Treatment of Persistent Postural-Perceptual Dizziness (PPPD)

Purpose of Review: When persistent postural-perceptual dizziness (PPPD) entered the diagnostic nomenclature in 2017, treatment options were adopted from its predecessors, including use of vestibular rehabilitation, psychotherapy, and serotonin reuptake inhibitors. Individualised treatment may require additional interventions to cover the full range of precipitating and perpetuating factors and medical and psychiatric comorbidities associated with PPPD. This article aims to review available and emerging treatment strategies for this prevalent functional neurological disorder and provides practical recommendations for personalising therapy. Recent Findings: As our knowledge of the underlying causes of PPPD continues to grow, evidence for the best treatment approach is still limited but accumulating. Vestibular rehabilitation, cognitive-behavioural therapy (CBT), and serotonin reuptake inhibitors, alone or in combination, can be beneficial with similar treatment effects in reducing dizziness handicap scores. Newer treatments that have been explored include self-help programmes of vestibular exercises, virtual reality, and electrical stimulation therapies. Summary: For individuals with PPPD, vestibular rehabilitation, CBT, and medication, and ideally for many patients a combination of more than one of these, can assist in breaking a cycle of maladaptive balance control that reinforces patient symptoms. Further evidence from larger randomised controlled studies with longer follow-up periods is needed.