Abstract
BackgroundPersistent postural-perceptual dizziness (PPPD) is the most common functional vestibular disorder. A multisensory mismatch altered by psychological influences is considered to be an important pathophysiological mechanism. Increased cortical and subcortical excitability may play a role in the pathophysiology of PPPD. We hypothesized that decreased motion perception thresholds reflect one mechanism of the abnormal vestibular responsiveness in this disorder. We investigated the vestibular perception thresholds and the vestibular ocular reflex with a rotatory chair experiment to gain insights in the processing and adaption to vestibular provocation.MethodsIn this cross-sectional study 26 female PPPD patients and 33 healthy female age matched controls (HC) were investigated sitting in a motorized rotary chair shielded regarding visual and acoustic stimuli. The chair was rotated for 20 minutes with slowly increasing velocity to a maximum of 72°/s. We functionally tested motion perception thresholds and vegetative responses to rotation as well as vestibular-ocular reflex thresholds. We additionally investigated several psychological comorbidities (i.e. depression, anxiety, somatosensory amplification) using validated scores. Conventional dizziness scores were obtained to quantify the experienced dizziness and impact on daily life.ResultsPPPD patients showed a significant reduced vestibulo-perceptual threshold (PPPD: 10.9°/s vs. HC: 29.5°/s; p<0.001) with increased motion sensitivity and concomitant vegetative response during and after the chair rotation compared to healthy controls. The extent of increased vestibular sensitivity was in correlation with the duration of the disease (p=0.043). No significant difference was measured regarding nystagmus parameters between both groups.ConclusionPPPD patients showed increased vegetative response as well as decreased vestibulo-perceptual thresholds which are related to disease duration. This is of interest as PPPD might be sustained by increased vestibular excitability leading to motion intolerance and induction of dizziness when exposed to movement.
Highlights
Persistent postural-perceptual dizziness (PPPD) is a common chronic functional vestibular disorder predominantly in middle-aged patients [1]
Five PPPD patients had a history of a previous benign paroxysmal positional vertigo (BPPV) more than one year ago and one PPPD patient had a completely resolved vestibular neuritis more than one year ago
All PPPD patients were instructed for home based vestibular and balance exercises within in the scope of diagnosis in our outpatient clinic
Summary
Persistent postural-perceptual dizziness (PPPD) is a common chronic functional vestibular disorder predominantly in middle-aged patients [1]. Wurthmann et al BMC Neurol (2021) 21:394 supermarket-syndrome [2] and visually induced motion [3]. It was termed phobic postural vertigo (PPV) by Brandt and Dieterich [4]. PPPD is characterized by persisting subjective dizziness, unsteadiness or non-rotational vertigo for at least three months and may be exacerbated by upright posture including the patient’s own movement as well as motion of complex visual stimuli [10]. Persistent postural-perceptual dizziness (PPPD) is the most common functional vestibular disorder. We investigated the vestibular perception thresholds and the vestibular ocular reflex with a rotatory chair experiment to gain insights in the processing and adaption to vestibular provocation
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