title: Persistent Postural-Perceptual Dizziness: A Matter of Higher, Central Dysfunction?
abstract: OBJECTIVE
  Persistent postural-perceptual dizziness (PPPD) is the most common vestibular disorder in the age group between 30 and 50 years. It is considered to be based on a multisensory maladjustment involving alterations of sensory response pattern including vestibular, visual and motion stimuli. Previous data supported a link between vestibular and pain mechanism. The aim of the study was to investigate whether other sensory inputs such as pain stimuli might be altered in terms of a more widespread central perception dysfunction in this disorder.
  
  
  METHODS
  Nociceptive blink reflex was measured in 27 patients with PPPD and compared with 27 healthy, age and gender matched controls. The habituation of the R2 component of the blink reflex was evaluated as the percentage area-under-the curve (AUC) decrease in ten consecutive blocks of five averaged rectified responses. Additionally, clinical characteristics were evaluated.
  
  
  RESULTS
  In patients with PPPD a lack of habituation was observed compared to healthy controls. Relative AUC decreased between the first and the tenth block by 19.48% in PPPD patients and by 31.63% (p = 0.035) in healthy controls. There was no correlation between clinical data (course of disease, comorbid depression, medication, trigger factors) or electrophysiological data (perception threshold, pain threshold, stimulus intensity) and habituation pattern. No trigeminal sensitization in terms of facilitation of absolute values could be detected.
  
  
  CONCLUSIONS
  Our study results supports the hypothesis of the multisensory dimension of impaired sensory processing in patients with PPPD extends beyond vestibular/visual motion stimuli and reflexive postural/oculomotor control mechanisms to other sensory inputs such as pain perception in terms of a more generalized disturbed habituation pattern.
authors.affiliation: Department of Neurology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Dagny
authors.initials: D
authors.lastname: Holle
authors.affiliation: Department of Neurology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Benedict
authors.initials: B
authors.lastname: Schulte-Steinberg
authors.affiliation: Department of Neurology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wurthmann
authors.affiliation: Department of Neurology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Naegel
authors.affiliation: Department of Neurology, Ruhr University Bochum, Bochum, Germany.
authors.forename: Ilya
authors.initials: I
authors.lastname: Ayzenberg
authors.affiliation: Department of Neurology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
authors.affiliation: Department of Neurology, Evangelical hospital Unna, Unna, Germany.
authors.forename: Zaza
authors.initials: Z
authors.lastname: Katsarava
authors.affiliation: Department of Neurology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Obermann
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001767:Blinking; D016022:Case-Control Studies; D004244:Dizziness / Q000175:diagnosis / Q000503:physiopathology*; D004594:Electrophysiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009038:Motion; D010146:Pain / Q000175:diagnosis / Q000503:physiopathology*; D058748:Pain Perception; D017288:Pain Threshold / Q000502:physiology*; D015203:Reproducibility of Results; D014717:Vertigo / Q000175:diagnosis / Q000503:physiopathology*; D015837:Vestibular Diseases / Q000175:diagnosis / Q000503:physiopathology*