Earlier German neurologists described a condition known as phobic postural vertigo (PPV) in which a patient experiences postural dizziness, rocking or swaying without any spinning sensations known as vertigo spells. Phobic postural vertigo (PPV) is now known as a Persistent postural perceptual dizziness (PPPD)

It is a chronic condition that is responsible for affecting the brain functioning and causes hindrance in the vestibular system. When a person experiences disorders in the nervous system, it may sometimes result in Persistent Postural-Perceptual Dizziness.

Several causes lead to PPPD. It is either caused by a medical event, long-standing neuro-otological condition or due to a psychological event. It may further result in triggering the functions of the vestibular system thereby resulting in other neurological disorders. If a person experiencing PPPD syndrome is affected by any vestibular disorder, medical illness or psychological disorder, the symptoms of PPPD start triggering even further with time thereby making the condition worse.

A person suffering from PPPD experiences various symptoms starting from persistent dizziness, swaying to non-spinning vertigo spells which may make the person lose balance and feel unsteady. Unlike vertigo sensations or sudden bouts of dizziness, Persistent Postural-Perceptual Dizziness lasts for a longer timeframe. Persistent Postural-Perceptual Dizziness symptoms are triggered by the patient’s movement or exposure to moving stimuli like crowded surroundings such as when you are amidst traffic, walking on a crowded street or sitting in a crowded place.

Generally, symptoms of Persistent Postural-Perceptual Dizziness are not persistent. They come and go without any discernible reason. It takes a few seconds for PPPD symptoms to settle itself when a patient experiences any sort of distractions, the symptoms of Persistent Postural-Perceptual Dizziness tend to alleviate on self if the case is not intense and symptoms are not triggered.

Significant changes in the behaviour patterns, mild depression, a rise in anxiety levels and obsessive-compulsive personality are observed in the patients suffering from Persistent Postural-Perceptual Dizziness (PPPD).

A lot of research went on the topic to identify whether PPPD is a neurological disorder or psychological condition. It studies are to be believed it has been a clear fact that

Persistent Postural Perceptual Dizziness (PPPD) is a chronic neurological disorder and not a psychiatric disorder.

Exposure to moving stimuli and patients who hold a medical history of vertigo conditions may cause Persistent Postural Perceptual Dizziness in a patient. It is advised to seek medical help as soon as you observe any symptoms of Persistent Postural Perceptual Dizziness (PPPD). An expert doctor will carry out various tests to diagnose the condition closely. He would even seek your complete medical history for accurate diagnosis of the condition and would suggest you with right Persistent Postural Perceptual Dizziness treatment and would guide you with the right techniques and procedures of PPPD exercises that should be practised daily for early recovery.

Patients suffering from Persistent Postural Perceptual Dizziness show secondary symptoms like depression and anxiety, severe disability and avoidance behaviour. Doctors customize effective PPPD treatment as per the patient’s needs and symptoms they are showing to manage the symptoms effectively.

Doctors generally suggest various physical therapies and cognitive-behavioural therapies as PPP treatment to cure the ailment. A dosage of serotonergic medications such as Stemetil tablet and vestibular rehabilitation therapy along with counselling are given by doctors to the patients experiencing Persistent Postural Perceptual Dizziness (Chakkar aana).

Certain conditions trigger the symptoms of Persistent Postural Perceptual Dizziness (PPPD), it is advised to avoid certain situations:

  1. Sitting or standing in Upright posture triggers Persistent Postural Perceptual Dizziness symptoms.
  2. Vertigo bouts result in triggering the condition even further.
  3. If a patient of PPPD is exposed to crowded places or moving stimuli like traffics, it results in triggering PPPD symptoms and making them worse.
  4. Certain medical conditions like dysrhythmias trigger the symptoms of Persistent Postural Perceptual Dizziness.
  5. Side effects of certain drugs that are used in treating vertigo spells, unsteadiness or dizziness sometimes trigger PPPD symptoms.
  6. Additional patterns like high anxiety levels or mild depression can even result in triggering PPPD symptoms.

Get yourself diagnosed if you are experiencing any PPPD symptoms and prevent it from triggering any further while making the condition worse.

Diagnosis of Persistent Postural-Perceptual Dizziness

To diagnose PPPD condition, laboratory tests and physical examinations are not much effective as it may show the ongoing or previous vestibular disorder. Physical exams are not effective in diagnosing the patient’s PPPD symptoms.

Doctors diagnose PPPD conditions by looking at the primary symptoms. Unsteadiness or dizziness and its triggers, symptoms caused due to the body postures experienced by patients for 3 months or more than three months, exposure to moving stimuli, vestibular disorder, Behavioral patterns, etc. are taken into account by doctors to diagnose PPPD syndrome.

Best Persistent Postural Perceptual Dizziness treatment

Once you are diagnosed with PPPD syndrome, your doctor will advise you with the right Persistent Postural-Perceptual Dizziness treatment depending on the severity of the condition.

Here is a list of common PPPD treatment generally advised by doctors:


If a person is in the first stage of Persistent Postural Perceptual Dizziness and it is not fully developed, Counseling or psychotherapy helps in treating PPPD conditions quite well.

A long-standing PPPD condition is not treated well with Counseling or psychotherapy, as the condition has become chronic by now. Counseling does not prove to be effective in such a situation.


If a person is diagnosed with PPPD, your doctor may prescribe you with a dose of certain drugs like a Stemetil tablet to treat the condition. Certain weeks of medication are likely to alleviate PPPD symptoms and heal the condition if the person is in the initial stage of PPPD syndrome.

Medications do come with certain side effects and drugs used to treat PPPD conditions may show adverse effects too. 20% of patients suffering from PPPD may experience nausea, sleep disturbance, etc. as an adverse effect of a certain drug.

PPPD medications help in easing anxiety levels and depression in PPPD patients in many cases. Undergoing a PPPD treatment for at least a year is advised, as it reduces the risk of recurrence of PPPD symptoms.

Many neurologists suggest Benzodiazepines or vestibular suppressants for treating PPPD, but it gives very slow results and is not effective in treating PPPD at a faster rate.

Vestibular balance rehabilitation therapy (VRT)

PPPD exercises and Vestibular balance rehabilitation therapy is quite effective in treating Persistent Postural Perceptual Dizziness. When patients of PPPD do not respond well with medications, doctors recommend undergoing VRT as it helps in reducing the motion stimuli experienced by patients suffering from PPPD.

Vestibular rehabilitation therapy shows effective results in a shorter time frame and helps in dealing with the balance issues faced by the patient.

As per the needs and symptoms of the patients, doctors customize the set of exercises used in Vestibular rehabilitation therapy. 6-12 weeks of VRT exercises under expert guidance helps in giving optimal results and cure PPPD.


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Aditi Arora


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