Updates on persistent postural-perceptual dizziness (PPPD): a review article

Abstract

Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder, not a structural or psychiatric condition, presented by one or more dizziness, unsteadiness, or non-spinning vertigo symptoms. These symptoms will worsen with upright posture, movements, and exposure to complex visual stimuli. PPDD may be precipitated by disorders that impair balance or induce vestibular symptoms, such as peripheral or central vestibular diseases, other medical conditions, or psychological illness The exact pathophysiological mechanism is unknown, and it might result from functional adjustments to the postural control systems—alterations in the way multisensory information are processed or the integration of spatial orientation and danger perception in the cortex. PPPD is usually associated with co morbidities like anxiety. Subtypes of PPPD are phobic postural vertigo, space and motion discomfort, visual vertigo, and chronic subjective dizziness. PPPD is diagnosed according to the diagnostic criteria of the Barany society. Physical examination and diagnostic investigation are not pathognomic to PPPD. Treatment approaches include patient counseling, vestibular rehabilitation therapy, cognitive behavioral therapy, and medications.