Persistent postural perceptual dizziness is on a spectrum in the general population
Persistent postural perceptual dizziness is on a spectrum in the general population
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DOI：
10.1212/wnl.0000000000009373
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发表时间：
2020-05-05
期刊：
影响因子：
9.9
通讯作者：
Sumner, Petroc
中科院分区：
文献类型：
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作者：
Powell, Georgina;Derry-Sumner, Hannah;Sumner, Petroc
目的研究持续性体位性知觉头晕（PPPD）的症状比以前认为的更普遍，并且在一般人群中具有谱性，从而挑战目前认为PPPD只是前庭损伤的结果的理论。方法收集PPPD常见的2份临床问卷（视觉眩晕模拟量表[VVAS]和情境特征问卷[SCQ]），分为4组：社区研究志愿者（VVAS组1941人，SCQ组1474人）；在线付费参与者（VVAS 190人，SCQ 125人）；学生（n = 204，仅VVAS）；诊断为PPPD的患者（n = 25）。结果我们发现，在3个非临床队列中，分别约有9%、4%和11%的患者在PPPD的一项测量（VVAS）中得分高于第25百分位，49%和54%的患者在另一项测量（SCQ）中得分高于第25百分位。分数与年龄呈负相关（与预期相反）。正如预期的那样，在两个人群中，得分与偏头痛相关，但这只解释了一小部分差异，表明偏头痛不是一般人群中PPPD症状谱的主要因素。结论：我们在非临床人群中发现了高水平的PPPD症状，这表明PPPD是一个预先存在于人群中的谱系，而不仅仅是前庭损伤的结果。不典型的视觉-前庭处理使一些人容易发生视觉引起的头晕，当前庭损伤（或更广泛的损伤）发生时，这种情况会加剧。
ObjectiveTo examine the idea that symptoms of persistent postural perceptual dizziness (PPPD) are more common than previously assumed and lie on a spectrum in the general population, thus challenging current theories that PPPD is only a consequence of a vestibular insult.MethodsWe collected 2 common clinical questionnaires of PPPD (Visual Vertigo Analogue Scale [VVAS] and Situational Characteristics Questionnaire [SCQ]) in 4 cohorts: community research volunteers (n = 1941 for VVAS, n = 1,474 for SCQ); paid online participants (n = 190 for VVAS, n = 125 for SCQ); students (n = 204, VVAS only); and patients diagnosed with PPPD (n = 25).ResultsWe found that around 9%, 4%, and 11%, respectively, of the 3 nonclinical cohorts scored above the 25th percentile patient score on 1 PPPD measure (VVAS) and 49% and 54% scored above the 25th percentile patient score on the other measure (SCQ). Scores correlated negatively with age (counter to expectation). As expected, scores correlated with migraine in 2 populations, but this only explained a small part of the variance, suggesting that migraine is not the major factor underlying the spectrum of PPPD symptoms in the general population.ConclusionWe found high levels of PPPD symptoms in nonclinical populations, suggesting that PPPD is a spectrum that preexists in the population, rather than only being a consequence of vestibular insult. Atypical visuo-vestibular processing predisposes some individuals to visually induced dizziness, which is then exacerbated should vestibular insult (or more generalized insult) occur.