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Research Background: Vitamin D insufficiency/deficiency is known to be related to occurrences and recurrences of benign paroxysmal positional vertigo (BPPV). However, the efficacy of vitamin D supplementation in reducing recurrences of BPPV remains to be established. We performed a meta-analysis to determine the therapeutic effects of vitamin D supplementation, with or without calcium, for preventing recurrences of BPPV., Methods: We searched the PubMed, the Embase, the Web of Science and the reference lists of the articles. We included randomized or non-randomized trials that determined the efficacy of supplementing vitamin D or related compounds, alone or with calcium, in comparison to placebo or no intervention in preventing recurrences of BPPV. The primary outcome was the number of patients with BPPV recurrences. Data were collected and pooled using a weighted relative risk (RR) with corresponding 95% CIs, where possible, by adopting the fixed-effect or random-effect model according to the heterogeneity among the studies. The between-study heterogeneity was tested using the χ 2 test and the I 2 statistic, and funnel plots were used to evaluate any publication bias., Results: We included five trials (four non-randomized trials and one randomized controlled trial) with a total of 1250 participants. The analyses showed a significant preventive effect on the recurrences of BPPV (RR = 0.37; 95% CI = 0.18-0.76; p = 0.007 with the random-effects model) with supplementation of vitamin D. Although a considerable heterogeneity was detected among the studies, the sensitivity analyses showed the reliability and stability of our results., Conclusions: Vitamin D supplementation provides a benefit for secondary prevention of BPPV. Supplementation of vitamin D should be considered in patients with frequent attacks of BPPV, especially when serum vitamin D is subnormal., (© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To assess the effect of vitamin D and calcium supplementation in preventing recurrences of benign paroxysmal positional vertigo (BPPV)., Methods: We performed an investigator-initiated, blinded-outcome assessor, parallel, multicenter, randomized controlled trial in 8 hospitals between December 2013 and May 2017. Patients with confirmed BPPV were randomly assigned to the intervention (n = 518) or the observation (n = 532) group after successful treatment with canalith repositioning maneuvers. The primary outcome was the annual recurrence rate (ARR). Patients in the intervention group had taken vitamin D 400 IU and 500 mg of calcium carbonate twice a day for 1 year when serum vitamin D level was lower than 20 ng/mL. Patients in the observation group were assigned to follow-ups without further vitamin D evaluation or supplementation., Results: The intervention group showed a reduction in the ARR (0.83 [95% confidence interval (CI), 0.74-0.92] vs 1.10 [95% CI, 1.00-1.19] recurrences per 1 person-year) with an incidence rate ratio of 0.76 (95% CI, 0.66-0.87, p < 0.001) and an absolute rate ratio of -0.27 (-0.40 to -0.14) from intention-to-treat analysis. The number needed to treat was 3.70 (95% CI, 2.50-7.14). The proportion of patients with recurrence was also lower in the intervention than in the observation group (37.8 vs 46.7%, p = 0.005)., Conclusions: Supplementation of vitamin D and calcium may be considered in patients with frequent attacks of BPPV, especially when serum vitamin D is subnormal., Classification of Evidence: This study provides Class III evidence that for patients with BPPV, vitamin D and calcium supplementation reduces recurrences of BPPV., (© 2020 American Academy of Neurology.)

Background and Purpose: Although acute attacks of benign paroxysmal positional vertigo (BPPV) may be treated with canalith repositioning maneuvers, there have been no well-designed prospective trials to prevent this highly prevalent and recurrent disorder. This topical review explores the evidence related to the association between deficient calcium metabolism and BPPV. We also describe the development of therapeutic options to prevent recurrences of BPPV and introduce results from a recent randomized controlled trial on the effect of vitamin D and calcium supplementation in preventing BPPV recurrences., Summary of Key Points: The literature describes 3 lines of evidence on association of impaired calcium metabolism and development of BPPV: (1) decreased bone mineral density was more frequently observed in persons with BPPV than in healthy controls; (2) estrogen plays a vital role in maintenance of otoconia, and estrogen deficiency appears to precipitate degeneration of otoconia and development of BPPV; and (3) lower serum vitamin D level is associated with development of BPPV, and supplementation of vitamin D and calcium carbonate may reduce further attacks of BPPV in persons with BPPV and subnormal serum vitamin D level., Recommendations for Clinical Practice: Restoration of impaired calcium metabolism with supplementation of vitamin D or estrogen should be considered in the treatment of individuals with frequent recurrences of BPPV. Future randomized controlled trials are mandatory to validate these supplementation therapies in individuals with recurrent BPPV.

