What is PPPD and how is it treated?

Formerly known as Chronic Subjective Dizziness, PPPD (persistent postural-perceptual dizziness) is a chronic vestibular disorder that can be successfully treated.

A consensus among vestibular experts lead to this definition of PPPD

One or more symptoms of dizziness, unsteadiness, or non-spinning vertigo are present on most days for 3 months or more.
Symptoms last for prolonged (hours long) periods of time, but may wax and wane in severity.
Symptoms need not be present continuously throughout the entire day.
Persistent symptoms occur without specific provocation, but are exacerbated by three factors:
- Upright posture
- Active or passive motion without regard to direction or position
- Exposure to moving visual stimuli or complex visual patterns.
The disorder is precipitated by conditions that cause vertigo, unsteadiness, dizziness, or problems with balance including acute, episodic, or chronic vestibular syndromes, other neurologic or medical illnesses, or psychological distress.
Symptoms cause significant distress or functional impairment.
Symptoms are not better accounted for by another disease or disorder.
Source: Staab et al 2017

By the time a person has developed PPPD, the initial triggering condition may have resolved, but the brain is still stimulated into a dizzy message signal by movement of their body or that of the world around them. We will commonly hear these folks say, “I hate going to the grocery store. It’s so overwhelming with all the people and products.” Or they might note that complex patterns are very bothersome, or wide open spaces. Driving in traffic or doing computer work may increase their symptoms.

Research supports using customized, vestibular therapy to treat these symptoms. It’s done in a graded approach, starting with gently stimulating activities, and gradually increasing in complexity as the person’s tolerance improves.

SELECTED FOR YOU: Unilateral Vestibular Loss

Our providers often guide patients through gradual return to real-life situations as well, such as assigning them to walk around a quiet store for a few minutes and sit and rest and perform grounding techniques if symptoms increase. Gradually, they are able to tolerate longer durations in busier stores.

Sometimes medication is helpful as well. SSRIs and SNRIs may be prescribed to further support recovery, as research shows this also can improve symptoms for those with PPPD.

Sources:
1. Staab JP, Eckhardt-Henn A, Horii A, Jacob R, Strupp M, Brandt T, Bronstein A. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res. 2017;27(4):191-208. doi: 10.3233/VES-170622. PMID: 29036855; PMCID: PMC9249299.
2. https://dizziness-and-balance.com/disorders/psych/pppd.html
3. https://www.neuropt.org/docs/default-source/vsig-english-pt-fact-sheets/persistent-postural-perceptual-dizzinessf4a035a5390366a68a96ff00001fc240.pdf?sfvrsn=28a35343_0

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