Usually, it is triggered by an episode of vertigo or dizziness or some other shocking event that causes psychological distress. After this first episode, the person continues to have a sense of motion, dizziness, or unsteadiness that can last for hours or days at a time. These symptoms are present almost all the time, but sufferers may periodically feel better or worse.

“Certain body positions, such as sitting or standing and gazing at complex patterns or complex movements, worsen symptoms. As a result, people with PPPD often fear losing their balance or falling. They may avoid situations that aggravate their symptoms, to the point where it can start to make life and day-to-day life difficult. They generally avoid movement, which worsens their dizziness, thus entering a vicious cycle,” he says. Mr. Georgios Konstantinidis ENT, Director of the 4th Otorhinolaryngology Clinic, Head and Neck Surgery Clinic Metropolitan General.

How is it caused?

“If the brain thinks we might be in danger of falling, it automatically reacts to protect us. Think about how we feel when we walk on ice or stand on a ladder: our bodies stiffen, we take shorter steps, and we focus on staying upright. At the same time, the balance system uses less information from the vestibular system and more from the vision system. Normally, when the risk of falling is over, when e.g. stop walking on an icy surface, the balance system returns to normal. But in people with PPPD, the brain remains in a “high-risk” state, even if our balance is not threatened. This causes a vicious cycle:

• We worry about falling and pay more attention to maintaining our balance
• The brain remains alert and relies more on visual stimuli
• Complex visual patterns and movement, suggest that we may be in danger of falling

This description may give the false impression that PPPD is “just in our heads”, but the symptoms are real. PPPD has some features in common with anxiety disorders, but is not a psychiatric disorder. Some studies have found differences in brain activity in people with PPPD, compared to people without PPPD. These differences can make it difficult for the brain to integrate different sources of information and correctly assess threats,” the expert points out.

Diagnosis

“There is no test that is specific to PPPD. However, PPPD is not a diagnosis of exclusion, that is, a diagnosis made when no other cause can be found to account for the symptoms. Instead, diagnosis is based on clinical criteria.
PPPD can overlap and coexist with other vestibular disorders, such as Ménière’s disease, the presence of which should also be investigated diagnostically,” he adds.

Treatment

“Once the diagnosis is made, the first step in treatment is to help the sufferer understand what causes PPPD and how the brain misinterprets normal balance stimuli as a threat. Knowing what is happening will help patients feel better and motivate them to be more actively involved in their treatment.

Treatment for PPPD usually involves “retraining” the brain, through a combination of vestibular rehabilitation, stress management strategies, medication, and cognitive-behavioral therapy (CBT). Ideally, a multidisciplinary team of specialists working together to treat the patient is required. Both vestibular rehabilitation and CBT require practice and effort on the part of the sufferer. The therapists teach the skills required, but the patients are the ones who have to apply them” concludes Mr. Konstantinidis.