Those in neuro-otology practice will be familiar with PPPD now appearing in the forthcoming beta edition of ICD-11. This condition combines the symptoms of phobic postural vertigo and chronic subjective dizziness in which anxiety plays a part. The underlying hypothesis is that ‘anxiety-related personality traits and high anxiety during acute vestibular events sustain unnecessary utilisation of high risk postural control strategies including stiffening at the ankles and visual dependence’. On the basis of this hypothesis, the authors conducted this study to systematically evaluate the performance of PPPD subjects in different conditions of sensory integration using the EquiTest Sensory Organisation Test (SOT). They enrolled 50 women aged between 28 and 59 years. Twenty had PPPD following an acute vertigo and 15 had recovered from the acute vestibular insult. The two groups were compared with 15 healthy controls. SOT scores in conditions 1-6 (C1-6), composite scores (CS) and the standard EquiTest ratios were determined. Mallinson and Longbridge criteria were used to further distinguish between vestibular vs non-vestibular performance patterns. PPPD patients had poorer SOT scores across the board compared with the recovered and control groups especially in the simpler tasks (C2 and C3). The authors suggested that the pattern of abnormalities may have been caused by a confluence of three factors: ‘use of high-risk postural control strategies when not needed, excessive visual or somatosensory dependence and anxiety’. Scores in C4 to C6 were lower in the PPPD and recovered groups than in controls. The authors conclude that the patterns of functional impairments in PPPD patients are consistent with emerging data on brain mechanisms and that the study provides insights into neurophysiologic mechanisms in PPPD.
Posturography in persistent postural-perceptual dizziness (PPPD)
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