Targeted Vestibular Rehabilitation Accelerates Symptom Relief by Promoting Vestibular Compensation in BPPV Patients With Residual Symptoms: Evidence From Resting-State fMRI.

AIMS: Residual dizziness (RD) is commonly observed in patients with benign paroxysmal positional vertigo (BPPV) following successful canalith repositioning procedures. Targeted vestibular rehabilitation therapy (tVRT) is a novel strategy designed to address specific vestibular deficits. This study aims to investigate whether tVRT can accelerate the vestibular rehabilitation process in patients with RD of BPPV and explore its neural mechanisms. METHODS: Ninety-four BPPV patients with RD were enrolled and received a 4-week tVRT program tailored to utricular deficits. A rs-fMRI subgroup (n = 43) was used to assess brain activity and functional connectivity (FC) before and after successful intervention. RESULTS: The tVRT group demonstrated significantly lower DHI and SAS scores and higher ABC score. rs-fMRI revealed that tVRT increased ALFF in the right superior temporal gyrus (STG), positively correlated with ABC scores, and enhanced ReHo in the right anterior cingulate cortex (ACC). The tVRT group showed enhanced STG-cerebellar tonsil connectivity, along with reduced STG-posterior cingulate cortex connectivity. Using right ACC as seed, FC between the ACC and lingual gyrus was increased. STG-cerebellar tonsil FC was negatively correlated with RD duration. CONCLUSION: tVRT accelerates vestibular compensation in patients, which may be mediated by enhanced neural activity and reorganization of brain networks involved in vestibular processing.