Multimodal treatment of persistent postural–perceptual dizziness

Axer, Hubertus; Finn, Sigrid; Wassermann, Alexander; Guntinas‐Lichius, Orlando; Klingner, Carsten M.; Witte, Otto W.

doi:10.1002/brb3.1864

Cited by 51 publications

(45 citation statements)

References 30 publications

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“…Some central vertigo patients have vestibular migraine that does not meet criteria but does respond to treatment. We recently demonstrated the benefit of a multimodal interdisciplinary therapy program in various conditions of chronic dizziness and vertigo 23 as well as in different age groups. 11 The DHI has been used as a validated evaluation tool for perceived impairment associated to dizziness and vertigo in a variety of studies.…”

Section: Discussionmentioning

confidence: 99%

Age-Associated Characteristics of Patients With Chronic Dizziness and Vertigo

Wassermann

Finn

Axer

2021

J Geriatr Psychiatry Neurol

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Objective: The incidence of dizziness and vertigo is increasing with age, and symptoms lead to significant limitations in daily living and to disability in older patients. Method: Data of 1,752 patients with chronic dizziness/vertigo subjected to a tertiary care, specialized interdisciplinary vertigo center were analyzed. Age, gender, symptoms, medical diagnosis, and Dizziness Handicap Inventory (DHI) were collected based on a questionnaire and analysis of associated patient records. The patients were assigned to 3 age groups (< 41, 41-65, and > 65 years). Results: 33.7% of the patients were older than 65 years. Frequency of symptoms and DHI score increased with age. Older patients reported less frequently about coexisting symptoms such as nausea, headache, tinnitus, ear pressure, and visual impairment. Multisensory deficit, central vertigo, bilateral vestibulopathy, and benign paroxysmal positional vertigo were diagnosed increasingly with age, while persistent postural–perceptual dizziness and vestibular migraine were diagnosed in the younger age groups. Conclusion: In the diagnostic work-up of older patients age-specific characteristics of dizziness/vertigo have to be considered. The older patient generally is more impaired by the symptoms but possibly will not report typical diagnosis-defining symptoms.

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Section: Discussionmentioning

confidence: 99%

Age-Associated Characteristics of Patients With Chronic Dizziness and Vertigo

Wassermann

Finn

Axer

2021

J Geriatr Psychiatry Neurol

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“…Patients with chronic vestibular syndromes usually recover from acute symptoms and often lack distinguishable symptoms or findings on vestibular tests. Nonetheless, each chronic vestibular disease may have a different pathophysiology and should therefore be treated using different strategies (11)(12)(13). As the first step in the correct diagnosis of chronic vestibular diseases, information on disease distribution is important.…”

Section: Discussionmentioning

confidence: 99%

Test Batteries and the Diagnostic Algorithm for Chronic Vestibular Syndromes

et al. 2021

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Objective: To develop a diagnostic algorithm for chronic vestibular syndromes by determining significant items that differ among diagnoses.Methods: Two hundred thirty-one patients with chronic vestibular syndromes lasting for >3 months were included. Full vestibular tests and questionnaire surveys were performed: bithermal caloric test, cervical and ocular vestibular-evoked myogenic potential assessment, video head impulse test (vHIT), posturography, rotatory chair test, dizziness handicap inventory, hospital anxiety and depression scale (HADS), and Niigata persistent postural-perceptual dizziness (PPPD) questionnaire (NPQ). Differences in each item of the vestibular tests/questionnaires/demographic data were tested among the diagnoses. A receiver operating characteristic (ROC) curve was created for the significant items. The value that provided the best combination of sensitivity/specificity on the ROC curve was adopted as a threshold for diagnosing the targeted disease. Multiple diagnostic algorithms were proposed, and their diagnostic accuracy was calculated.Results: There were 92 patients with PPPD, 44 with chronic dizziness due to anxiety (CDA), 31 with unilateral vestibular hypofunction (UVH), 37 with undifferentiated dizziness (UD), and 27 with other conditions. The top four diagnoses accounted for 88% of all chronic vestibular syndromes. Five significant items that differed among the four diseases were identified. The visual stimulation and total NPQ scores were significantly higher in the patients with PPPD than in those with UVH and UD. The percentage of canal paresis (CP %) was significantly higher in the patients with UVH than in those with PPPD, CDA, and UD. The patients with CDA were significantly younger and had higher anxiety scores on the HADS (HADS-A) than those with UVH and UD. Moreover, catch-up saccades (CUSs) in the vHIT were more frequently seen in the patients with UVH than in those with PPPD. The most useful algorithm that tested the total and visual stimulation NPQ scores for PPPD followed by the CP%/CUSs for UVH and HADS-A score/age for CDA showed an overall diagnostic accuracy of 72.8%.Conclusions: Among the full vestibular tests and questionnaires, the items useful for differentiating chronic vestibular syndromes were identified. We proposed a diagnostic algorithm for chronic vestibular syndromes composed of these items, which could be useful in clinical settings.

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“…The lack of reported improvements is in line with previous studies, where additional support is often needed to affect these variables (Apolinario‐Hagen, 2019 ; Cuijpers et al., 2017 ). Specific cognitive therapy and medications may have a role in the management of dizziness where comorbidity with mental disorders is present (Axer et al., 2020 ; Ketola et al., 2015 ; Staab, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Web‐based vestibular rehabilitation in persistent postural‐perceptual dizziness

et al. 2021

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Objectives:The aims of the study were to investigate the feasibility and preliminary outcome of a Norwegian web-based self-help application for vestibular rehabilitation (VR) among patients with high symptom burden of chronic dizziness fulfilling the criteria for persistent postural-perceptual dizziness (PPPD). Materials and methods:The web application consists of six weekly online sessions, with written information and video presentations. It is self-instructive and freely available on NHI.no (https://nhi.no/for-helsepersonell/vestibular-rehabilitering/). Ten consecutive patients referred to a neurologic outpatient clinic for chronic dizziness were included. They signed informed consent forms and were examined at inclusion and after three months. State of health and symptom burden were recorded using Vertigo symptom score (VSS), Niigata symptom score (NPQ), Patient Health Questionnaire (PHQ-9) and health-related quality of life score (EQ5D-5L). Experiences with the program were measured using a semi-structured interview at the end of the study.Results: Nine out of ten patients completed the program. The findings suggest that the web application was easy to use, instructive and educatable. Challenges were the load of exercises, motivation to continue training during relapses and performing the body rolling on the floor. Participants had high symptom burden (VSS mean 32.9) and long duration of symptoms in years (mean 11.5). The participants improved on average 6.9 points on the VSS score.Conclusions: This web application for chronic dizziness appears to be feasible and may reduce symptoms in patients who have struggled with serious and long-lasting dizziness.

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Multimodal treatment of persistent postural–perceptual dizziness

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 51 publications

References 30 publications

Age-Associated Characteristics of Patients With Chronic Dizziness and Vertigo

Age-Associated Characteristics of Patients With Chronic Dizziness and Vertigo

Test Batteries and the Diagnostic Algorithm for Chronic Vestibular Syndromes

Web‐based vestibular rehabilitation in persistent postural‐perceptual dizziness

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