The original article can be found online at https://doi.org/10.1007/s00415-024-12346-9.Correction to: Journal of Neurologyhttps://doi.org/10.1007/s00415-024-12346-9In the original version of this article, few parts of Table 1 were duplicated. The correct Table 1 should have beenGraphBy Eunjin Kwon; Hye Seon Jeong; Seong-Hae Jeong; Hyo-Jung Kim and Ji-Soo KimReported by Author; Author; Author; Author; Author [Extracted from the article]

Many investigations have found common occurrences of benign paroxysmal positional vertigo (BPPV) in women, and clinical experience has shown that BPPV can develop due to increased hormonal fluctuations, especially during menopause. Therefore, knowledge about neurochemicals and their involvement with BPPV is imperative for the management of neurological issues in women. This review will discuss appropriate gender-based considerations of BPPV based on experimental and clinical evidence. The studies describe 2 lines of evidence regarding the association of perimenopause in women and the development of BPPV: (1) experimental evidence: the existence of estrogen receptors in the inner ear, otoconial malformations in osteopenic/osteoporotic rats, changes in otoconin 90 caused by hormone replacement therapy, and impaired calcium absorption following estrogen deprivation corrected by estrogen replacement therapy and (2) clinical evidence: epidemiological aspects, osteoporosis and estrogen deficiency. Future studies are necessary to validate the effects of hormonal replacement therapy and phytoestrogen in women with recurrent BPPV. [ABSTRACT FROM AUTHOR]

Abstract: Background: In benign paroxysmal positional vertigo involving the horizontal canal (HC-BPPV), nystagmus may be induced by neck flexion in the pitch plane while sitting (head-bending nystagmus). Objective: To determine the characteristics and lateralizing value of head-bending nystagmus in HC-BPPV. Methods: Using video-oculography, head-bending nystagmus was recorded in 54 patients with HC-BPPV (32 canalolithiasis and 22 cupulolithiasis). Lesion side was determined by comparing intensity of the nystagmus induced by lateral head turning (head-turning nystagmus) in supine. Results: Head-bending nystagmus was observed in 39 patients (72.2%) and lying-down nystagmus in 41 (75.9%). Thirty three patients (61.1%) showed both types of nystagmus while six (11.1%) had only head-bending and another eight (14.8%) showed only lying-down nystagmus. In 45 patients with asymmetrical head-turning nystagmus, the direction of head-bending nystagmus was mostly toward the affected ear in canalolithasis (88.9%) and toward the intact ear in cupulolithasis (80.0%). In 9 (16.7%) patients whose affected ear could not be determined due to symmetrical head-turning nystagmus, the particle repositioning maneuver based on the direction of head-bending or lying-down nystagmus resulted in the resolution of symptom. Two patients showed a transition from canalo- to cupulolithiasis during head-bending posture. Conclusion: In HC-BPPV, neck flexion in the pitch plane while sitting may generate nystagmus by inducing ampullopetal migration of the otolithic debris in the horizontal canal or by ampullofugal deflection of the cupula by the attached otolithic debris. Head-bending nystagmus may be a valuable sign for lateralizing the involved canal in HC-BPPV, especially when patients show symmetrical head-turning nystagmus. Conversion of canalo- into cupulolithiasis by the neck flexion supports the current explanation of the mechanisms of HC-BPPV. [Copyright &y& Elsevier]