Therefore, developing another treatment option is a priority. Nonetheless, among patients who properly received SSRI treatment, more than 30% of them reported no significant benefits ( 14, 15). Moreover, it remains a possibility that SSRI may directly have effects on the vestibular nuclear complex, which is related to motion-sensitive neural pathways ( 13). It has been reported that SSRI may indirectly interfere with dizziness symptoms by reducing anxiety and depressive symptoms, which are often observed in patients with PPPD ( 12). Regarding pharmacological treatment, selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) are the first line of treatment options and are most commonly used. While there are available treatments with some evidence of benefit including pharmacology, vestibular rehabilitation, and cognitive behavioral therapy, there are currently no gold standard guidelines for the treatment of PPPD ( 11, 12). The unifying diagnosis of PPPD was established incorporating several descriptions of these syndromes by the Bárány Society in 2017, and it is now included in the International Classification of Diseases 11th Revision (ICD-11) ( 10). Prior to being established as a new diagnostic term, there were several clinical syndromes of functional dizziness such as chronic subjective dizziness (CSD) ( 4, 5), phobic postural vertigo (PPV) ( 6), visual vertigo (VV) ( 7), and space-motion discomfort (SMD) ( 8, 9). PPPD is a common disorder, which comprises about one-fifth of patients who visited the tertiary care dizziness clinic ( 2, 3). Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder that is characterized by waxing and waning non-spinning dizziness for more than 3 months ( 1). In a comparison with the changes in rCBF between the groups, a significant treatment-by-time interaction effect was found in the right superior temporal and left hippocampus, controlling for age and sex.
For the Activities-specific Balance Confidence (ABC) Scale and the Hamilton Anxiety Rating Scale scores, there were no significant main effects of time, treatment, and treatment-by-time interaction. However, the treatment-by-time interaction effect and the main effect of time on HDRS score appear to be due to one data point, an increase in depressive symptoms reported by the sham group at the 3-month follow-up. For the Hamilton Depression Rating Scale (HDRS) score, there was a statistical significance for the treatment-by-time interaction effect and the main effect of time, but not for the main effect of treatment. For the primary outcome measure of the Dizziness Handicap Inventory (DHI) score, a significant main effect of time was found, but neither the treatment-by-time interaction effect nor the main effect of treatment was significant.
0 kommentar(er)
