Korkmaz, HanifiKaraer, Isil CakmakOrman, KubraTalu, BurcuInceoglu, Feyza2026-04-042026-04-0420260340-53541432-1459https://doi.org/10.1007/s00415-026-13767-4https://hdl.handle.net/11616/109893BackgroundPost-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.eninfo:eu-repo/semantics/openAccessPost-earthquake dizziness syndromeVisuo-vestibular integrationSensory conflictVirtual reality-based assessmentVestibular rehabilitationCognitive behavioral therapyArticle273410.1007/s00415-026-13767-4WOS:001721876700003Q1