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Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness
  1. Stoyan Popkirov1,
  2. Jeffrey P Staab2,
  3. Jon Stone3
  1. 1Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
  2. 2Department of Psychiatry and Psychology and Otorhinolaryngology – Head and Neck Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  3. 3Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, UK
  1. Correspondence to Dr Stoyan Popkirov, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, 44892 Bochum, Germany; popkirov{at}


Persistent postural-perceptual dizziness (PPPD) is a newly defined diagnostic syndrome that unifies key features of chronic subjective dizziness, phobic postural vertigo and related disorders. It describes a common chronic dysfunction of the vestibular system and brain that produces persistent dizziness, non-spinning vertigo and/or unsteadiness. The disorder constitutes a long-term maladaptation to a neuro-otological, medical or psychological event that triggered vestibular symptoms, and is usefully considered within the spectrum of other functional neurological disorders. While diagnostic tests and conventional imaging usually remain negative, patients with PPPD present in a characteristic way that maps on to positive diagnostic criteria. Patients often develop secondary functional gait disorder, anxiety, avoidance behaviour and severe disability. Once recognised, PPPD can be managed with effective communication and tailored treatment strategies, including specialised physical therapy (vestibular rehabilitation), serotonergic medications and cognitive-behavioural therapy.

  • persistent postural-perceptual dizziness
  • chronic subjective dizziness
  • phobic postural vertigo
  • visual vertigo
  • functional dizziness

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  • Contributors SP wrote the first draft of the article, and all authors were involved in rewrites.

  • Funding This work was supported in part by a scholarship for SP from the FoRUM Forschungsreferat (research office) of the Medical Faculty of the Ruhr-University Bochum, Germany. JeS is supported by research funding from the US National Institute on Deafness and Other Communication Disorders and Mayo Clinic. JoS is supported by an NHS Scotland NRS Career Fellowship.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed. This paper was reviewed by Adolfo Bronstein, London, UK.

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