Abstract Objective: To analyze the changes in spontaneous brain activity in persistent postural-perceptual dizziness (PPPD) patients during resting state by using the fractional amplitude of low frequency fluctuation (fALFF). Methods: Twelve PPPD patients were enrolled and assigned to the PPPD group. Patients were tested to exclude peripheral vestibular lesions, focal lesions, other neurological diseases, and other diseases associated with chronic dizziness. At the same time, 12 age- and gender-matched healthy subjects were recruited as the control group. A detailed medical history was collected from all subjects. Functional MRI (fMRI) was conducted and the fALFF calculated to explore the changes in spontaneous functional brain activity in resting state PPPD patients. Results: Compared with that of healthy subjects, the fALFF value in the right cuneus was significantly lower in PPPD patients (X=15, Y=－69, Z=6, k=82, P<0.001, FWE corrected). Further correlation analysis revealed that the changes of fALFF were negatively correlated with DHI (r=－0.67, P=0.02) and DHI-F (r=－0.71, P=0.01) scores. Conclusion: In patients with PPPD, the spontaneous functional activity of the cuneus was disordered, which may lead to persistent dizziness and instability and the worsening of symptoms from complex visual stimuli.