Popkirov Stoyan, Stone Jon, Holle-Lee Dagny
Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany.
Centre for Clinical Brain Sciences, Western General Hospital, University of Edinburgh, Edinburgh, UK.
Curr Treat Options Neurol. 2018 Oct 13;20(12):50. doi: 10.1007/s11940-018-0535-0.
Persistent postural-perceptual dizziness (PPPD) is a newly defined disorder of functional dizziness that in the International Classification of Diseases in its 11th revision (ICD-11) supersedes phobic postural vertigo and chronic subjective dizziness. Despite efforts to unify the diagnosis of functional (somatoform) dizziness, patients will present with a variety of triggers, perpetuating factors, and comorbidities, requiring individualized treatment. This article will review different treatment strategies for this common functional neurological disorder and provide practical recommendations for tailored therapy.
An emerging understanding of the underlying pathophysiology that considers vestibular, postural, cognitive, and emotional aspects can enable patients to profit from vestibular rehabilitation, as well as cognitive-behavioral therapy (CBT). Crucially, approaches from CBT should inform and augment physiotherapeutic techniques, and, on the other hand, vestibular exercises or relaxation techniques can be integrated into CBT programs. Antidepressant medication might further facilitate rehabilitation, though the mechanisms are yet to be elucidated, and the level of evidence is low. In PPPD and related disorders, vestibular rehabilitation combined with CBT, and possibly supported by medication, can help patients escape a cycle of maladaptive balance control, recalibrate vestibular systems, and regain independence in everyday life.
持续性姿势 - 知觉性头晕（PPPD）是一种新定义的功能性头晕疾病，在《国际疾病分类》第11版（ICD - 11）中取代了恐旷姿势性眩晕和慢性主观性头晕。尽管努力统一功能性（躯体形式）头晕的诊断，但患者会表现出各种触发因素、持续因素和合并症，需要个体化治疗。本文将综述这种常见功能性神经疾病的不同治疗策略，并为量身定制的治疗提供实用建议。
对潜在病理生理学的新认识，即考虑前庭、姿势、认知和情感方面，可使患者从前庭康复以及认知行为疗法（CBT）中获益。至关重要的是，CBT的方法应指导并增强物理治疗技术，另一方面，前庭锻炼或放松技术可融入CBT项目。抗抑郁药物可能进一步促进康复，尽管其机制尚待阐明，且证据水平较低。在PPPD及相关疾病中，前庭康复结合CBT，并可能辅以药物治疗，可帮助患者摆脱适应不良的平衡控制循环，重新校准前庭系统，并在日常生活中恢复独立能力。
