PPPD is a common neuro-vestibular cause of chronic dizziness. While it was recently formed as an entity, the constellation of symptoms that characterize PPPD have existed as part of other previously described entities, including phobic postural vertigo (described back in 1986 by Drs. Brandt and Dieterich), space-motion discomfort, and chronic subjective dizziness.

Diagnosis

People suffering from PPPD often describe an almost constant sensation of dizziness and/or dysequilibrium that is usually aggravated by walking, moving around, head movements, stress, and busy visual scenes. The symptoms are usually triggered by some event that caused vertigo or significant dizziness, a fall or near fall, a high level of stress, or a serious medical condition. For example, although vestibular neuritis causes vertigo that lasts for only a few days, it can trigger the onset of PPPD. It is possible that such events trigger a neurotransmitter imbalance in the brain that results in the dizziness, which may explain why treatment with antidepressant medications work.

The International Barany Society diagnostic criteria for PPPD [Staab, 2016]:

  • A. One or more symptoms of dizziness, unsteadiness or non-spinning vertigo on most days for at least 3 months
    1. Symptoms last for prolonged (hours) periods of time, but may wax and wane in severity
    2. Symptoms need to be present continuously throughout the entire day.
  • B. Persistent symptoms occur without specific provocation but are exacerbated by three factors:
    1. upright posture
    2. active or passive motion without regard to direction or position
    3. exposure to moving visual stimuli or complex visual patterns
  • C. The disorder is triggered by events that cause vertigo, unsteadiness, dizziness, or problems with balance, including acute, episodic, or chronic vestibular syndromes, other neurological or medical illnesses, and psychological distress.
    • When triggered by an acute or episodic precipitant, symptoms settle into the pattern of criterion A as the precipitant resolves, but may occur intermittently at first, and then consolidate into a persistent course
    • When triggered by a chronic precipitant, symptoms may develop slowly at first and worsen gradually.
  • D. Symptoms cause significant distress or functional impairment
  • E. Symptoms are not better accounted for by another disease or disorder

There are no special tests that can confirm the presence of PPPD. The diagnosis if made clinically. Tests are useful to exclude other conditions that can also cause dizziness (e.g. vertebrobasilar strokes). It is important to be evaluated for other vestibular disorders as well, since some may masquerade as PPPD and some may xo-exist with PPPD. As such, it is essential see a physician who is familiar with PPPD as well as other vestibular disorders.

Treatment

In my experience, PPPD is a very treatable condition. Several treatment options exist including medications (e.g. antidepressants, benzodiazepines), vestibular therapy, and cognitive-behavioral therapy (CBT). It is important to discuss these options with a physician who is familiar with PPPD to choose and optimize the best treatment plan for your needs.


References

Staab JP, Eckhardt-Henn, Horri A, et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): consensus document of the committee for the classification of vestibular disorders of the Barany Society. J Vestib Res 2016;27:191-208