Delta-Band EEG Microstate Dynamics as Promising Candidate Markers of Central Vertigo Severity

Background/Objectives: Central vertigo (CV) lacks objective biomarkers for severity assessment. This study examined whether resting-state EEG microstate dynamics across frequency bands can distinguish CV severity. Methods: Resting-state EEG was recorded from 50 patients with stroke-related CV and 31 healthy controls. Patients were classified as moderate (MD, n = 31) or severe (SV, n = 19) based on Dizziness Handicap Inventory scores. Microstate analysis was performed in the delta, theta, alpha, and beta bands to assess microstate topographies, temporal parameters, and transition probabilities. Correlations with clinical measures and receiver operating characteristic analyses were conducted. Results: CV patients showed severity-dependent alterations in EEG microstate dynamics, most pronounced in the delta band. Delta-band microstate transition probabilities correlated significantly with symptom severity and balance confidence. The delta-band transition from microstate C to microstate B accurately differentiated MD from SV patients (AUC = 0.983). Conclusions: Delta-band EEG microstate transition dynamics reflect network dysfunction in CV and may serve as promising candidate biomarkers for CV severity stratification.