Clinical characteristics of patients with persistent postural-perceptual dizziness

Bittar, Roseli Saraiva Moreira; Lins, Eliane Maria Dias von Söhsten

doi:10.1016/j.bjorl.2014.08.012

Cited by 78 publications

(83 citation statements)

References 29 publications

(50 reference statements)

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“…A second explanation is that activity truly was suppressed in the amygdala and associated emotional processing regions in patients with PPPD. On first glance, this is difficult to reconcile with clinical research data on the multiple roles of anxietyrelated factors in PPPD 2,3 and its precursors, 4,5,7,9,[11][12][13][14][15][16]28 neuroanatomical evidence of close linkages between vestibular and anxiety systems at multiple levels in the brain, 46 and neuroimaging data showing increased activity and connectivity between vestibular, visual, and anxiety regions mediated by neuroticism and introversion in normal individuals. 18,19 However, it could have occurred if participants in the PPPD group responded more to spatial elements of the stimuli than their emotional content or if activity in the amygdala was suppressed by the potentially noxious nature of the visual task.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Responses to Stationary Emotional Stimuli Measured by fMRI in Women with Persistent Postural-Perceptual Dizziness

Lins

Bittar

Bazán

et al. 2020

Int Arch Otorhinolaryngol

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Introduction Persistent postural-perceptual dizziness (PPPD) is a functional vestibular disorder characterized by chronic dizziness, unsteadiness, and hypersensitivity to motion. Preexisting anxiety disorders and neurotic personality traits confer vulnerability to PPPD. High anxiety during acute vertigo or dizziness incites it. A functional magnetic resonance imaging (fMRI) study of chronic subjective dizziness found unexpectedly hypoactive responses to vestibular stimulation in cortical regions that integrate threat assessment and spatial perception. Objective This fMRI study used non-moving, but emotionally charged visual stimuli to investigate the brain's activity of PPPD patients and control subjects. Methods The participants included 16 women with PPPD and 16 age-matched women who recovered completely from acute episodes of vertigo or dizziness capable of triggering PPPD. Brain responses to positive, neutral, and negative figures from the International Affective Picture System were measured with fMRI and compared between the groups. Dizziness handicap, anxiety, and depression were assessed with validated questionnaires. Results Between group analyses: Participants with PPPD showed reduced activity in anterior cingulate cortex and increased activity in left angular gyrus in response to negative versus positive stimuli, which was not observed in recovered individuals. Within group analyses: Participants with PPPD had increased activity in visuospatial areas (parahippocampal gyrus, intraparietal sulcus) in negative versus positive and negative versus neutral contrasts, whereas recovered individuals had increased activity in anxiety regions (amygdala, orbitofrontal cortex). Conclusion Patients with PPPD may be more attuned to spatial elements than to the content of emotionally charged visual stimuli.

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Section: Discussionmentioning

confidence: 99%

Cerebral Responses to Stationary Emotional Stimuli Measured by fMRI in Women with Persistent Postural-Perceptual Dizziness

Lins

Bittar

Bazán

et al. 2020

Int Arch Otorhinolaryngol

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“…In fact, this study categorized visual vertigo and motion sensitivity as forms of vestibular migraine, which has been our traditional clinical practice, but which may be better considered as 3PD (aka chronic subjective dizziness). 17–19 …”

Section: Discussionmentioning

confidence: 99%

Development of a Statistical Model for the Prediction of Common Vestibular Diagnoses

Friedland

Tarima

Erbe

et al. 2016

JAMA Otolaryngol Head Neck Surg

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Importance Vestibular patients are often complex, require additional clinic visit time, and utilize greater clinical resources for diagnosis. A pre-encounter intake questionnaire may predict the most common disorders allowing for more efficient allocation of resources and use of providers. Objective To develop a statistical model for predicting vestibular diagnoses, prior to clinical evaluation, from an intake questionnaire. Design, Setting and Participants Retrospective review of 414 new vestibular patient intake questionnaires and medical records with performance of logistic regression analyses and development of predictive models. Intervention Use of a vestibular intake questionnaire for triaging of new patients with complaints of dizziness. Main Outcome Measures Predictors for the diagnosis of BPPV, Meniere disease, and vestibular migraine. Results Ear-related disorders accounted for 48% of all diagnoses while neurologic conditions accounted for 37% of diagnoses. Three disorders – benign paroxysmal positional vertigo (BPPV), Meniere disease and vestibular migraine – comprised 69% of all diagnoses. The diagnosis of BPPV could be predicted from four variables with a sensitivity of 79% and specificity of 65%. The diagnosis of Meniere disease could be predicted from five variables with a sensitivity of 81% and specificity of 85%. The diagnosis of vestibular migraine could be predicted from four variables with a sensitivity of 76% and specificity of 59%. Conclusions A pre-encounter history questionnaire can provide useful diagnostic information for common vestibular disorders. This can help direct appointment scheduling to improve clinical efficiency, time to intervention, and use of resources. Further refinement may enable shorter questionnaires or screening algorithms.

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“…Disability varied widely from individuals who had few limitations in daily functioning to those who were severely impaired and unable to work. The average age of patients presenting for evaluation of PPV, CSD, and PPPD is the mid-40 s, with a range from adolescence to late adulthood [10,79,100]. A female predominance has been reported in the first clinical reports on PPPD [10,100].…”

Section: Estimates Of the Prevalence Of Pppdmentioning

confidence: 99%

Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society

Staab

Eckhardt-Henn

Horii

et al. 2017

VES

511

465

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Abstract. This paper presents diagnostic criteria for persistent postural-perceptual dizziness (PPPD) to be included in the International Classification of Vestibular Disorders (ICVD). The term PPPD is new, but the disorder is not. Its diagnostic criteria were derived by expert consensus from an exhaustive review of 30 years of research on phobic postural vertigo, space-motion discomfort, visual vertigo, and chronic subjective dizziness. PPPD manifests with one or more symptoms of dizziness, unsteadiness, or non-spinning vertigo that are present on most days for three months or more and are exacerbated by upright posture, active or passive movement, and exposure to moving or complex visual stimuli. PPPD may be precipitated by conditions that disrupt balance or cause vertigo, unsteadiness, or dizziness, including peripheral or central vestibular disorders, other medical illnesses, or psychological distress. PPPD may be present alone or co-exist with other conditions. Possible subtypes await future identification and validation. The pathophysiologic processes underlying PPPD are not fully known. Emerging research suggests that it may arise from functional changes in postural control mechanisms, multi-sensory information processing, or cortical integration of spatial orientation and threat assessment. Thus, PPPD is classified as a chronic functional vestibular disorder. It is not a structural or psychiatric condition.

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Clinical characteristics of patients with persistent postural-perceptual dizziness

Abstract: Persistent postural-perceptual dizziness affects more women than men, with a high associated prevalence of metabolic disorders and migraine. Questionnaires help to identify the predisposition to persistent postural-perceptual dizziness. The prognosis is good with adequate treatment.

Cited by 78 publications

References 29 publications

Cerebral Responses to Stationary Emotional Stimuli Measured by fMRI in Women with Persistent Postural-Perceptual Dizziness

Cerebral Responses to Stationary Emotional Stimuli Measured by fMRI in Women with Persistent Postural-Perceptual Dizziness

Development of a Statistical Model for the Prediction of Common Vestibular Diagnoses

Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society

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