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In rare cases deficiency can be acquired through copper malabsorption resulting in copper deficiency myelopathy that presents with myelin abnormalities, axonal damage and white matter lesions 55,56,57

Adaptation exercises improve vestibulo-ocular reflex gain through repetitive head movements with visual fixation, while substitution exercises develop alternative balance and gaze stability strategies using visual and proprioceptive cues ( Ongoing care and family-centered support Long-term audiological surveillance is essential, as aminoglycosides accumulate within cochlear hair cells and may contribute to delayed or progressive dysfunction even after treatment discontinuation ( Family education about etiology, prognosis, and intervention options empowers informed decision-making

Studies suggest KPV is well-tolerated and may provide ongoing benefits for inflammatory and immune-related conditions

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