High beta activity tracks disease state in persistent postural-perceptual dizziness: A longitudinal quantitative EEG
Suk Jae Kim1, Chi-Hun Kim1, Sookyung Ryoo2
1Department of Neurology, Samsung Smart Neurology Clinic, Cheonan, Republic of Korea.
Summary
Quantitative electroencephalography (qEEG) reveals elevated high beta brainwave activity in persistent postural-perceptual dizziness (PPPD). This brain activity normalizes with treatment and increases upon relapse, suggesting it as a biomarker for PPPD disease activity.
Area of Science:
- Neuroscience
- Clinical Neurology
- Biomarker Research
Background:
- Persistent postural-perceptual dizziness (PPPD) is a chronic vestibular disorder lacking objective measures for disease activity monitoring.
- Quantitative electroencephalography (qEEG) has shown cortical hyperexcitability in migraine, but its role in PPPD is unexplored.
- High beta (25-30 Hz) activity is investigated as a potential state-dependent biomarker for PPPD.
Purpose of the Study:
- To investigate high beta activity using qEEG as a state-dependent biomarker in PPPD patients.
- To compare qEEG findings in PPPD patients with healthy controls (HC) and vestibular migraine (VM) patients.
- To assess the changes in high beta activity with treatment and during relapse in PPPD.
Main Methods:
- A retrospective longitudinal study analyzed resting-state qEEG data from 163 unmedicated PPPD patients, 86 HC, and 67 VM patients.
- Absolute power in the high beta frequency band was z-score normalized against an age-adjusted reference database.
- The number of electrodes with high beta absolute power z-score > +1.96 was the primary outcome, with follow-up qEEG during treatment and after discontinuation.
Main Results:
- PPPD patients exhibited significantly higher high beta electrode counts compared to HC and VM groups (p < 0.001), with high diagnostic accuracy (AUC = 0.956).
- High beta activity was not confounded by age, sex, comorbid migraine, or anxiety in PPPD patients.
- Marked treatment responders showed near-normalization of high beta activity, which correlated with clinical improvement (ρ = 0.509; p < 0.001).
- Discontinuation of treatment led to a V-shaped trajectory in high beta activity, with relapse mirroring initial elevated levels.
Conclusions:
- Elevated high beta activity on qEEG is a promising, state-dependent biomarker for PPPD, distinct from other dizzy disorders.
- The observed reduction with treatment and increase upon relapse supports high beta activity as a clinically accessible metric for monitoring PPPD disease activity.
- Further multicenter, prospective validation is warranted to confirm these findings for widespread clinical application.
