You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Nimodipine Improves Reinnervation and Neuromuscular Function after Injury to the Recurrent Laryngeal Nerve in the Rat
Abstract 1:
Objectives : Injury of the recurrent laryngeal nerve ( RLN ) is associated with a high degree of neuronal survival , but leads to various levels of vocal fold motion impairment or laryngeal synkinesis , which has been attributed to misdirected reinnervation of the target muscles in the larynx or aberrant , competing reinnervation from adjacent nerve fibers . The aim of the present study was to evaluate the impact of the regeneration-promoting agent nimodipine on reinnervation and neuromuscular function following RLN crush injury . Methods : Sixty adult rats were r and omized into nimodipine-treated or untreated groups and then underwent RLN crush injury .  Reinnervation of the posterior cricoarytenoid muscle ( PCA ) was assessed by electrophysiological examination , retro grade tracing of lower motor neurons before and after injury , and quantification of neuromuscular junctions in the PCA muscle . Results : At 6 weeks after injury , the nimodipine-treated animals showed significantly enhanced neuromuscular function and also demonstrated a higher number of motor neurons in the brain stem that had reinnervated the PCA , compared to the untreated animals . The somatotopic organization of ambiguus motor neurons innervating the larynx was similar before injury and after reinnervation . Conclusions : Nimodipine improves regeneration and neuromuscular function following RLN injury in the adult rat , and could be of use in future strategies following RLN injury


Title 2:
Nimodipine promotes regeneration of peripheral facial nerve function after traumatic injury following maxillofacial surgery: an off label pilot-study.
Abstract 2:
BACKGROUND Animal tests , retro- and prospect i ve clinical trials in neurosurgical departments have shown a beneficial effect of nimodipine on the preservation and recovery of facial and acoustic nerve function following vestibular schwannoma surgery . Encouraged by these positive results a pilot- study of nimodipine treatment in patients with a peripheral facial nerve ( FN ) paresis following maxillofacial surgery was performed . The rate and time of FN recovery were analysed and compared with the results in the literature . METHODS Thirteen patients ( n = 13 ) suffering from a moderate ( 1/13 ) up to a severe ( 12/13 ) peripheral FN paresis after maxillofacial surgery were treated with orally administered nimodipine . The anatomical main course of the FN was preserved in all patients with a 2nd to 3rd degree of Sunderl and -injury ( Sunderl and , 1951 ) . After no evidence of a spontaneous regeneration had shown , oral medication with nimodipine was started as an " off-label " use . RESULTS An improvement of the FN function correlated to the start of the vasoactive medication and as a consequence a recovery of the FN function up to House-Brackmann ( HB ) grade I ° -II ° was observed in all the patients within a period of 2 months after the beginning of treatment ( p = 0.00027 ) . CONCLUSIONS The clinical observations in these patients suggest a positive effect of nimodipine on the acceleration of peripheral FN regeneration after surgically caused trauma . The results of this pilot- study are very promising . A prospect i ve study with a larger number of patients is planned to approve the beneficial effect of nimodipine on the peripheral FN in maxillofacial or otorhinolaryngological surgery


Title 3:
Prospective investigation of nimodipine for acute vocal fold paralysis.
Abstract 3:
INTRODUCTION Nimodipine has been shown to be beneficial for recovery from acute vocal fold paralysis ( AVFP ) in an animal model . METHODS prospect i ve , open-label trial of patients with AVFP was performed using nimodipine . Consecutive patients were evaluated and offered nimodipine therapy . RESULTS Fifty-three patients were considered for treatment with nimodipine .  Thirteen did not qualify for inclusion , 5 were lost to follow-up , and 7 had side effects requiring cessation of treatment . Thus 28 patients ( 30 paralyzed vocal folds ) were analyzed . Eighteen of the paralyzed vocal folds experienced recovery of purpose ful motion ( 60 % ) . Historical controls and laryngeal electromyography meta- analysis suggest no more than a 20 % recovery rate from AVFP . CONCLUSIONS This open label study using nimodipine for treatment of AVFP demonstrates tripling of the recovery rate of vocal fold motion compared with historical controls . Further study in a r and omized , controlled manner is warranted


