Is nimodipine effective for neuroprotection following cranial nerve injury?
Bottom line: Nimodipine significantly increased the odds of vocal fold motion and facial recovery after injury.
Background: Nimodipine is a calcium channel blocker that has been used to treat hypertension and vasospasm. Various otolaryngology studies suggest that nimodipine exerts a neuroprotective effect on injured neurons, but the exact mechanism remains unknown and no large, multi-institutional clinical trials exist to investigate its efficacy for treatment of various cranial nerve injuries.
Study design: Literature review of nine studies ranging in date from January 1, 1987, to October 11, 2017.
Setting: PubMed, Embase, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, Clinical Trials.gov, WHO International Clinical Trials Registry Platform, and EU Clinical Trials Register databases.
Synopsis: Overall, nimodipine-treated patients had significantly higher odds of recovering vocal fold or facial motion compared with controls. Nimodipine efficacy on vocal fold motion recovery following recurrent laryngeal nerve (RLN) injury was assessed in three studies; nimodipine treatment was associated with a statistically significant increase in odds of vocal fold motion recovery at three to six months after RLN injury. Nimodipine efficacy on facial motion recovery following facial nerve injury was assessed in three studies; nimodipine treatment was associated with a statistically significant moderate increase in odds of facial motion recovery at six to 12 months after vestibular schwannoma surgery. The effect of nimodipine on symptoms relating to the cochleovestibular nerve was investigated in three trials, which showed general improvement of patient-reported symptoms of subjective tinnitus and vertigo; study methodology and outcome measures were too heterogeneous to be combined for meta-analysis, however. Of the nine studies, five reported on adverse events associated with nimodipine treatment, with the most common being drowsiness and dizziness, likely secondary to hypotension. Limitations included heterogeneity of some of the studies related to the cochleovestibular nerve.
Citation: Lin RJ, Klein-Fedyshin M, Rosen CA. Nimodipine improves vocal fold and facial motion recovery after injury: a systematic review and meta-analysis.