{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T04:55:52Z","timestamp":1781758552119,"version":"3.54.5"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background and purpose<\/jats:title>\n                    <jats:p>\n                      Dizziness associated with central neurological disorders\u2014broadly defined as dizziness or vertigo attributable to central nervous system pathology affecting central vestibular processing\u2014is a clinically challenging and heterogeneous condition with limited treatment options.\n                      <jats:italic>Ginkgo biloba<\/jats:italic>\n                      extract\u2014through its microcirculatory, neuroprotective, and anti-inflammatory mechanisms\u2014represents a biologically plausible intervention. However, its efficacy in this setting has not been comprehensively established. We evaluated the efficacy and safety of\n                      <jats:italic>Ginkgo biloba<\/jats:italic>\n                      extract through a systematic review and meta-analysis of randomized controlled trials (RCTs).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Nine international and Korean databases were searched from January 1974 through November 2025. Studies were eligible if they were RCTs enrolling adults aged 18\u202fyears or older with cerebrovascular disease, neurodegenerative disease, or central vestibular dysfunction who had dizziness, vertigo, or balance-related symptoms or relevant outcome assessments. Cochrane RoB 2.0 tool and certainty of evidence was rated using the Assessment, Development and Evaluations (GRADE) approach. Prespecified subgroup analyses by underlying etiology and intervention type, together with leave-one-out sensitivity analyses, were performed to explore heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nine RCTs (\n                      <jats:italic>N<\/jats:italic>\n                      \u202f=\u202f2,394) were included; participants were predominantly drawn from dementia populations (71.6%), with smaller contributions from cerebral arteriosclerosis (23.0%) and vertebrobasilar or posterior circulation disorders (5.4%).\n                      <jats:italic>Ginkgo biloba<\/jats:italic>\n                      significantly reduced dizziness\/vertigo severity on the 11-point box scale (MD\u202f\u2212\u202f0.76, 95% CI\u202f\u2212\u202f1.35 to \u22120.18;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.01) and VAS (SMD\u202f\u2212\u202f0.38, 95% CI\u202f\u2212\u202f0.58 to \u22120.19;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.0001). Moderate-certainty evidence suggested improvements in functional outcomes and quality of life, including the Alzheimer\u2019s Disease Activities of Daily Living International Scale (MD\u202f=\u202f\u22120.17, 95% CI: \u22120.22 to \u22120.13) and the Dementia Quality of Life \u2013 Proxy (MD\u202f=\u202f2.00, 95% CI: 0.85 to 3.15). The intervention was generally well tolerated, with significantly lower risks of angina pectoris (OR 0.51, 95% CI 0.31 to 0.85) and tinnitus (OR 0.37, 95% CI 0.22 to 0.63) and no significant increase in other adverse events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Ginkgo biloba<\/jats:italic>\n                      extract may reduce dizziness severity and improve daily functioning in patients with central neurological disorders accompanied by dizziness or vertigo, with a favorable safety profile. However, given the small number of eligible trials, substantial clinical and statistical heterogeneity, and the predominance of dementia-derived data, these findings should be interpreted with caution. Well-designed RCTs in clearly defined central vestibular populations, ideally confirmed by neuroimaging or vestibular testing, are needed to confirm these results.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD420251229692<\/jats:ext-link>\n                      , PROSPERO: CRD420251229692.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1860538","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T04:41:00Z","timestamp":1781757660000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ginkgo biloba extract for dizziness-related symptoms in central neurological disorders: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Young-Hyo","family":"Jeon","sequence":"first","affiliation":[{"name":"Department of Health Convergence, College of Science and Industry Convergence at Ewha Womans University","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong Ah","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Health Convergence, College of Science and Industry Convergence at Ewha Womans University","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Yoon","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine","place":["Ulsan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seunghyun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine","place":["Ulsan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nam-Kyong","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Health Convergence, College of Science and Industry Convergence at Ewha Womans University","place":["Seoul, Republic of Korea"]},{"name":"Department of Industrial Pharmaceutical Science, College of Pharmacy, Ewha Womans University","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji-Yun","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine","place":["Ulsan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/B978-0-444-63437-5.00005-4","article-title":"The epidemiology of dizziness and vertigo","volume":"137","author":"Neuhauser","year":"2016","journal-title":"Handb Clin Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1007\/s00115-009-2738-9","article-title":"Epidemiology of dizziness and vertigo","volume":"80","author":"Neuhauser","year":"2009","journal-title":"Nervenarzt"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"173","DOI":"10.3238\/arztebl.2008.0173","article-title":"Diagnosis and treatment of vertigo and dizziness","volume":"105","author":"Strupp","year":"2008","journal-title":"Dtsch Arztebl Int"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1111\/j.1553-2712.2008.00189.x","article-title":"Dizziness presentations in US emergency departments, 1995\u20132004","volume":"15","author":"Kerber","year":"2008","journal-title":"Acad Emerg Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1038\/nrneurol.2017.58","article-title":"The dizzy patient: don't forget disorders of the central vestibular system","volume":"13","author":"Brandt","year":"2017","journal-title":"Nat