持续性姿势-感知性头晕（PPPD）：慢性头晕最常见的原因。

文献信息

中文摘要

持续性姿势-感知性头晕（PPPD）是一种功能性疾病，是慢性头晕最常见的原因。PPPD的诊断标准由Bárány学会于2017年发布，随后被纳入国际疾病分类第11版（ICD-11）。核心症状为头晕、不稳感或非旋转性眩晕，持续超过三个月。持续性症状无特定诱因即可发生，但可因直立姿势/行走、主动或被动运动以及暴露于移动或复杂视觉刺激而加重。急性或发作性前庭障碍常先于PPPD起病，但常规前庭功能检查通常显示正常结果。使用静息态功能MRI的研究显示，前庭皮层与视觉区域之间的功能连接较低，而躯体感觉与视觉区域之间的功能连接较高，提示视觉和躯体感觉信息的感觉权重上调。这种中枢改变已被证明与外周高反应性相关，如视觉刺激负荷姿势描记法和头侧倾倾斜主观视觉垂直测试所分别检测到的视觉和颈部本体感觉超敏反应。因此，症状可因视觉刺激或与身体运动相关的躯体感觉输入而加重。视觉刺激后，凝视稳定性仍然降低，这可以解释视觉刺激引起的持续性头晕。使用5-羟色胺能抗抑郁药的药物治疗、前庭康复和认知行为治疗已显示出良好效果；然而，它们并非对所有患者都有效。迫切需要建立针对PPPD病理生理学（即视觉/躯体感觉输入的感觉权重上调）的新型治疗方法。

英文摘要

Persistent postural- perceptual dizziness (PPPD) is a functional disorder that is the most frequent cause of chronic dizziness. Diagnostic criteria for PPPD were published by Bárány Society in 2017 and were then included in the International Classification of Diseases, 11th revision (ICD-11). Core symptoms are dizziness, unsteadiness or non-spinning vertigo, lasting more than three months. Persistent symptoms occur without specific provocation, but are exacerbated by upright posture/walking, active or passive motion, and exposure to moving or complex visual stimuli. An acute or episodic vestibular disorder often precedes the onset of PPPD, but conventional vestibular function tests typically show normal results. Studies using resting-state functional MRI have revealed that functional connectivity between the vestibular cortex and visual areas were low, while that between the somatosensory and visual areas was high, suggesting sensory upweighting of visual and somatosensory information. Such central changes have been shown to associate with peripheral hyper-responsiveness as demonstrated by visual stimulus-loaded posturography and head-roll tilt subjective visual vertical testing, which detects visual and neck proprioceptive hypersensitivity, respectively. As a result, symptoms are exacerbated by visual stimulation or somatosensory input associated with body motion. After visual stimulation, gaze stability remains reduced, which would account for the prolonged dizziness induced by visual stimuli. Pharmacological treatments using serotonergic anti-depressants, vestibular rehabilitation, and cognitive behavioral therapy have been shown favorable effects; however, they are not always effective for all patients. There is an urgent need to establish novel treatments tailored to the pathophysiology of PPPD, i.e., sensory upweighting of visual/somatosensory inputs.