Update on functional vestibular and gait disorders

Three functional neurological disorders are encountered in neuro-otologic practice, persistent postural-perceptual dizziness (PPPD), which is the commonest cause of chronic vestibular and balance symptoms, mal de debarquement (MdDS), a rarer but potentially debilitating disorder, and functional gait disorder, an often overlooked but treatable condition.

Recent investigations of PPPD suggested that there may be subtypes or subthreshold variants that merit further investigation. Studies of pathological mechanisms continue to offer new insights into the complex processes that initiate and sustain the disorder, which will require nuanced models to bring together disparate findings. Evidence continues to accumulate in support of vestibulo-ocular reflex readaptation therapy for MdDS, with pilot studies offering refinements and possible alternatives. Functional gait disorder is one of the commonest manifestations of functional neurological disorder, often presenting with other functional neurological symptoms including PPPD. Specialized methods of physical and occupational therapy continue to mature. Optimal outcomes may require short and focused periods of intensive treatment.

Evolving theories and continuing emergence of new data are beginning to make functional vestibular and gait disorders a manageable part of neuro-otologic practice.