Data-driven vestibular fMRI in PPPD and residual dizziness after BPPV: a narrative methodological review of AI-based phenotyping and longitudinal modeling

Neuroimaging studies of vertigo and chronic dizziness have identified abnormalities across vestibular, visual, somatosensory, and cognitive-emotional networks, but conventional group-level analyses are limited in capturing individual heterogeneity and longitudinal change....

Continue reading at PubMed

✦ The floor

Discussion

Signed responses from readers of the wire.

✦ Clinical Takeaway ✦

No actionable clinical change — this is a methodological review proposing AI-assisted fMRI frameworks for vestibular research; findings are not yet ready to influence routine clinical practice.

✦ Why It Matters ✦

Establishing rigorous AI-driven neuroimaging methods for vestibular disorders like PPPD could accelerate the development of objective biomarkers, addressing a major diagnostic gap in dizziness medicine.

✦ Key Points ✦

01Reviews AI-based phenotyping and longitudinal modeling using vestibular fMRI in PPPD and post-BPPV residual dizziness.
02PPPD (persistent postural-perceptual dizziness) is a chronic functional dizziness disorder with no current objective biomarker.
03Residual dizziness after BPPV treatment affects a significant subset of patients and lacks clear mechanistic explanation.
04The narrative review format limits evidence strength; no new experimental data are presented.
05Published in Frontiers in Neurology (DOI: 10.3389/fneur.2026.1915520).

✦ Claims & Evidence ✦

ClaimEvidenceSupport

AI-based phenotyping and longitudinal fMRI modeling can improve understanding of PPPD and residual dizziness after BPPV.

opinionpartially supported

✦ Research metadata ✦

PMID: 42846342
DOI: 10.3389/fneur.2026.1915520.
Journal: Frontiers in Neurology
Publication type: review
Evidence level: 5
Population: Patients with PPPD and residual dizziness following BPPV treatment
Intervention: Data-driven vestibular fMRI with AI-based phenotyping and longitudinal modeling

Primary outcomes

Methodological frameworks for AI-based vestibular fMRI phenotyping; Longitudinal modeling approaches for dizziness disorder characterization

✦ Related stories ✦

PubMed·Clinical trial·Vestibular·2mo ago

Endolymphatic duct blockage for Ménière's disease: a double-blind, randomised controlled trial

Await full results publication and effect-size data before adopting endolymphatic duct blockage; findings from this RCT may eventually shift surgical management of Ménière's disease, but no practice change is warranted until the complete trial data are reviewed.

PubMed·Journal article·Vestibular·3mo ago

Effects of Vestibular Rehabilitation with Virtual Reality in Adults with Vestibular Dysfunction: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis provides the strongest available evidence class on VR-based vestibular rehabilitation; if results are positive, audiologists and vestibular therapists should consider VR as an adjunct or alternative to conventional rehab, pending review...

PubMed·Journal article·Vestibular·6w ago

Targeted Vestibular Rehabilitation Accelerates Symptom Relief by Promoting Vestibular Compensation in BPPV Patients With Residual Symptoms: Evidence From Resting-State fMRI

Targeted vestibular rehabilitation therapy should be considered for BPPV patients with residual dizziness after canalith repositioning, as fMRI evidence now provides a neurological basis for its benefit in this subgroup.

PubMed·Journal article·Vestibular·3mo ago

Betahistine for residual dizziness after canalith repositioning in benign paroxysmal positional vertigo: a systematic review of randomized controlled trials

Audiologists and vestibular specialists managing post-CRM residual dizziness in BPPV patients should review this systematic review's pooled findings; if betahistine shows significant benefit, it may warrant a protocol update in collaboration with referring physicians.

PubMed·Clinical trial·Vestibular·2w ago

Efficacy of Incremental Vestibular Ocular Reflex Adaptation Training on Gait, Balance, and Quality of Life in Individuals With Chronic Peripheral Vestibular Hypofunction: A Randomized Controlled Trial

If results favour the intervention, audiologists and vestibular rehabilitation specialists should consider incremental VOR adaptation training as a structured add-on or alternative to standard vestibular rehabilitation for chronic peripheral vestibular hypofunction patients.

PubMed·Journal article·Vestibular·4mo ago

Comparative efficacy of non-pharmacological interventions for persistent postural-perceptual dizziness: a systematic review and network meta-analysis of balance, anxiety, and depression outcomes

Audiologists and vestibular specialists managing PPPD should review the ranked treatment outcomes from this network meta-analysis to inform which non-pharmacological interventions — such as vestibular rehabilitation, CBT, or mindfulness — are most likely to address balance,...

PubMed·Journal article·Vestibular·3mo ago

Internet-based vestibular rehabilitation versus written instructions after acute vertigo: A randomised controlled trial

If internet-based vestibular rehabilitation proves superior to written instructions, clinicians treating acute vestibular syndrome in emergency settings should consider recommending structured online rehab programs as a first-line follow-up resource — pending full review of the...

PubMed·Journal article·Vestibular·4mo ago

Efficacy of Vestibular Rehabilitation Therapy on Benign Paroxysmal Positional Vertigo After Repositioning: Improvement of Vestibular Symptoms and Vertigo Disability

Audiologists and vestibular specialists should consider recommending vestibular rehabilitation therapy following canalith repositioning in BPPV patients, as this RCT-level evidence suggests it meaningfully reduces residual vestibular symptoms and vertigo-related disability.