Yagi Chihiro, Kimura Akira, Kai Ryota, Yamagishi Tatsuya, Ohshima Shinsuke, Izumi Shuji, Horii Arata
Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Front Neurol. 2025 Mar 19;16:1566898. doi: 10.3389/fneur.2025.1566898. eCollection 2025.
Persistent postural-perceptual dizziness (PPPD) is a chronic neuro-otologic disorder characterized by vestibular symptoms such as dizziness, unsteadiness, or non-spinning vertigo. Its pathophysiology is presumed to involve sensory reweighting to visual/somatosensory sensations for maintaining spatial orientation. Serotonergic antidepressants are a major treatment option for PPPD. However, no reports describe the long-term outcomes of these therapeutic agents in patients with PPPD. Therefore, we evaluated the efficacy of antidepressants administered for up to 3 years after initiation in patients with PPPD.
Forty-three patients with PPPD (12 men and 31 women; median age at the start of treatment: 49 years) who were started on antidepressants at our department between July 2018 and February 2023 were enrolled. The Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS), and Niigata PPPD Questionnaire (NPQ) were used as evaluation measures. Scores at 3 and 6 months and at 1, 1.5, 2, 2.5, and 3 years after starting the medication were compared with pre-treatment scores. Furthermore, head-tilt perception gain (HTPG), an indicator of somatosensory hypersensitivity, was measured before and after treatment.
Significant improvements in all DHI, HADS, and NPQ measures were observed from 3 months onward and were maintained at all timepoints up to 3 years after treatment. Meanwhile, there was no significant improvement in HTPG after medication treatment was initiated. Patients whose DHI scores improved by ≥18 points were considered treatment responders; 27 of the 43 patients were responders at 1 year after treatment. During the initial 2 weeks of treatment, adverse events, including nausea/abdominal distension, were observed in 26 patients; however, the adverse events did not last until the subsequent observation timepoint. During the case enrollment period, antidepressants were started in 59 patients, and 43 patients included in the present study were able to continue medication (overall adherence rate: 72.9%).
The long-term efficacy and safety of serotonergic antidepressants were demonstrated in patients with PPPD. However, somatosensory hypersensitivity, which is sometimes observed as a clinical feature in patients with PPPD, did not improve after pharmacotherapy. Developing treatments to reduce hypersensitivity may improve treatment outcomes.
持续性姿势 - 感知性头晕（PPPD）是一种慢性神经耳科疾病，其特征为头晕、不稳或非旋转性眩晕等前庭症状。据推测，其病理生理学涉及感觉重新加权以适应视觉/躯体感觉，从而维持空间定向。血清素能抗抑郁药是PPPD的主要治疗选择。然而，尚无关于这些治疗药物在PPPD患者中长期疗效的报道。因此，我们评估了PPPD患者开始使用抗抑郁药长达3年的疗效。
纳入2018年7月至2023年2月在我院开始使用抗抑郁药治疗的43例PPPD患者（12例男性，31例女性；治疗开始时的中位年龄：49岁）。使用头晕残障量表（DHI）、医院焦虑抑郁量表（HADS）和新潟PPPD问卷（NPQ）作为评估指标。将用药后3个月和6个月以及1、1.5、2、2.5和3年时的得分与治疗前得分进行比较。此外，在治疗前后测量体感超敏指标头倾斜感知增益（HTPG）。
从3个月起，所有DHI、HADS和NPQ指标均有显著改善，并在治疗后长达3年的所有时间点保持。同时，开始药物治疗后HTPG无显著改善。DHI得分改善≥18分的患者被视为治疗有效者；43例患者中有27例在治疗1年后为有效者。在治疗的最初2周内，26例患者出现了包括恶心/腹胀在内的不良事件；然而，这些不良事件并未持续到随后的观察时间点。在病例纳入期间，59例患者开始使用抗抑郁药，本研究纳入的43例患者能够继续用药（总体依从率：72.9%）。
血清素能抗抑郁药在PPPD患者中显示出长期疗效和安全性。然而，PPPD患者有时表现出的体感超敏在药物治疗后并未改善。开发降低超敏反应的治疗方法可能会改善治疗效果。