Rev Neurol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1055\/s-0029-1241037","article-title":"Inner ear Dysfunction due to Vertebrobasilar Ischemic Stroke","volume":"29","author":"Kim","year":"2009","journal-title":"Semin Neurol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1097\/WCO.0b013e32835c5ec4","article-title":"Vestibular rehabilitation","volume":"26","author":"Herdman","year":"2013","journal-title":"Curr Opin Neurol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"CD010696","DOI":"10.1002\/14651858.CD010696.pub2","article-title":"Betahistine for symptoms of vertigo","volume":"2020","author":"Murdin","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1358\/DOF.1987.012.07.77903","article-title":"Ginkgolides: potent platelet activating factor antagonists isolated from Ginkgo biloba L: chemistry, pharmacology and clinical applications","volume":"12","author":"Braquet","year":"1987","journal-title":"Drugs of The Future"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"12197","DOI":"10.1073\/pnas.182425199","article-title":"Inhibition of amyloid-\u03b2 aggregation and caspase-3 activation by the Ginkgo biloba extract EGb761","volume":"99","author":"Luo","year":"2002","journal-title":"Proc Natl Acad Sci"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1779","DOI":"10.1007\/s00018-003-3080-1","article-title":"Neuroprotective effects of Ginkgo biloba extract","volume":"60","author":"Ahlemeyer","year":"2003","journal-title":"Cell Mol Life Sci"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"25","DOI":"10.2174\/1389450003349380","article-title":"Ginkgo biloba extract (EGb 761) and CNS functions basic studies and clinical applications","volume":"1","author":"DeFeudis","year":"2000","journal-title":"Curr Drug Targets"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"682439","DOI":"10.1155\/2014\/682439","article-title":"Treatment of Vertigo: a randomized, double-blind trial comparing efficacy and safety of Ginkgo biloba extract EGb 761 and Betahistine","volume":"2014","author":"Sokolova","year":"2014","journal-title":"Int J Otolaryngol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"140","DOI":"10.4103\/0973-7847.162137","article-title":"Rethinking Ginkgo biloba L.: medicinal uses and conservation","volume":"9","author":"Isah","year":"2015","journal-title":"Pharmacogn Rev"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/0197-2456(86)90046-2","article-title":"Meta-analysis in clinical trials","volume":"7","author":"DerSimonian","year":"1986","journal-title":"Control Clin Trials"},{"key":"ref18","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Chandler","year":"2019"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.jclinepi.2010.07.015","article-title":"GRADE guidelines: 3. Rating the quality of evidence","volume":"64","author":"Balshem","year":"2011","journal-title":"J Clin Epidemiol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"187","DOI":"10.12793\/jkscpt.1995.3.2.187","article-title":"Studies on the efficacy and safety of Ginkgo Biloba extract (TanaminR) in the dizziness of central origin","volume":"3","author":"Kim","year":"1995","journal-title":"J Korean Soc Clin Pharmacol Ther"},{"key":"ref22","first-page":"291","article-title":"Ginkgo biloba (EGb 761) in the treatment of equilibrium disorders","volume":"15","author":"Cesarani","year":"1998","journal-title":"Adv Ther"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"541","DOI":"10.2174\/156720505774932287","article-title":"A randomized, double-blind, placebo-controlled trial of two doses of Ginkgo biloba extract in dementia of the Alzheimer's type","volume":"2","author":"Schneider","year":"2005","journal-title":"Curr Alzheimer Res"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1055\/s-0031-1296579","article-title":"Ginkgo biloba special extract in dementia with neuropsychiatric features","volume":"57","author":"Napryeyenko","year":"2007","journal-title":"Arzneimittelforschung"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1186","DOI":"10.1002\/gps.2662","article-title":"Efficacy and safety of a once-daily formulation of Ginkgo biloba extract EGb 761 in dementia with neuropsychiatric features: a randomized controlled trial","volume":"26","author":"Ihl","year":"2011","journal-title":"Int J Geriatr Psychiatry"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1016\/j.jpsychires.2012.03.003","article-title":"Ginkgo biloba extract EGb 761\u00ae in dementia with neuropsychiatric features: a randomised, placebo-controlled trial to confirm the efficacy and safety of a daily dose of 240 mg","volume":"46","author":"Herrschaft","year":"2012","journal-title":"J Psychiatr Res"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"83","DOI":"10.19852\/j.cnki.jtcm.20211214.001","article-title":"Effectiveness and safety of Ginkgo biloba extract (GBE50) in the treatment of dizziness caused by cerebral arteriosclerosis: a multi-center, double-blind, randomized controlled trial","volume":"42","author":"Rina","year":"2021","journal-title":"J Tradit Chin Med"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"91","DOI":"10.4236\/nm.2022.133008","article-title":"Ginkgo biloba extract EGb 761\u00ae improves central vestibular vertigo in patients undergoing vestibular exercises: a randomised placebo-controlled trial","volume":"13","author":"Heide","year":"2022","journal-title":"Neuroscience and Medicine"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"174","DOI":"10.37290\/ctnr2641-452X.22:174-180","article-title":"Evaluating the effectiveness of Ginkgo Biloba extract in alleviating dizziness and improving nutritional status in cerebral arteriosclerosis patients. Current topics in nutraceutical","volume":"22","author":"Li","year":"2024","journal-title":"Research"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"d4002","DOI":"10.1136\/bmj.d4002","article-title":"Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials","volume":"343","author":"Sterne","year":"2011","journal-title":"BMJ"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1860538\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T04:41:11Z","timestamp":1781757671000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1860538\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,18]]},"references-count":30,"alternative-id":["10.3389\/fneur.2026.1860538"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1860538","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,18]]},"article-number":"1860538"}}