Journal Club- Persistent Postural-Perceptual Dizziness

Join Co-Founder Helena Esmonde PT, DPT, NCS and Dr. Joel A. Goebel, MD, FACS, FRCS as they discuss and take live questions about recent research on the topic of Persistent Postural-Perceptual Dizziness.

[thedizzybusypt]

Outstanding broadcast! Dr Goebel rocks! (Not in the otoconia way). Whenever I have patients with acute forms of vertigo, I work extra hard at providing good dizziness neuroscience education using analogies, stories, and motivational education. My goal is to prevent acute vertigo from becoming chronic. It would be interesting to study acute vertigo patients who may have tendencies toward 3PD comparing those who receive dizziness neuroscience education with those who do not receive it. I think we can learn from the chronic pain world and pain neuroscience education initiatives.

[vertigo]

Great webcast, I always learn so much here, please keep doing these. I was at a course where Dr. Staubb from Mayo Clinic gave an hour lecture on PPPD, PTS can find him on YouTube. We need a team effort in treating these patients and the challenge with CBT, is sometimes they are 3 months out in accepting new patients.

[JoannaTremlett]

Anyone with 3pd or mdds, vm, cervicogenic Dizziness.see the steady coach . You tube .she's a trained audiologist

[pollymoyer]

Edited to add that I've been allocated a @ tag/address/handle (or whatever it is) in this post that I don't use and I have no idea how to get rid of it. I would be grateful for a response to my comments when you have time but don't know if I will receive a notification if I get one. I am not very tech savvy when it comes to all this which puts me at a disadvantage regarding my access needs.

Hi @Vestibular First and many thanks for this informative talk which I only just heard about via one of the VM groups. One of the key differences between MdDS and the symptoms of PPPD is that p/w MdDS (which I had on and off for many years) generally feel a reduction of symptoms (or complete relief from them) when we are re-exposed to passive motion (irrespective of any character traits or hormone status, as far as I can tell) whereas people with the symptoms associated with PPPD generally feel worse in motion. My concern about PPPD is that it is being over diagnosed in some clinics and MdDS is being under diagnosed and that in some cases people with MdDS have had their diagnoses changed to PPPD via re-issued clinical letters, without any further consultations taking place. In some instances it is being diagnosed before people even walk through the door, based on a previous episode of 'dizziness' alone.

I really appreciate that Dr Goebel gives his patients literature about PPPD but am concerned that there was no patient representation in the FND Subtypes paper so hope he and other clinicians have raised their concerns about this. I agree that we need more debate since the PPPD researchers are now tweeting things along the lines of 'a broad or imperfect term is still more clear and useful than none, provided people understand it as such and are working to refine it' but I don't think this understanding is being clearly communicated to patients. It is unfortunate that the FND Society's approach to debate and patient engagement was, in my experience, very poor and I am also aware that Prof O'Leary has noted that FND ed is 'reckless' so the practice is 'reckless' too. Meanwhile Prof Kanaan's 'territorial expansion' commentary (which was published alongside the Subtypes paper) is now mostly behind a paywall but he kindly sent me the full document and, from the patient perspective, I have many concerns about it which need unpacking, preferably by patients and doctors together.

A FAQ in the PPPD group I'm in (I don't have pppd but do have mild orthostatic intolerance which I think could easily be misdiagnosed as PPPD) is 'are there any eminent doctors from the various specialisms involved (eg neuro-otology, neurology, neural ophthalmology, psychiatry etc etc) who have accepted a pppd dx? If it's as common as everyone says it is, there must be at least one.' So, if you know of any, I'd be very grateful if you can let me know who they are.

[JoannaTremlett]

Mine was being told I have a brain tumour ( rathke cleft cyst ) and then 3 weeks later I developed 3pd .still got it a year later but I'm really working on the anxiety and walking exercises .

[ΑλεξάνδραΨαρρά-υο]

Is Videonystagmography a test for diagnosing pppd?