Jáuregui-Renaud Kathrine, Cabrera-Pereyra Rodrigo, Miguel-Puga José Adán, Alcántara-Thome Mónica
Unidad de Investigación Médica en Otoneurología, Instituto Mexicano del Seguro Social, Ciudad de México 06720, Mexico.
Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México 06720, Mexico.
J Clin Med. 2024 Nov 6;13(22):6665. doi: 10.3390/jcm13226665.
: Persistent Postural-Perceptual Dizziness (PPPD) is a frequent diagnosis in patients with chronic dizziness, ineffective postural control, visual dependence, and emotional symptoms. : 53 patients with PPPD (25-84 years old) and 53 adults (29-84 years old) with no vestibular disease agreed to participate in this study. Assessments included: vestibular function tests (sinusoidal yaw rotation and vestibular-evoked myogenic potentials); accuracy and precision of Subjective Visual Vertical (SVV) estimation while static and during on-axis yaw rotation; static posturography with open/closed eyes and 30° neck extension, while standing on hard/soft surface; questionnaires on symptoms of unsteadiness, spatial anxiety, dizziness-related handicap, anxiety/depression, depersonalization/derealization, and perceived stress. After preliminary bivariate analyses, analysis of covariance was performed on the measurements of postural sway, spatial anxiety, and dizziness-related handicap ( < 0.05). : Higher intraindividual variability (reduced precision) on SVV estimations was evident in patients with PPPD compared to adults with no vestibular disease, which was related to the length of postural sway, to velocity displacement in the sagittal plane, as well as to spatial anxiety and common mental symptoms (including depersonalization/derealization symptoms). Covariance analysis showed contribution of these factors to the dizziness-related handicap reported by the patients. : Unprecise graviception could be a contributing factor to the postural instability and mental symptoms reported by patients with PPPD, which in turn contribute to their dizziness-related handicap.
持续性姿势-感知性头晕（PPPD）是慢性头晕、姿势控制无效、视觉依赖和情绪症状患者的常见诊断。53例PPPD患者（25 - 84岁）和53例无前庭疾病的成年人（29 - 84岁）同意参与本研究。评估包括：前庭功能测试（正弦偏航旋转和前庭诱发肌源性电位）；静态和轴上偏航旋转期间主观视觉垂直（SVV）估计的准确性和精确性；在硬/软表面站立时睁眼/闭眼和颈部伸展30°的静态姿势描记法；关于不稳定症状、空间焦虑、头晕相关障碍、焦虑/抑郁、人格解体/现实解体以及感知压力的问卷。经过初步双变量分析后，对姿势摆动、空间焦虑和头晕相关障碍的测量进行了协方差分析（<0.05）。与无前庭疾病的成年人相比，PPPD患者在SVV估计上的个体内变异性更高（精确性降低），这与姿势摆动的长度、矢状面的速度位移以及空间焦虑和常见精神症状（包括人格解体/现实解体症状）有关。协方差分析显示这些因素对患者报告的头晕相关障碍有影响。不精确的重力感知可能是PPPD患者报告的姿势不稳定和精神症状的一个促成因素，进而导致他们的头晕相关障碍。
