Cilostazol versus aspirin therapy in patients with chronic dizziness after ischemic stroke

Johkura, Ken; Yoshida, Tamaki N.; Kudo, Yosuke; Nakae, Yoshiharu; Momoo, Takayuki; Kuroiwa, Yoshiyuki

doi:10.1016/j.clineuro.2012.01.029

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Cilostazol versus aspirin therapy in patients with chronic dizziness after ischemic stroke☆

Ken Johkura
- Department of Neurology and Stroke Center, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
- Corresponding author at: Department of Neurology and Stroke Center, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka 254-8502, Japan. Tel.: +81 463 32 1950; fax: +81 463 31 1865.
Tamaki N. Yoshida
- Department of Neurology and Stroke Center, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
Yosuke Kudo
- Department of Neurology and Stroke Center, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
Yoshiharu Nakae
- Department of Neurology and Stroke Center, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
Takayuki Momoo
- Department of Neurology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Yoshiyuki Kuroiwa
- Department of Neurology, Yokohama City University Graduate School of Medicine, Yokohama, Japan

Received 20 December 2011; received in revised form 10 January 2012; accepted 18 January 2012. published online 15 February 2012.
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Abstract

Background

Chronic dizziness is frequently reported by patients in the chronic stage after ischemic stroke. The aim of this study was to determine the efficacy of cilostazol versus that of aspirin for the chronic dizziness that follows ischemic stroke.

Methods

We performed a prospective, randomized, open-label, blinded endpoint trial. One hundred six patients who suffered supratentorial ischemic stroke within the previous 1–6 months and subsequently complained of persistent dizziness without other obvious sequelae were enrolled. Patients were randomly given cilostazol (200mg/day) or aspirin (100mg/day) for 6 months. Rates of improvement in the dizziness were then evaluated. Changes in fixation suppression of the vestibulo-ocular reflex (an indicator of cerebral control over the brainstem reflex related to balance), regional cerebral blood flow (CBF) in the cerebrum, cerebellum, and brainstem; and the Zung Self-Rating Depression Scale (SDS) were also evaluated.

Results

Dizziness was significantly improved in the cilostazol group versus the aspirin group (P<0.0001) after the 6-month therapy. The capacity for fixation suppression of the vestibulo-ocular reflex was improved (P<0.0001), and regional CBF in the cerebrum (relative to that in the brainstem [P=0.003] and to that in the cerebello-brainstem [P=0.012]) was increased only in the cilostazol group. There was no statistical difference in the change in SDS scores between the two groups.

Conclusion

Cilostazol improves the chronic dizziness that follows ischemic stroke and increases supratentorial CBF and cerebral function for adaptation of the brainstem reflex related to the sense of balance.

Keywords: Chronic dizziness, Ischemic stroke, Antiplatelet therapy, Cilostazol, Aspirin