modify behavior and antagonize cisplatin-induced emesis in the ferret. Eur J Pharmacol 2005; 506:241-7. [PMID: 15627434 DOI: 10.1016/j.ejphar.2004.11.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2004] [Revised: 11/01/2004] [Accepted: 11/12/2004] [Indexed: 11/17/2022]
Abstract
The action of ondansetron (1 mg/kg, i.p.) and (+)-(2S,3S)-3-(2-methoxybenzylamino)-2-phenylpiperidine (CP-99,994; 10 mg/kg, i.p.) on spontaneous behavior and the emesis induced by cisplatin (10 mg/kg, i.p.) was studied in the ferret. Ondansetron was inactive to modify behavior, but CP-99,994 reduced spontaneous locomotor activity and lip licking by 48% (P<0.01) and 79% (P<0.01), respectively; CP-99,994 also abolished spontaneous burrowing activity (P<0.05). Treatment of animals with cisplatin induced an emetic response that was abolished by both ondansetron and CP-99,994 (P<0.01). However, cisplatin did not significantly modify other behavioral measures although animals that received CP-99,994, cisplatin, or CP-99,994 in combination with cisplatin exhibited more episodes of defecation than animals that received ondansetron (P<0.05). The action of CP-99,994 to modify behavior in this species is discussed in relation to animal models of nausea.
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Affiliation(s)
- Angie H Y Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
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Stieler JM, Reichardt P, Riess H, Oettle H. Treatment Options for Chemotherapy-Induced Nausea and Vomiting. ACTA ACUST UNITED AC 2003. [DOI: 10.2165/00024669-200302010-00002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Abstract
Despite important advances in pharmacotherapeutic options for the prevention and treatment of nausea and vomiting during the 1990s, a significant proportion of patients still suffer debilitating nausea and vomiting symptoms. The most problematic areas are chemotherapy-induced nausea and vomiting particularly delayed emesis, postoperative nausea and vomiting, opioid-induced nausea and vomiting and motion sickness. The most vigorous research into new anti-emetics has focused on the neurokinin-1 (substance P) antagonists. Clinical trials conducted to date indicate that these agents have similar efficacy to 5-HT(3) antagonists in acute chemotherapy-induced nausea and vomiting, superior efficacy to available agents in delayed emesis, possibly superior efficacy against emesis in postoperative nausea and vomiting and no evidence of efficacy versus opioid or motion-induced nausea and vomiting. Other pharmacological strategies in development include agonising CB1 (cannabinoid) receptors, "broad spectrum" receptor antagonists and 5-HT(1A) receptor agonists, although clinical trials of these types of agents are not yet available. The neurokinin-1 antagonists appear to be promising agents for some nausea and vomiting states, although further clarification of their role is required.
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Affiliation(s)
- Peter S Loewen
- Pharmaceutical Sciences Clinical Service Unit, Vancouver Hospital & Health Sciences Center, University of British Columbia, Vancouver, BC, Canada
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Abstract
Substance P has been extensively studied and is considered the prototypic neuropeptide of the more than 50 known neuroactive molecules. The understanding of substance P has evolved beyond the original concept as the pain transmitter of the dorsal horn. Animal and genetic research, recent developments of nonpeptide substance P antagonists, and important changes in the understanding of neurotransmission have each contributed to the current understanding of substance P After 7 decades, the physiologic role of substance P is known as a modulator of nociception, involved in signaling the intensity of noxious or aversive stimuli. Genetic studies in mice and development of substance P antagonists provide more recent results that support the redefinition of the central role of substance P Evidence suggests that this neuropeptide is an integral part of central nervous system pathways involved in psychologic stress.
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Affiliation(s)
- C L DeVane
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, USA.
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