Persistent postural-perceptual dizziness as a regulatory dysfunction of the balance system

Abstract

The problem of chronic functional dizziness is highly relevant nowadays. In case of a great number of patients suffering from persistent postural-perceptual dizziness, lack of a unified understanding of the pathogenesis, diagnostic mistakes, and, as a result, improper treatment lead to a deterioration in the quality of life and disability. The purpose of the review is to analyse and highlight the persistent postural-perceptual dizziness problem, to explore the currently existing pathogenetic concepts, methods of diagnosis and treatment of this group of patients. Domestic and foreign scientific papers have been analysed using the largest world citation databases according to the following keywords: psychogenic dizziness, chronic subjective dizziness, vestibular rehabilitation, stabilometry, persistent postural-perceptual dizziness, postural phobic instability, selective serotonin reuptake inhibitors, cognitive behavioral therapy. The data of 78 scientific works of the research subject are the basis of the review. The article presents a brief historical background, contemporary conceptions of pathogenesis, symptoms and clinical manifestations of persistent postural-perceptual dizziness. The particular attention is given to the diagnostic methods and treatment principles. Relevant questionnaires and diagnostic scales as well as the Barany Society criteria are also considered. A multidisciplinary approach to treatment which allows to achieve a lasting positive effect is described. Segregation of persistent postural-perceptual dizziness into a separate nosological item, understanding of its pathogenesis, an integrated approach to diagnosis with assessment of structural, functional and mental disturbances, just like complex therapeutic strategies make а fully recovery possible.