Increased parietal operculum functional connectivity following vestibular rehabilitation in benign paroxysmal positional vertigo patients with residual dizziness: a randomized controlled resting-state fMRI study

Introduction: Residual dizziness (RD) is common in patients with benign paroxysmal positional vertigo (BPPV) after successful canalith repositioning procedures. This study aimed to investigate the therapeutic effects of vestibular rehabilitation (VR) on BPPV patients experiencing RD, and to explore the impact of VR on functional connectivity (FC), specifically focusing on the bilateral parietal operculum (OP) cortex.

Methods: Seventy patients with RD were randomly assigned to either a four-week VR group or a control group that received no treatment. Assessments included the dizziness Visual Analog Scale (VAS), Dizziness Handicap Inventory (DHI), Hamilton Anxiety/Depression Scale (HAMA/HAMD), and resting-state functional magnetic resonance imaging.

Results: The VR group exhibited a significant decline in scores on VAS, DHI, HAMA and HAMD following training (all p < 0.05). Furthermore, the VR group demonstrated increased FC between the left OP and both the left precuneus and left middle frontal gyrus (MFG), and between the right OP and the right MFG (voxel-level p < 0.001; cluster-level p < 0.05, FDR corrected). Additionally, these changes in FC were found to correlate with clinical features, including scores on HAMA (p = 0.012, r = - 0.513) and DHI (p = 0.022, r = - 0.475) after the intervention.

Conclusion: This study demonstrated the therapeutic effects of VR in alleviating RD and emotional disorders, as well as in improving overall quality of life. Notably, these positive outcomes might be associated with increased FC between brain regions involved in mood regulation and vestibular processing. Our findings offer novel neuroimaging evidence that supports the hypothesis that VR facilitates dynamic vestibular compensation.