Trial data suggest that management of vitamin D deficiency should be considered in patients with frequent attacks of benign paroxysmal positional vertigo.
Results from an investigator-initiated, blinded-outcome-assessor, parallel, randomized controlled trial (NCT02031692) suggest that the supplementation of vitamin D and calcium may be considered in patients with frequent attacks of benign paroxysmal positional vertigo (BPPV), especially when serum vitamin D is subnormal.
BPPV, characterized by brief attacks of vertigo that are induced by a change in head position with respect to gravity, occur frequently with a 1- to 10-year recurrence rate of 15% to 56%. Study author Seong-Hae Jeong, MD, PhD, department of neurology, Chungnam University Hospital, and colleagues aimed to assess the effect of vitamin D and calcium supplementation in preventing recurrences of BPPV.
They observed that those assigned to the intervention group (n = 518), who 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, had a reduction in the annual recurrence rate (ARR, 0.83; 95% CI, 0.74—0.92; recurrences per 1-person year) from the intention-to-treat analysis (ARR, 1.10; 95% CI, 1.00–1.19).
Furthermore, the intervention group had an incidence rate ratio (IRR) of 0.76 (95% CI, 0.66—0.87; P <.001) and an absolute rate ratio of —0.27 (95% CI, –0.40 to –0.14) from the intention-to-treat analysis.
“Until now, canalith repositioning maneuvers have been the only verified treatments of BPPV when it occurred, and no medical treatments have been available to prevent recurrences in this highly prevalent and recurrent disorder,” Jeong and colleagues concluded.
The intervention group also had a lower proportion of patients with recurrence compared to the observation group (37.8% vs 46.7%; P = .005). Additionally, the effect of prevention was more prominent in those with decreased serum vitamin D at baseline (serum vitamin D <20 ng/ml). The frequencies of unexpected fall and fracture did not differ between the groups (P >.05), and both groups showed a significant improvement in the quality of life (QOL) scored with UCLA Dizziness Questionnaire (UCLA-DQ).
Prevention of BPPV was similar throughout all subgroups, except for those younger than 65, without vascular risk factors, or with a history of migraine (P <.05 for all tests). Values remained similar across all tests except the involved canals and types of BPPV, and ability for independent walking.
Additionally, Jeong and colleagues noted that BPPV’ status as a non-life-threatening disorder, from the aspect of cost-effectiveness, the potential benefit of vitamin D and calcium is validated. They estimated that those with BPPV in the United States experience annual costs of $2684.74.
As well, the authors acknowledged the interesting finding that those with migraine (intervention group, n = 111 [24.9%]; observation group, n = 117 [23%]) did not benefit from vitamin D and calcium supplementation compared to those without migraine. “There is a fair amount of overlap between BPPV and atypical/ vestibular migraine, and this finding may suggest those with migraine may have been misclassified and instead had vestibular migraine,” they wrote.
Adverse events (AEs) occurred in 26 patients in the intervention group and 3 from the prevention group. In total, 8 of them were related to the study drug and 2 were related to other adverse events. Discontinuation of calcium supplementation occurred in 2 patients, 2 months after initiation due to hypercalcemia.
Jeong SH, Kim JS, Kim HJ, et al. Prevention of benign paroxysmal positional vertigo with Vit D supplementation: A randomized trial. Neurology. Published online August 5, 2020. doi: 10.1212/WNL.0000000000010343