Persistent Postural-Perceptual Dizziness: Review and Update on Key Mechanisms of the Most Common Functional Neuro-otologic Disorder

Jeffrey P Staab

doi:10.1016/j.ncl.2023.04.003

Persistent Postural-Perceptual Dizziness: Review and Update on Key Mechanisms of the Most Common Functional Neuro-otologic Disorder

Neurol Clin. 2023 Nov;41(4):647-664. doi: 10.1016/j.ncl.2023.04.003. Epub 2023 Jun 1.

Author

Jeffrey P Staab¹

Affiliation

¹ Department of Psychiatry and Psychology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA. Electronic address: staab.jeffrey@mayo.edu.

PMID: 37775196
DOI: 10.1016/j.ncl.2023.04.003

Abstract

Persistent postural-perceptual dizziness (PPPD) is a functional neuro-otologic (vestibular) disorder manifesting dizziness, unsteadiness, or nonspinning vertigo lasting 3 months or more and exacerbated by upright posture, active or passive motion, and complex visual stimuli. PPPD is the most common cause of chronic vestibular symptoms. Early pathophysiologic models of PPPD emphasized the adverse effects of anxiety on postural control and spatial orientation. More recent concepts added predictive processing of sensory inputs and alterations in motion perception. Herein, a third-generation model incorporates prioritization of postural stability over fluid locomotion to explain symptoms, physiologic and neuroimaging data, and effects of current treatments.

Keywords: Functional dizziness; Functional neurological disorder; Locomotion; Perception of motion; Persistent postural-perceptual dizziness; Postural control; Spatial orientation.

Publication types

Review
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Dizziness* / diagnosis
Dizziness* / etiology
Dizziness* / therapy
Humans
Neuroimaging
Vertigo / diagnosis
Vertigo / therapy
Vestibular Diseases* / complications
Vestibular Diseases* / diagnosis