Repetitive transcranial magnetic stimulation as add-on therapy in persistent postural-perceptual dizziness

Abstract

Abstract Background To observe the clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) as add-on therapy for patients with PPPD. Methods In this randomized, double-blind, sham-controlled trial, we assigned patients diagnosed with PPPD in a 1:1 ratio to receive active or sham rTMS treatment as add-on therapy over the existing routine treatments. The primary efficacy end point was the levels of vertigo, anxiety and depression at baseline, 2 weeks and 4 weeks of treatment as indicated by the Dizziness Impairment Inventory (DHI), Hamilton Anxiety Inventory (HAMA) and Hamilton Depression Inventory (HAMD), respectively. The primary safety endpoint was the adverse events. Results Twenty-two participants were assigned to undergo active rTMS (10 Hz for 20 min in the left dorsolateral prefrontal cortex (DLPFC) once a day, 5 times a week for 20 sessions) and 22 to sham rTMS. The HAMA, HAMD and DHI scores at the end of 2 or 4 weeks significantly decreased in rTMS group as compared with sham rTMS group (P༜0.05). There was a correlation between the decrease in DHI score and the decrease in HAMA and HAMD scores. The incidence of adverse reactions in rTMS group was 9% (2/22), which was not statistically significant as compared with sham rTMS group (P > 0.05). Conclusions This pilot study shown that rTMS is beneficial to patients with PPPD as add-on therapy. Further multi-centered, large-scale randomized clinical trials are warranted.