Vitamin D and homocysteine in benign paroxysmal positional vertigo

Abstract

Introduction. Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. Among the possible pathophysiological concepts, the largest evidence to date has been collected on the relationship of BPPV with a lack of vitamin D. Few studies have also been published on the assessment of factors of endothelial dysfunction (and, as a result, disturbances in the microcirculation of the inner ear) and BPPV. The problems of metabolic disorders in BPPV were still poorly highlighted in Russian sources.Objective. To investigate the levels of 25-OH-vitamin D and homocysteine among patients with BPPV and compare these factors depending on recurrence.Materials and methods. The study included 53 patients with BPPV, age 60 ± 12.6 (Me 62 [55; 68]), men accounted for 24.5%, women – 75.5%. All patients underwent a study of the neurological status and neurovestibularexamination, which included the Halmagi test, the head shake test, the Fukuda test, the Dix – Hallpike and McClure – Pagnini tests. Plasma 25-OH-vitamin D and homocysteine levels were assessed using enzyme-linked immunosorbent assay. The severity of vertigo was assessed using the dizziness handicap inventory (DHI).Results. The level of 25-OH vitamin D in with BPPV varied from 5.2 to 40 ng/ml, the average value was 19.53 ± 9.07 ng/ml, which corresponds to the deficit according to international recommendations (Me 17 [13; 24.8]). The level of 25-OH vitamin D in the group with recurrent BPPV was (Me 15 [12 and 22]), which was significantly lower than in the group with a single BPPV episode. The DHI score was significantly lower in the group with recurrent BPPV. There was a negative relationship between 25-OH-vitamin D levels and age, and a negative relationship between 25-OH-vitamin D and homocysteine in the DPPV group.Conclusion. There was a decrease in the level of 25-OH-vitamin D among patients with BPPV; in the group with recurrent BPPV, the level of 25-OH-vitamin D was significantly lower than in the group with a single dose of BPPV. The presence of an inverse correlation between the level of homocysteine and 25-OH-vitamin D indicates the advisability of more detailed studies of the potential contribution of endothelial dysfunction to the development of peripheral vestibular disorders due to impaired microcirculation of the otoconial apparatus.