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Exercising the brain through physical rehabilitation may be the key to treating vertigo patients whose affliction can’t be cured with medication, an expert says.

Vertigo is dizziness arising from a balance disorder that can be caused by various factors, including ear problems and mental stress. An estimated 4 million people in Japan experience vertigo each year.

“It feels as if I’m floating in the air just as I do while on a moving elevator, or as if I’m taking a nose dive in a roller coaster,” said a 57-year-old woman in Kanagawa Prefecture who has vertigo.

It was 26 years ago that the woman, who didn’t want her name used, experienced dizziness for the first time. “I was unable to stand on my feet as I saw the ceiling turning around,” she said.

Due to a lack of expert doctors, many vertigo patients in Japan don’t receive the appropriate diagnosis or treatment.

It was years before the woman was recognized as suffering from paroxysmal vertigo.

According to Fumiyuki Goto, the doctor treating her, humans maintain the body’s balance through the cerebellum, which receives positional information from the eye, the vestibule part of the inner ear, and touch and pressure sense.

Vertigo can result if any of these malfunction, but most cases are attributable to vestibular problems, says Goto, who works at the National Hospital Organization’s Tokyo Medical Center.

Medications used for treatment include drugs that ease dizziness and nausea as well as antidepressants, and in some cases, surgery is performed. These treatments, which are covered by public medical insurance, are sufficient for most vertigo patients. However, 1 in 10 remains uncured, and rehabilitation is the only hope left, Goto says.

When either the left and right vestibular system malfunctions, the sense of balance is undermined, a situation that can cause vertigo. Usually, however, a brain mechanism called central compensation kicks in and restores the sense of balance. Chronic vertigo occurs when this mechanism somehow does not work.

But patients may be able to turn on their compensation mechanism by repeatedly stimulating their eyes, ears and soles through physical rehabilitation exercises, such as making eye movements, shaking the head and stamping the feet, according to Goto. “At first, symptoms such as nausea appear, but unless the brain is worked in this way, a cure is impossible.”

The Tokyo Medical Center accepts vertigo patients for a five-day group rehabilitation therapy program.

Rehabilitation therapy is not yet widely available in Japan, as there are only around 100 doctors with the necessary expertise.

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