Pharmacology of the vestibular system

In the past year significant advances have been made in our understanding o f the neurochemistry and neuropharmacology of the peripheral and central ve stibular systems. The recognition of the central importance of excitatory a mino acids and their receptors at the level of the hair cells, vestibular n erve and vestibular nucleus has progressed further, and the role of nitric oxide in relation to activation of the N-methyl-D-aspartate receptor subtyp e is becoming increasingly clear. Increasing evidence suggests that excessi ve N-methyl-D-aspartate receptor activation and nitric oxide production aft er exposure to aminoglycoside antibiotics is a critical part of hair cell d eath, and new pharmacological strategies for preventing aminoglycoside otot oxicity are emerging as a result. Conversely, the use of aminoglycosides to lesion the peripheral vestibular system in the treatment of Meniere's dise ase has been studied intensively. In the vestibular nucleus, new studies su ggest the importance of opioid, nociceptin and glucocorticoid receptors in the control of vestibular reflex function. Finally, the mechanisms of actio n and optimal use of antihistamines in the treatment of Vestibular disorder s has also received a great deal of attention. Curr Opin Neurol 13:31-37. ( C) 2000 Lippincott Williams & Wilkins.