Reham Ali Mohamed Ahmed, Ayman A Mohamed, Ahmed Youssef, Ebtesam Fahmy, Hussein Sherif Hamdy, Hesham Nafia, Islam H Fayed, Sara S El-Din
These findings suggest that rTMS may enhance VR outcomes and support its potential as a clinical application in patients with chronic vestibular dizziness.
OBJECTIVE: To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on dizziness, balance, and postural stability in adult patients with chronic vestibular dizziness.
DESIGN: A double-blind randomized controlled trial.
SETTING: Outpatient clinic.
PARTICIPANTS: Fifty-six adults with chronic vestibular dizziness were randomly assigned to study group and control groups. Baseline symptoms had persisted for a mean of (14.3mo), median (14mo), and range (6-28mo; N=56).
INTERVENTION: The study group received rTMS and vestibular rehabilitation (VR), whereas the control group received sham stimulation as rTMS and VR. The treatment period lasted for 8 weeks. The rTMS was applied at a frequency of 10 Hz and 90% of the resting motor threshold. The rTMS and VR were implemented 3 sessions per week (24 VR sessions per participant).
MAIN OUTCOME MEASURES: The primary outcome measures included Visual Vertigo Analogue Scale (VVAS) and Berg Balance Scale(BBS). The secondary outcome measures included computerized dynamic posturography (somatosensory component, visual component, vestibular component, preference component, and total equilibrium composite).
RESULTS: After 8 weeks, the study group showed significant improvements more than the control group in all outcomes measures, including VVAS, BBS, and all domains of computerized dynamic posturography (P<.05). Notable effects included VVAS (-2.1; 95% confidence interval [CI], -2.8 to -1.4; d=1.02), BBS (+6.3; 95% CI, 4.2-8.4; d=1.15), and total equilibrium composite (+6.9; 95% CI, 4.7-9.1; d=1.10), indicating large clinical impact. Clinically meaningful changes included: VVAS reduction of 2.1 points (95% CI, -2.8 to -1.4; Cohen's d=1.02, large effect), BBS improvement of 6.3 points (95% CI, 4.2-8.4; Cohen's d=1.15, large effect). These effect sizes represent clinically significant improvements in symptom severity and balance function.
CONCLUSION: These findings suggest that rTMS may enhance VR outcomes and support its potential as a clinical application in patients with chronic vestibular dizziness.