Motion sickness - what to do?

From a 2011 BMJ review:

Travel by car, train, or other transport is part of everyday life for most people, and therefore motion sickness is a quite common problem. It was recognized in the early days of sea travel and the word for sickness, “nausea,” derives from the Greek word νανς, meaning “ship.”

Motion sickness is also a potentially disabling problem, thought to be due to sensory conflict or “mismatch” involving the vestibular system.

Symptoms can be provoked by:

- externally imposed motion
- implied self motion from a moving visual field, such as in a cinema

Symptoms

Motion sickness manifests with:

- nausea, vomiting, and stomach awareness
- increased salivation
- belching
- pallor
- sweating
- headache
- dizziness
- apathy, drowsiness, and malaise
- hyperventilation

Habituation

Behavioral treatments such as habituation can be effective but at the same time they can be unpleasant and time consuming

Hyoscine

Hyoscine is an effective preventive medication. There are oral forms and transdermal patches. Hyoscine nasal spray is also effective in preventing motion sickness

Evidence to support the use of other drugs is weaker, especially taking into account the trade off between efficacy and adverse effects. Traditional remedies such as ginger and acupressure bands have not been effective.

References:

Managing motion sickness. BMJ Review 2011; 343 doi: 10.1136/bmj.d7430
Image source: OpenClipArt.org, public domain.

African trypanosomiasis - killer coma - the evolving story of sleeping sickness (Lancet review)

Human African trypanosomiasis (sleeping sickness) occurs in sub-Saharan Africa. It is caused by the protozoan parasite Trypanosoma brucei, transmitted by tsetse flies.

With 12,000 cases of this disabling and fatal disease reported per year, trypanosomiasis belongs to the most neglected tropical diseases.

Life cycle of the Trypanosoma brucei parasites. Source: CDC, Wikipedia, public domain.

The clinical presentation is complex, and diagnosis and treatment difficult. The available drugs are old, complicated to administer, and can cause severe adverse reactions.

Imagine a disease that starts with a fly's bite and ends in death. The first stage of this disease causes non-specific symptoms such as itching and joint pains. If left untreated, it progresses to the second stage weeks, months, or even years later in which the affected person displays dramatic neurological and psychiatric symptoms before slipping into a fatal coma.

New diagnostic methods and safe and effective drugs are urgently needed. There is no field-friendly diagnostic test.  Until recently, the most effective treatment for the second stage as almost as dangerous as the disease.

Vector control, to reduce the number of flies in existing foci, needs to be organised on a pan-African basis.

References:
[Seminar] Human African trypanosomiasis. Reto Brun, Johannes Blum, Francois Chappuis, Christian Burri. The Lancet, Jan 2010.
Killer coma: the evolving story of sleeping sickness treatment. The Lancet, Volume 375, Issue 9709, Page 93, 9 January 2010.