Efficacy and Safety Analysis of Repetitive Transcranial Magnetic Stimulation in Patients with Persistent Postural Perceptual Dizziness: A Single-Center, Single-Blind, Randomized Placebo-Controlled Trial

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.