Title 4:
New Approaches to the Management of Peripheral Vertigo: Efficacy and Safety of Two Calcium Antagonists in a 12-week, Multinational, Double-Blind Study
Abstract 4:
Objective To evaluate the efficacy and safety profile of one 30-mg nimodipine oral tablet taken three times per day ( one tablet with breakfast , one with lunch , and one with dinner ) or one 150-mg cinnarizine verum oral capsule taken once each day with dinner for 12 weeks . Study Design Comparative in a double-blind , multinational pilot study . Setting Tertiary referral center . Patients A total of 221 patients met the study criteria ; of that total , 181 adult patients completed the study , including 135 women and 46 men whose ages ranged from 20 to 80 years . Interventions Two calcium antagonists were used to treat vertigo ( nimodipine , 89 patients ; cinnarizine , 92 patients ) , and all patients were maintained on the same dosage regimen until they completed 12 weeks of treatment . Patients were evaluated at 2- and 4-week intervals ; an additional evaluation was made at Week 14 to determine vertigo recurrence in the posttreatment period . Main Outcome Measures The response was evaluated by using the vertigo severity index , a count of vertigo episodes in a given time period . Each episode is weighted according to its intensity . Results Nimodipine treatment decreased the incidence of moderate vertigo episodes by 78.8 % and decreased severe vertigo episodes by 85.0 % . Cinnarizine treatment decreased the incidence of moderate vertigo episodes by 65.8 % and decreased severe vertigo episodes by 89.8 % . Nimodipine and cinnarizine exhibited similar safety profiles . Only two patients withdrew from the study because of adverse events possibly related to the study drug . One patient withdrew from the cinnarizine group because of headache , and one patient withdrew from the nimodipine group because of lipothymia . Conclusion These data confirm the marked efficacy of both nimodipine and cinnarizine in the treatment of vestibular vertigo


Title 5:
Diagnosis and Prognosis of Iatrogenic Injury of the Recurrent Laryngeal Nerve
Abstract 5:
Objectives : Following perioperative injury to a macroscopically intact recurrent laryngeal nerve ( RLN ) , there are two possible intraneural injury types : 1 ) axonal injury , including disruption of axons , and 2 ) conduction block , only affecting the Schwann cells and the nodes of Ranvier . In this study , it was hypothesized that the functional outcome after RLN injury may depend on the type of nerve injury . Methods : Fifteen patients with acute postoperative unilateral RLN paralysis were prospect ively studied .  Electrophysiological examination ( laryngeal electromyography ) was used to differentiate between the two types of nerve injury . Vocal fold motions were monitored by repeated laryngoscopy during the study period ( up to 6 months ) . Three of the patients with axonal injury were treated with the regeneration-promoting agent nimodipine . Results : The patients with conduction block all recovered normal vocal fold motion , whereas patients with axonal injury within the nerve had a significantly worse outcome . The 3 patients who were treated with nimodipine all recovered normal or near-normal vocal fold mobility despite the more severe axonal injury . Conclusions : In contrast to previous reports , our results show that laryngeal electromyography is a reliable tool for diagnosing the type of injury within the injured RLN , making it possible to predict the functional outcome in these patients . On the basis of the results , a future r and omized study on nimodipine treatment for RLN axonal injury is suggested


Title 6:
Evaluation of the effect of nimodipine o.d. (extended release) vs nimodipine t.i.d. in the treatment of peripheral vertigo.
Abstract 6:
SUMMARY Vertigo has a negative impact on quality of life ; therefore , it is important to find an effective and convenient therapy that allows patients to continue their everyday tasks as soon as possible and to have a better quality of life . METHODS There were two formulations used to assess the effectiveness in vertigo treatment from peripheral origin : nimodipine administrated three times daily ( Nimotop ® ) 30 mg versus nimodipine AP administrated once daily ( Tropocer ® ) 90 mg ; both of them in a administrated in a prospect i ve , r and omized , double-blind , double dummy , multicenter and parallel-group study , where patients with peripheral vertigo defined as a score ≥7 on the Vertigo-Dizziness Differential Diagnosis Score were included . The patients were evaluated by vertigo severity index and vestibular disability index . RESULTS In the AP nimodipine group ( NAP ) , vertigo severity index was decreased by 50 % : 24 % of patients in 14 days , 41 % in 4 weeks and 89 % in 8 weeks . The vestibular disability index was decreased by 50 % : 24 % of patients in 15 days , 83 % in 4 weeks and 92 % of patients in 8 weeks . In the conventional nimodipine group ( NC ) , rate of vertigo severity was decreased by 50 % : 17 % of patients in 14 days , 41 % of patients in 4 weeks and 90 % of patients in 8 weeks . The vestibular disability index was decreased by 50 % : 15 days in 17 % of patients , 53 % in 4 weeks and 64 % in 8 weeks , without difference between groups . CONCLUSIONS both products were effective and well tolerated in the treatment of peripheral vertigo
Existing evidence supports the positive effect of nimodipine on vocal fold and facial motion recovery after injury .