Multimodal treatment of persistent postural-perceptual dizziness

被引:43
作者
Axer, Hubertus [1 ]
Finn, Sigrid [1 ]
Wassermann, Alexander [1 ]
Guntinas-Lichius, Orlando [2 ]
Klingner, Carsten M. [1 ,3 ]
Witte, Otto W. [1 ]
机构
[1] Jena Univ Hosp, Dept Neurol, Ctr Vertigo & Dizziness, Jena, Germany
[2] Jena Univ Hosp, Dept Otorhinolaryngol, Jena, Germany
[3] Jena Univ Hosp, Biomagnet Ctr, Jena, Germany
关键词
cognitive-behavioral therapy; functional dizziness; multimodal treatment; persistent postural-perceptual dizziness; vestibular rehabilitation; COGNITIVE-BEHAVIORAL THERAPY; CHRONIC SUBJECTIVE DIZZINESS; FOLLOW-UP; VERTIGO; ANXIETY; DEPRESSION; DISORDERS; SYMPTOMS; TRIAL;
D O I
10.1002/brb3.1864
中图分类号
B84 [心理学]; C [社会科学总论]; Q98 [人类学];
学科分类号
03 ; 0303 ; 030303 ; 04 ; 0402 ;
摘要
Background Persistent postural-perceptual dizziness (PPPD) is a chronic disorder with fluctuating symptoms of dizziness, unsteadiness, or vertigo for at least three months. Its pathophysiological mechanisms give theoretical support for the use of multimodal treatment. However, there are different therapeutic programs and principles available, and their clinical effectiveness remains elusive. Methods A database of patients who participated in a day care multimodal treatment program was analyzed regarding the therapeutic effects on PPPD. Vertigo Severity Scale (VSS) and Hospital Anxiety and Depression Scale (HADS) were assessed before and 6 months after therapy. Results Of a total of 657 patients treated with a tertiary care multimodal treatment program, 46.4% met the criteria for PPPD. PPPD patients were younger than patients with somatic diagnoses and complained more distress due to dizziness. 63.6% completed the follow-up questionnaire. All patients showed significant changes in VSS and HADS anxiety, but the PPPD patients generally showed a tendency to improve more than the patients with somatic diagnoses. The change in the autonomic-anxiety subscore of VSS only reached statistical significance when comparing PPPD with somatic diagnoses (p = .002). Conclusions Therapeutic principles comprise cognitive-behavioral therapy, vestibular rehabilitation exercises, and serotonergic medication. However, large-scale, randomized, controlled trials are still missing. Follow-up observations after multimodal interdisciplinary therapy reveal an improvement in symptoms in most patients with chronic dizziness. The study was not designed to detect diagnosis-specific effects, but patients with PPPD and patients with other vestibular disorders benefit from multimodal therapies.
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页数:10
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