A new study in Neurology suggests that a simple and inexpensive treatment might reduce recurrence of vertigo, however. The recommendation is to take vitamin D and calcium twice a day and is based on recent Korean research.
“Our study suggests that for people with benign paroxysmal positional vertigo, taking a supplement of vitamin D and calcium is a simple, low-risk way to prevent vertigo from recurring,” explained Ji-Soo Kim, MD, PhD, of Chungnam National University College of Medicine in Korea. “It is especially effective if you have low vitamin D levels to begin with.”
The condition occurs when a change in head position causes a sudden spinning sensation. Treatment includes having a medical professional perform a series of head movements that shift particles in the ears that cause the vertigo, but recurrence is frequent.
About 86% of patients with that type of vertigo report that it interrupts their daily life or causes them to miss work.
The study was an investigator-initiated, blinded-outcome-assessor, parallel, multicenter, randomized controlled trial in eight hospitals between December 2013 and May 2017. Researchers divided about 850 patients with confirmed BPPV into two groups after a successful treatment with canalith repositioning maneuvers. Defined as 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 their serum vitamin D level was lower than 20 ng/ml. Patients in the observation group, on the other hand, had follow-ups without further vitamin D evaluation or supplementation.
Researchers report that the intervention group showed a reduction in the ARR [0.83 (95% CI, 0.74-0.92) versus 1.10 (95% CI, 1.00-1.19) recurrences per one person-year] with an incidence rate ratio of 0.76 (95% CI, 0.66-0.87, P <.001) and an absolute rate ratio of -0.27 (-0.40 to -0.14) from intention-to treat-analysis. They calculated that the number needed to treat was 3.70 (95% CI, 2.50-7.14), adding that the proportion of patients with recurrence was also lower in the intervention than in the observation group (37.8 vs. 46.7%, P = .005).
“Supplementation of vitamin D and calcium may be considered in patients with frequent attacks of BPPV, especially when serum vitamin D is subnormal,” according to the authors, who add that their study provides Class III evidence that for patients with BPPV, vitamin D and calcium supplementation reduces recurrences of BPPV.
The study advises that patients using the supplements had an average recurrence rate of 0.83 times per person-year, compared with 1.10 times per person-year for those in the observation group, a 24% reduction in the annual recurrence rate.
The authors also emphasize that the benefit appeared greater in patients who were more deficient in vitamin D at the start of the study. Specifically, those who started with vitamin D levels lower than 10 ng/mL saw a 45% reduction in annual recurrence rate, while those starting with vitamin D levels at 10 to 20 ng/mL saw only a 14% reduction. Overall, they add, 38% of the participants in the intervention group had another vertigo episode versus 47% of those in the observation group.
“Our results are exciting because so far, going to the doctor to have them perform head movements has been the main way we treat benign paroxysmal positional vertigo,” said Dr. Kim. “Our study suggests an inexpensive, low-risk treatment like vitamin D and calcium tablets may be effective at preventing this common, and commonly recurring, disorder.”
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