(Seasickness; Mal de Mer)
The symptoms of motion sickness includes a symptom complex, which includes the usual nausea, often accompanied by vague abdominal discomfort, vomiting, dizziness, pallor, diaphoresis and similar symptoms. It is induced by certain forms of motion, particularly repetitive angular and linear acceleration, and deceleration due to conflicting or vestibular, visual and proprioceptive inputs. Behavior modification and drug therapy can help to prevent the symptoms or to control them.
Motion sickness is a normal physiological response to a provoking stimulus. The individual’s susceptibility to motion sickness is very different; but more often it occurs in women and children aged between 2 and 12 years. Sickness rarely occurs after 50 and in infants <2 years on. The incidence ranges from <1% to almost 100% in aircraft on ships in rough seas and after the occurrence of the weightless environment of space.
The symptoms of motion sickness includes a symptom complex, which includes the usual nausea, often accompanied by vague abdominal discomfort, vomiting, dizziness, pallor, diaphoresis and similar symptoms. It is induced by certain forms of motion, particularly repetitive angular and linear acceleration, and deceleration due to conflicting or vestibular, visual and proprioceptive inputs. Behavior modification and drug therapy can help to prevent the symptoms or to control them. Motion sickness is a normal physiological response to a provoking stimulus. The individual’s susceptibility to motion sickness is very different; but more often it occurs in women and children aged between 2 and 12 years. Sickness rarely occurs after 50 and in infants <2 years on. The incidence ranges from <1% to almost 100% in aircraft on ships in rough seas and after the occurrence of the weightless environment of space. Etiology The main cause is an excessive stimulation of the vestibular apparatus by motion. Vestibular stimulation can be from an angular motion (detected by the semicircular canals), or linear acceleration or gravity (detected by the otolith [utricle and saccule]) derived. CNS components that mediate sickness, the vestibular system and the core of the brain stem, the hypothalamus, the nodule and uvula of the cerebellum and refractive middle (e.g., B. Mark chemoreceptor trigger zone, vomiting center and emetic-efferents). The exact pathophysiology is not defined, but the sickness occurs only when the eighth cranial nerve and vestibular pathways to the cerebellum are intact; Persons with an impaired functional vestibular-cochlear system are immune to motion sickness. Movement in any type of transport, including boat, automobile, railroad, aircraft, spacecraft, and driving devices in the playground or in amusement parks may cause an excessive Vestibularisreizung. Possible triggers include conflicting vestibular, visual and proprioceptive information. For example, a visual stimulus, which transmits the information to remain at a point, with a sense of motion interfere such. As when looking at a seemingly motionless ship cabin wall as the ship rocks back and forth. Alternatively, a moving visual impression may collide with a lack of movement perception z. at the sight of a fast-moving slides (also called "pseudo motion disease" or Pseudokinetose, given the lack of real movement) as through a microscope or observing a virtual video game while sitting quietly in a chair. When watching waves from a boat, a person can experience contradictory visual impressions (the movement of the waves in one direction) and vestibular input (the vertical movement of the boat itself). Another possible cause is a conflict among the inputs between angulärer and linear Beschleuinigung or gravity as such. B. may in a weightless space when rotating, occur (anguläre Bechleunigung). A movement pattern from the expected pattern is different (eg., In a weightless environment when you float instead of falling), can be a trigger. Risk Factors Factors that increase the risk of developing a sickness or the severity of symptoms are: Poor air (eg, exposure to fumes, smoke or carbon monoxide.) Emotional factors (eg anxiety.) Migraine labyrinthitis Hormonal factors (eg. B. pregnancy, use of hormonal contraceptives) (in weightlessness syndrome sickness during space flight) is an etiologic factor weightlessness (lack of gravity). This syndrome reduces the efficiency of the astronauts during the first flight day, after a few days but done the adaptation. Symptoms and complaints Characteristic manifestations include nausea, vomiting, pallor, diaphoresis and vague discomfort in the abdomen. Other symptoms that may precede the characteristic symptoms are yawning, hyperventilation, salivation and drowsiness. Aerophagia, dizziness, headache, fatigue, weakness and lack of concentration may also occur. Pain, shortness of breath, weakness or focal neurological deficits as well as vision and speech disorders are not present. With continued exposure to the movement, patients often get used to it within a few days. However, the symptoms may appear after a short break at any time in intensification or resumption of motion. Prolonged sickness and the associated vomiting can lead in rare cases to dehydration associated with hypotension, exhaustion and depression. Diagnosis Clinical Evaluation The diagnosis is suspected in patients with symptoms that were compatible subjected to typical triggers. The diagnosis is made clinically and is usually easy. However, the possibility of another diagnosis (eg. As cerebral hemorrhage or infarction) in some people should be considered, especially in the elderly, patients with no prior history of motion sickness or those with risk factors for cerebral hemorrhage or infarction, acute nausea and vomiting during driving development. Patients with focal neurological symptoms, significant headache or other atypical findings of sickness should be investigated further. taking treatment Prophylactic medications (eg. as scopolamine, antihistamines or antidopaminergic drug prophylaxis without medication and treatment antiemetics (eg. as serotonin antagonists) Sometimes oral or intravenous fluid and electrolyte replacement therapy people who are prone to motion sickness, should prophylactic drugs and other preventive measures applied before symptoms begin;. interventions are less