Li Wenze, Liu Chang, Zhang Yuqing, Peng Maolin, Luo Xiuhang, Zhang Hongfa, Lan Hairong, Li Zhipeng, Chen Yankun, Li Zhen, Xiao Zhimin, Tong Linyan, Chen Yangmei
Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Neurol Ther. 2025 Jun;14(3):849-863. doi: 10.1007/s40120-025-00733-x. Epub 2025 Mar 31.
Persistent postural-perceptual dizziness (PPPD) is a chronic functional dizziness often triggered by vestibular, psychological, or environmental factors. Current treatments, including pharmacological and cognitive therapies, show limitations. In recent years, transcranial magnetic stimulation (TMS) has been explored in other neuropsychiatric disorders but has not been studied extensively for PPPD.
We aimed to evaluate the efficacy and safety of TMS of the left high-frequency dorsolateral prefrontal cortex (DLPFC) in improving dizziness and mood disorders in patients with PPPD in a single-blind, placebo-randomized controlled trial.
This trial recruited patients from October 8, 2023, to June 30, 2024, with follow-up completed on September 30, 2024, of 80 patients screened from the second affiliated hospital of Chongqing Medical University in China. Totals of 4 patients were excluded and 66 patients were randomized. PPPD patients were randomized to receive either TMS (10 Hz, 20 min) or SHAM-TMS treatments to the left DLPFC over ten sessions within 2 weeks. Dizziness severity, anxiety, and depression quality were assessed at baseline, post-treatment, and 1 and 3 months. Adverse events were also monitored.
Of 66 eligible patients [median (IQR) age, 54.5 (49.8-67.0) years; Of 42 women (63.6%)], 33 were randomized to the TMS group, and 33 were randomized to the SHAM-TMS group. After three months, a total of 52 participants (TMS group [n = 27]; SHAM-TMS group [n = 25)] completed the follow-up. At 2 weeks, 1 month, and 3 months post-treatment, the TMS group exhibited significant reductions in the levels of dizziness and anxiety compared to both their baseline measurements and the SHAM-TMS group at the same time points (all, p < 0.05). In the SHAM-TMS group, dizziness showed a significant improvement only at 2 weeks post-treatment compared to baseline (p < 0.05). Additionally, in the TMS group, Hamilton Depression Rating Scale (HAMD) scores decreased at both 2 weeks and 1 month relative to baseline. In contrast, the SHAM-TMS group displayed no significant changes in HAMD scores during the 3-month follow-up.
TMS targeting the DLPFC significantly alleviated symptoms of dizziness and anxiety in patients with PPPD. This non-invasive treatment may offer a safe and effective therapeutic alternative for managing PPPD symptoms. Further large-scale studies are recommended to confirm these findings.
ClinicalTrials.gov identifier, CTR2400093690.
持续性姿势 - 感知性头晕（PPPD）是一种慢性功能性头晕，常由前庭、心理或环境因素引发。目前的治疗方法，包括药物治疗和认知疗法，都存在局限性。近年来，经颅磁刺激（TMS）已在其他神经精神疾病中进行了探索，但尚未对PPPD进行广泛研究。
我们旨在通过一项单盲、安慰剂随机对照试验，评估左侧高频背外侧前额叶皮质（DLPFC）的TMS在改善PPPD患者头晕和情绪障碍方面的疗效和安全性。
本试验于2023年10月8日至2024年6月30日招募患者，对从中国重庆医科大学附属第二医院筛选出的80例患者进行随访，随访于2024年9月30日完成。共有4例患者被排除，66例患者被随机分组。PPPD患者被随机分为接受TMS（10Hz，20分钟）或假TMS治疗，对左侧DLPFC进行为期2周的十次治疗。在基线、治疗后、1个月和3个月时评估头晕严重程度、焦虑和抑郁情况。同时监测不良事件。
66例符合条件的患者[年龄中位数（IQR）为54.5（49.8 - 67.0）岁；42例女性（63.6%）]，33例被随机分配到TMS组，33例被随机分配到假TMS组。三个月后，共有52名参与者（TMS组[n = 27]；假TMS组[n = 25]）完成随访。在治疗后2周、1个月和3个月时，与基线测量值以及假TMS组在相同时间点相比，TMS组的头晕和焦虑水平显著降低（均p < 0.05）。在假TMS组中，与基线相比，仅在治疗后2周时头晕有显著改善（p < 0.05）。此外，在TMS组中，汉密尔顿抑郁量表（HAMD）评分在2周和1个月时相对于基线均有所下降。相比之下，假TMS组在3个月的随访期间HAMD评分无显著变化。
针对DLPFC的TMS显著减轻了PPPD患者的头晕和焦虑症状。这种非侵入性治疗可能为管理PPPD症状提供一种安全有效的治疗选择。建议进一步开展大规模研究以证实这些发现。
ClinicalTrials.gov标识符，CTR2400093690。
