Persistent Postural-Perceptual Dizziness in Children and Adolescents

Abstract

Objective: Persistent postural-perceptual dizziness (PPPD) is a recently defined diagnostic syndrome characterized by chronic symptoms of dizziness, unsteadiness, and/or non-spinning vertigo. Although PPPD has been studied in adults, reports in the pediatric population are few. The goal of this study was to describe the presentation and treatment of PPPD in a group of pediatric patients. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: ≤21\u200ayears old, who met Bárány Society consensus criteria for a diagnosis of PPPD and were followed for ≥6\u200amonths or until symptom resolution. Main Outcome Measures(s): Patient demographics, comorbidities, symptom chronicity, and response to treatment(s). Results: Of the 53 patients identified, 44 (83.0%) were women. Mean age at the time of initial evaluation was 14.6\u200ayears old. Common diagnoses in addition to PPPD included benign paroxysmal positional vertigo (64.2%), vestibular migraine (56.6%), and anxiety (28.3%). A high proportion of patients (43.4%) reported initially missing school or work due to their symptoms. Eighteen patients (34.0%) reported symptom resolution ranging from 2 to 48\u200amonths after diagnosis (median 9\u200amo). Of these patients, 15 of 18 attended physical therapy (PT), 11 of 18 attended cognitive behavioral therapy (CBT) and/or biofeedback therapy, and 10 of 18 took selective serotonin reuptake inhibitor (SSRI) medications, and 7 of 18 (40%) did a combination of all three therapies. Conclusion: PPPD can impact patients at a young age, and prolonged symptoms present a significant burden to children and adolescents, many of whom are unable to attend school. Treatments such as PT, CBT, and SSRI medication may be effective.