Persistent postural perceptual dizziness (PPPD)
Persistent postural perceptual dizziness (PPPD) is a fairly recently defined term for a commonly known cause of chronic dizziness and imbalance. It replaces the older terminology of phobic postural vertigo (PPV) and chronic subjective dizziness (CSD).
In 2014 scientists around the world reached consensus and defined the term persistent postural perceptual dizziness (PPPD). The World Health Organization has now accepted it as a specific diagnosis.
The main symptoms of PPPD are a persistent sensation of rocking, or swaying unsteadiness and /or dizziness without vertigo lasting 3 months or more. Patients also develop avoidance behavior.
Symptoms are present on more days than not. It is worse in certain positions with certain head movements and when exposed to motion.
PPPD usually follows after acute vertigo, dizziness and imbalance caused by conditions such as benign paroxysmal positional vertigo (BPPV), Meniere’s disease, vestibular neuritis or injuries. It may also co exist with these conditions. Although not part of the symptoms, anxiety and mild depression may be present. Other psychiatric and personality disorders may also be present. As stated by Staab persistent postural perceptual dizziness is a physiolocical disorder with psychological consequences. The risk of development is higher if a patient experiences an acute vestibular spell with high levels of anxiety and caution, coupled with expectations for a negative outcome.
Patients with PPPD avoid certain situations and triggering events that may aggravate their symptoms. Vestibular examination is usually normal but may show a specific vestibular problem. In these cases the vestibular findings does not explain all the symptoms.
The treatment suggested includes the use of medication for at least one year. Selective serotonin reuptake inhibitors (SSRI) are preferred to vestibular suppressants, which seems not to be effective. Vestibular rehabilitation helps to desensitize the patient to motion. Psychotherapy and cognitive behavioral therapy may be of benefit if started early enough.