Prevention of Recurrent Benign Paroxysmal Positional Vertigo: The Role of Combined Supplementation with Vitamin D and Antioxidants

Abstract

Benign paroxysmal positional vertigo (BPPV) usually has a favorable course, although it is possible to observe BPPV with a high recurrence rate. Previous studies suggested that vitamin D deficiency might affect BPPV recurrences, and oxidative stress might play a complementary role in BPPV pathogenesis. This multicentric trial aimed to evaluate the effectiveness of oral nutritional supplementation with a compound of alpha-lipoic acid, Carnosine, and Zinc (LICA® (Difass International, Coriano (RN), Italy)), vitamins of group B and vitamin D in preventing BPPV recurrences. A total of 128 patients with high recurrence-BPPV were randomized in three arms: Arm 1 consisted of subjects with “insufficient” or “deficient” vitamin D blood levels, treated with daily oral supplementation of LICA®, vitamins of group B and vitamin D3 (800 UI), Arm 2 included BPPV subjects with “sufficient” vitamin D who did not receive any nutritional support, and Arm 3 included subjects with a “sufficient” serum concentration of vitamin D who received supplementation with a compound of LICA® and Curcumin. After six months of follow-up, a significant reduction of BPPV relapses compared to the baseline was found only in Arm 1 (−2.32, 95% CI: 3.41–1.62, p-value < 0.0001). Study results suggested that oral nutritional supplementation with vitamin D3 plus antioxidants can prevent relapses in patients suffering from high recurrence-BPPV.

Vitamin D Supplementation and Recurrence of Benign Paroxysmal Positional Vertigo

“…We conducted a review of the study results on vitamin D supplementation for preventing recurrences of BPPV within the last 3 years ( Table 2 ). Out of the five articles examined, the majority, four out of five, reported that vitamin D supplementation in BPPV patients effectively prevented recurrence of BPPV [ 19 , 20 , 21 , 29 ]. Consistently, these studies showed that the group supplemented with vitamin D exhibited a lower recurrence rate compared to the control group without vitamin D supplementation.…”

“…Libonati et al conducted a study reporting that oral nutritional supplementation with vitamin D3 plus antioxidants could prevent relapses in patients suffering from high-recurrence BPPV, assessing the BPPV recurrence rate based on patients experiencing two or more episodes of BPPV within the previous 6 months or at least three episodes in the previous 12 months [ 21 ]. A total of 128 patients with high-recurrence BPPV involving the posterior semicircular canal or the lateral semicircular canal (both in geotropic and apogeotropic forms) were randomized into three arms.…”

“…A total of 128 patients with high-recurrence BPPV involving the posterior semicircular canal or the lateral semicircular canal (both in geotropic and apogeotropic forms) were randomized into three arms. After 6 months of follow-up, only Arm 1 exhibited a significant reduction in BPPV relapses compared to the baseline (−2.32, 95% confidence interval (CI) = −3.41–−1.62, p < 0.0001), with serum vitamin D levels of 18.2 ng/mL and 36.9 ng/mL for Arm 1 and Arm 2, respectively [ 21 ].…”

“…In this study, we aimed to explore recent research findings on vitamin D supplementation therapy for BPPV after 2020 through a clinical review. While previous studies focused on differences in recurrence rates between control and intervention groups [ 16 , 17 , 18 ], recent research results demonstrate the efficacy of vitamin D supplementation in reducing recurrence frequency, particularly in patients with frequent recurrences of BPPV [ 19 , 20 , 21 ]. While previous studies did not find significant differences in recurrence rates between patients experiencing multiple recurrences and those with a single recurrence, recent research suggests that vitamin D supplementation has an effect on reducing the number of recurrences.…”

Recurring benign paroxysmal positional vertigo after successful canalith repositioning manoeuvers

“…Regarding vitamin D deficiency, a previous meta-analysis demonstrated that it was an independent risk factor for BPPV occurrence and recurrence 38 ; this correlation may be explained by the fact that vitamin D deficiency may disrupt calcium metabolism in the inner lymphatic fluid and bone metabolism, leading to osteoporosis and increasing the risk of BPPV 39 . A recent multicentric study suggested that oral nutritional supplementation with vitamin D3 may prevent relapses in patients suffering from a high number of recurrent episodes of BPPV 40 . Further large-scale studies are necessary to establish the role of vitamin D supplementation in prevention of BPPV recurrence.…”