Predictors of persistent postural-perceptual dizziness (PPPD) and similar forms of chronic dizziness precipitated by peripheral vestibular disorders: a systematic review

Abstract

BackgroundThe literature on predictors of persistent postural-perceptual dizziness (PPPD) following peripheral vestibular insults has not been systematically reviewed.MethodsWe systematically reviewed studies on predictors of PPPD and its four predecessors (phobic postural vertigo, space-motion discomfort, chronic subjective dizziness and visual vertigo). Investigations focused on new onset chronic dizziness following peripheral vestibular insults, with a minimum follow-up of 3 months. Precipitating events, promoting factors, initial symptoms, physical and psychological comorbidities and results of vestibular testing and neuroimaging were extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsWe identified 13 studies examining predictors of PPPD or PPPD-like chronic dizziness. Anxiety following vestibular injury, dependent personality traits, autonomic arousal and increased body vigilance following precipitating events and visual dependence, but not the severity of initial or subsequent structural vestibular deficits or compensation status, were the most important predictors of chronic dizziness. Disease-related abnormalities of the otolithic organs and semi-circular canals and age-related brain changes seem to be important only in a minority of patients. Data on pre-existing anxiety were mixed.ConclusionsAfter acute vestibular events, psychological and behavioural responses and brain maladaptation are the most likely predictors of PPPD, rather than the severity of changes on vestibular testing. Age-related brain changes appear to have a smaller role and require further study. Premorbid psychiatric comorbidities, other than dependent personality traits, are not relevant for the development of PPPD.

Visual and vestibular motion perception in persistent postural-perceptual dizziness (PPPD)

“…Over-reliance on visual information for spatial orientation (e.g., visual dependence) has been correlated with the visual vertigo handicap following acute vestibular neuritis [ 6 ], i.e., it is characteristic of poorly recovered vestibular neuritis patients. Visual dependence was found to be a predictor for secondary PPPD following vestibular neuritis [ 5 ]. This implies changes in the visual motion perceptional sensitivity but thresholds of visual motion perception have not been examined in PPPD yet.…”

“…Importantly, perceptual unsteadiness and dizziness persists despite complete recovery of abnormal sensory (vestibular) function or the deliberation from abnormal vestibular excitation (BPPV). It is not related to the magnitude of previous or still persistent vestibular dysfunction [ 5 ]. This suggests that PPPD results from a maladaptation of perceived postural control in response to a misprediction of the sensory consequence of one’s own movements or even anticipated actions.…”

Persistent Challenges: A Comprehensive Review of Persistent Postural-Perceptual Dizziness, Controversies, and Clinical Complexities

“…Anxiety disorders, such as generalized anxiety disorder and panic disorder, often coexist with PPPD [19].…”

Clinical characteristics of persistent postural‐perceptual dizziness and its visual subtype in Korean patients: A multicenter cross‐sectional study

“…Results showed visual stimuli caused 47.4% of the variance, walking/active motion 12%, and passive motion/standing 7.67%. Furthermore, the concept of probable or subthreshold PPPD, which refers to patients not meeting all five of the diagnostic criteria, was found to be lacking sufficient published data to establish a clinically meaningful definition at that time (Adamec et al., 2020 ; Li et al., 2021 ; Powell et al., 2020 ; Staab, 2020 ; Staab et al., 2017 ; Trinidade et al., 2023 ; Wang et al., 2021 ; Zachou & Anagnostou, 2020 ). In this study, patients not meeting one or two of Criterion B's factors were classified as a clinical variant PPPD.…”