effective after symptoms have developed If there is vomiting, an antiemetic for better efficacy may be administered rectally or parenterally for prolonged vomiting intravenously given fluids and electrolytes as a substitute and. are required to maintain. scopolamine scopolamine, an anticholinergic prescription Med ikament, is effective for prevention, but the efficacy in the treatment is uncertain. Scopolamine than 1, 5-mg transdermal patch or available in oral form. The patch is a good choice for long trips because it h for up to 72 is effective. It is behind the ear 4 hours before its effect is required applied. When the treatment after 72 h is required, the patch is removed and a fresh placed behind the other ear. Orally one hour prior to departure 0.4-0.8 mg scopolamine can be taken, then as needed every 8 hours, it acts within 30 min. Anticholinergic side effects, which include drowsiness, blurred vision, dry mouth and bradycardia, are less common in patches. Accidental contamination of the eyes caused by residues of the patch can cause a rigid and strong dilated pupil. Additional side effects of scopolamine in the elderly may be confusion, hallucinations, and urinary retention. Scopolamine is contraindicated in individuals who are at risk of acute narrow- angle glaucoma. Tips and risks When an elderly person is confused and developed a fixed, dilated pupil during the trip, pull scopolamine toxicity (as well as intracranial hematomas with obstruction) into consideration. Scopolamine can be used in children> 12 years of age at the same dose as in adults. The use in children ? 12 years old can be sure, but is not recommended because the risk of side effects is higher ist.Antihistaminika The mechanism of action of antihistamines is probably anticholinergic. All active agents are sedating; nonsedating antihistamines do not seem to be effective. These drugs may be able to be effective for prevention and treatment. Anticholinergic side effects can be problematic, especially in the elderly. From 1 h before departure can not susceptible people prescription dimenhydrinate, diphenhydramine, meclizine or cyclizine be given in the following doses: diphenhydramine: adult, 25 to 50 mg p.o. every 4 to 8 h; Children ? 12 years, 25 to 50 mg p.o. every 4 to 6 hours; Children 6 to 11 years, 12.5 to 25 mg p.o. every 4 to 6 hours; Children from 2 to 5 years, 6.25 mg p.o. every 4 to 6 hours dimenhydrinate: Adults and children> 12 years, 50 to 100 mg po every 4 to 6 hours (not exceed 400 mg / day); Children 6 to 12 years, 25 to 50 mg p.o. every 6 to 8 h (150 mg / day does not exceed); Children from 2 to 5 years, 12.5 to 25 mg p.o. every 6 to 8 hours (no more than 75 mg / day) Meclizine: adults and children ? 12 years, 25 to 50 mg p.o. every 24 h Cyclizine: adult, 50 mg p.o. every 4 to 6 hours; Children 6 to 12 years, 25 mg 3 times daily, or four times daily Cyclizine and dimenhydrinate can vagal mediated GI symptoms minimieren.Antidopaminergen drug promethazine 25-50 mg po 1 hour before departure and then 2 times a day seems to be effective for prevention and treatment. The dosage for children 2-12 years of age is 0.5 mg / kg p.o. 1 hour before departure and then 2 times a day; it should not be used in children <2 years because of the risk of respiratory depression. Adding caffeine can increase the efficacy. Metoclopramide can also be effective, but there are indications that it is less effective than promethazine. Among the unwanted effects include extrapyramidal symptoms and Sedierung.Benzodiazepinen benzodiazepines may also have some benefit in the treatment of motion sickness, but they have a sedative effect serotonin antagonists serotonin (5-HT3) antagonists, such as ondansetron and granisetron, are highly effective antiemetics. non-drug measures Susceptible individuals should minimize exposure and a place with the least possible motion search (z. B. amidships near the water level, over wing aircraft). They should also try to minimize the discrepancy between visual and vestibular stimuli. In motor vehicles, the self-driving, then to prefer sitting in the front seat, because there the proper motion of the car is the best exercise. When traveling on a ship, it is better to fix the horizon or the mainland as the cabin wall. For all transport seats facing backwards as well as reading should be avoided. The best is the supine or semi-recumbent position with supported head. can thus help the vestibular sensory input is reduced sleep. When weightlessness syndrome should movements that aggravate symptoms, are avoided. Adequate ventilation contributes to the prevention of symptoms. The consumption of alcoholic beverages and overeating before or during travel increase the likelihood of sickness. On longer trips fluid and light food should be consumed in small amounts in short intervals; some people find that dry crackers and carbonated drinks, v. a. Ginger ale, are best. If the flight is short, should not eat or drink. Adjustment is one of the most effective prophylactic therapies for motion sickness and is carried out by repeated contact with the same stimulus. However, the adjustment runs specifically to the respective stimulus (z. B. can so sailors who have become accustomed to the movement of large ships, develop even motion sickness if they are on smaller boats) .Alternative therapies Some non-drug therapies are not streaky, but may still be helpful. These alternative therapies include the use of acupressure and electrostimulation bracelets. Both can be riskless used by people of all ages. Ginger, a dose of 0.5 to 1 g, which can be repeated, but should be limited to 4 g per day was used, but has been shown to be no more effective than a placebo. Important points sickness is caused by excessive stimulation of the vestibular system or by conflicts among proprioceptive, visual and vestibular sensory impressions. Diagnosis is based on clinical findings and is usually easy. Drug therapy is more effective prophylactic and usually involves scopolamine or an antihistamine. Once vomiting is determined serotonin antagonist antiemetics are preferred. To minimize motion sickness, it is recommended that people's position in a vehicle search, in which the slightest movement takes place to sleep as possible, ensure adequate ventilation and avoid alcohol and unnecessary food and drinks.