PPPDの診断と治療について

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  • 堀井 新
    新潟大学大学院医歯学総合研究科耳鼻咽喉科・頭頸部外科学分野

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タイトル別名
  • Diagnosis and Treatment of PPPD
  • PPPD ノ シンダン ト チリョウ ニ ツイテ

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<p>The diagnostic criteria for persistent postural-perceptual dizziness (PPPD) was established by the Committee for the Classification of Vestibular Disorders of the Barany Society, and published in the Journal of Vestibular Research in 2017. PPPD was included in the International Classification of Diseases 11th revision (ICD-11) of the World Health Organization (WHO) in 2018. The Japanese translation was published in Equilibrium Research in 2019. PPPD is characterized by chronic vestibular syndrome persisting for 3 months or more months, that is typically preceded by acute vestibular disorder. The core vestibular symptoms of PPPD are dizziness, unsteadiness, and/or non-spinning vertigo, which are exacerbated by upright posture/walking, active or passive movements, and exposure to moving or complex visual stimuli. PPPD is classified as a functional disorder, and is not a structural or psychiatric condition. Presence of the three exacerbating factors is characteristic of PPPD. No specific laboratory test for PPPD is available, and a precise assessment of the symptoms, exacerbating factors, and medical history is important for the diagnosis of PPPD. A questionnaire called the Niigata PPPD Questionnaire (NPQ), the validity and reliability of which have been statistically confirmed, has been developed to aid in the diagnosis of PPPD. A total score of 27 or more (full score, 72 points) had a sensitivity of 70% and specificity of 68% for predicting the diagnosis of PPPD among other vestibular disorders. Although the precise pathophysiology of PPPD remains unknown, alterations in postural control strategies, e.g., visual and somatosensory shifts, have been proposed as possible mechanisms underlying the development of PPPD. The differential diagnosis includes other chronic vestibular syndromes, such as uncompensated unilateral vestibular dysfunction, bilateral vestibulopathy, presby-vestibulopathy, and dizziness due to anxiety and depression. In most cases, PPPD can be distinguished from other chronic vestibular syndromes based on exacerbation of the symptoms by visual stimuli. The effectiveness of SSRIs/SNRIs, vestibular rehabilitation, and cognitive behavioral therapy in the treatment of PPPD have been reported, however, there are as yet no reports of randomized controlled trials.</p>

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