Primary or secondary chronic functional dizziness: does it make a difference? A DizzyReg study in 356 patients.

Area of Science:

• Neurology
• Otolaryngology
• Vestibular Science

Background:

• Persistent postural-perceptual dizziness (PPPD) is a functional disorder diagnosed using Bárány Society criteria.
• PPPD can be primary (p-PPPD) or secondary (s-PPPD) to an organic cause.
• Understanding the differences between p-PPPD and s-PPPD is crucial for diagnosis and management.

Purpose of the Study:

• To describe the demographic and clinical characteristics of primary (p-PPPD) and secondary (s-PPPD) persistent postural-perceptual dizziness patients.
• To identify differences in patient profiles and diagnostic findings between the two PPPD subtypes.
• To inform future research and clinical practice regarding PPPD classification.

Main Methods:

• Retrospective analysis of 356 patients diagnosed with PPPD at a tertiary vertigo center.
• Detailed vestibular testing, neurological and neuro-orthoptic examinations, and standardized questionnaires (DHI, VAP, EQ-5D-3L).
• Classification into p-PPPD (n=195) and s-PPPD (n=162) based on diagnostic criteria.

Main Results:

• Female gender predominated (56%), especially in s-PPPD (64%). Common triggers for s-PPPD included BPPV (27%) and vestibular migraine (24%).
• p-PPPD patients were younger (mean 44 vs. 48 years) with a bimodal age distribution.
• Posturography identified phobic sway in 50% of cases. s-PPPD patients reported higher handicap (DHI, VAP). p-PPPD showed higher rates of anxiety and depressive disorders.

Conclusions:

• Significant demographic and clinical differences exist between p-PPPD and s-PPPD.
• These findings support the subdivision of PPPD into primary and secondary forms for targeted research and treatment.
• Further prospective studies are warranted to validate these distinctions.