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    Treatment-related modulation of visuo-vestibular integration in post-earthquake dizziness syndrome: a longitudinal virtual reality-based study
    (Springer Heidelberg, 2026) Korkmaz, Hanifi; Karaer, Isil Cakmak; Orman, Kubra; Talu, Burcu; Inceoglu, Feyza
    BackgroundPost-earthquake dizziness syndrome (PEDS) is increasingly recognized as a condition marked by persistent dizziness and imbalance after major earthquakes, often without clear peripheral vestibular pathology. Despite proposed roles of visuo-vestibular dysfunction and sensory conflict, longitudinal objective evidence remains limited.ObjectiveTo examine the longitudinal effects of virtual reality-based vestibular rehabilitation (VR), cognitive behavioral therapy (CBT), and their integration (VR + CBT) on objective visuo-vestibular processing and symptom burden in adults with PEDS.MethodsIn a four-arm longitudinal study, 48 earthquake-exposed adults with PEDS were evaluated at baseline, post-intervention, and 3-month follow-up following an 8-week intervention. Objective visuo-vestibular outcomes were assessed using an immersive virtual reality-based system, including static and dynamic subjective visual vertical (SVV/DSVV), rod-and-frame test (RFT), and visual motion sensitivity (VMS) tests. Subjective outcomes included dizziness-related handicap (DHI) and post-traumatic stress symptoms (PCL-5).ResultsDizziness-related disability and trauma-related symptoms improved over time across groups, indicating clinical modifiability of PEDS. Objective measures demonstrated a domain-specific response profile: SVV and DSVV remained largely stable, whereas RFT showed improvement in active treatment arms, suggesting reduced visual frame dependence. VMS outcomes exhibited differential trajectories, with the integrated VR + CBT group showing the most consistent and durable modulation under visually provocative conditions.ConclusionsRecovery in PEDS appears to involve selective modulation of context-dependent visuo-vestibular processing rather than uniform changes across all spatial orientation measures. Integrated VR + CBT yields the most coherent and durable benefits in visually demanding domains, supporting multidisciplinary models that jointly address sensory conflict and cognitive-emotional mechanisms after major earthquakes.