Persistent Postural Perceptual Dizziness (PPPD) is a disorder that gives rise to long-term, chronic dizziness. It is quite a common condition & is usually treatable, if diagnosed in time.
PPPD disease usually occurs after an episode of Vertigo or dizziness, post which the patient continues to experience feelings of dizziness, false movement, & lightheadedness. These PPPD symptoms can last for hours or days after the first Vertigo or dizziness episode. Although these symptoms are usually present at all times, they often get better or worse at different times.
These PPPD symptoms can also be triggered by sitting or standing upright, seeing certain patterns, or doing certain movements. People with PPPD disease may feel anxiety about performing basic activities like walking or standing, & thus may develop a chronic fear of movement as a result of PPPD. PPPD as a disorder was first discovered & named in 2015. Before that the illness was described by several different names including space-motion discomfort (SMD), visual vertigo (VV), phobic postural vertigo (PPV), and chronic subjective dizziness (CSD). Although the exact number is unknown, researchers believe that about 1 in 4 people with underlying vestibular disorders like Vestibular Neuritis, or Meniere’s Disease, or Benign paroxysmal positional Vertigo (BPPV) develop PPPD symptoms.
Persistent postural perceptual dizziness symptoms are usually present with other vestibular disorders in a comorbid fashion, i.e., patients usually have PPPD along with any other vestibular disorder as well. For example, someone may have PPPD disease along with Meniere’s Disease, while someone else may have PPPD along with Vestibular Neuritis. The prevalence of PPPD is generally more among women than men, & the illness often manifests between the ages of 30 & 50 years.
The body’s balance system receives information from various parts of the body, including:
- The vestibular system, which consists of the semicircular canals & the otoliths in the inner ear. It helps the body maintain balance whenever you tilt or move your head in certain ways.
- The visual system, which helps you see
- The proprioceptive system, which sends signals about the body’s position, pressure, movement, & any vibrations felt from the legs, feet, & the entire body.
Usually, the brain relies on information received from the visual system more than that received from the vestibular system. However, when a patient suffers from PPPD disease, the brain is in a constant state of ‘movement anxiety’. In this state, the patient feels that every movement or activity, including standing up, can lead to falling or fainting, & thus they are in a constant fear.
PPPD is usually triggered by an episode of dizziness or vertigo, which causes the patient to become so afraid of ever fainting or feeling dizzy again that they develop irrational fears of movement. It might also be rightly argued that the basis for PPPD disease lies more in psychological than neurological or vestibular factors. The patient often ‘feels’ that they will faint if they perform certain activities or view certain movements or patterns, even when there are no apparent dangers of that happening.
This leads to a vicious cycle wherein the patient finds it hard to do basic everyday tasks because they fear that they might fall.
Although Persistent postural perceptual dizziness symptoms might feel like the result of a psychological issue, it really isn’t. The cause is usually the difference in the way the brain perceives balance inputs & signals from the environment & sensory organs in patients with PPPD disease than in those that haven’t got the condition. The first attack of Vertigo or dizziness in PPPD patients might also have been caused by a psychological issue like anxiety or panic attacks. If this is the case, patients must let the doctor know so they can get adequate PPPD treatment for their specific condition.
PPPD symptoms are of various types. Some of which include:
- Feelings of swaying or rocking to one side even when you’re perfectly still, also called non-spinning Vertigo,
- Unsteadiness, or a feeling that you’re about to fall,
- Light-headedness, or feeling like you’re about to pass out,
- Mild dissociation, or a feeling of being ‘spaced out’ or ‘zoned out’.
These PPPD symptoms might happen every day or every other day, regularly for at least 3 months in PPPD patients. Some of these symptoms may last for hours or even days in patients.
PPPD patients might feel worse when they:
- Stand or sit upright,
- See any kind of movement including scrolling on their phone screens, people walking in traffic, any kind of patterns, or certain athletic movements,
- See complex patterns like those on carpets, abstract paintings, weaves, etc.,
- Are walking or travelling in a car or any other vehicle
These PPPD symptoms appear worse than usual when the patient is tired or feeling out of sorts, than when they are distracted & don’t pay much attention to the symptoms. They are also quite persistent & long-lasting.
Your primary care doctor or health specialist, including a neurologist, an otolaryngologist, an otologist or a psychiatrist, can identify PPPD symptoms & accurately diagnose PPPD. There are no specific tests for making a PPPD diagnosis. Your doctor will likely ask for details of your symptoms, your medical history, any medications you are using, & a general overall idea of your physical & mental state.
PPPD diagnosis is usually based on proper clinical criteria, & the diagnosis is made after considering all the relevant medical factors present in the patient.
The tests that your doctor will give to you to diagnose PPPD will include:
- A general physical & mental examination,
- Tests that determine vestibular functions,
- Balance tests,
- Blood work,
- Imaging tests like the CT scan or the MRI
PPPD symptoms might also resemble those of other vestibular disorders such as Meniere’s Disease, and your doctor will, subsequently, also look to exclude those from the overall diagnosis results.
PPPD vertigo treatment depends on what exactly is causing the condition. Based on your diagnostic results & the opinion of your doctor, an adequate PPPD treatment strategy will be defined for you. PPPD treatment plan includes Vestibular rehabilitation exercises that help your body aquaint itself with the changes in the body’s balance system & devise new mechanisms to cope with the loss in the natural balance system.
PPPD treatment also involves ‘retraining’ the brain to think about the various sensory inputs pertaining to balance in a different way so as to not cause any anxiety in the patient about movements & activities. This includes cognitive behavioral therapy (CBT), medications to reduce anxiety, & PPPD exercises that help relax your shoulders & neck.
Additionally, your PPPD treatment plan may also include:
- Adaptation exercises,
- Gaze stabilization exercises,
- Target shooting exercises,
- Habituation exercises,
- Balance retraining exercises,
- Strengthening exercises,
- Gait training exercises,
- Range of motion sickness,
- Breathing & relaxation exercises,
- Walking & other kinds of aerobic exercises
Your doctor may also prescribe you certain medications that help control your dizziness & Vertigo symptoms. These medicines can also include some Vertigo treatment medicines like Meclizine, etc.
In addition, medicines like the SSRIs (Selective Serotonin Reuptake Inhibitors) & SNRIs (serotonin norepinephrine reuptake inhibitors) may also be prescribed to you for PPPD treatment.