Persistent postural perceptual dizziness PPPD in pediatric patients after COVID-19 infection, 2024, Noij et al.

Persistent postural perceptual dizziness PPPD in pediatric patients after COVID-19 infection
Noij; Babu; Drews; Lockshaw; Hermann; Malone; Jenks

BACKGROUND
Patients with long-COVID suffer from symptoms that continue or develop after a COVID-19 or SARSCoV-2 infection and are present for four or more weeks after the initial infection. This case series describes a group of previously healthy adolescent patients with long-COVID who were seen in a pediatric vestibular clinic for evaluation of severe dizziness and were diagnosed with persistent postural-perceptual dizziness (PPPD). By presenting their symptoms, management and treatment effects, this study aims to provide a diagnostic and therapeutic framework for providers who encounter these patients.

METHODS
Patient records were reviewed for past medical history, symptoms, physical exam findings, results of audiometric and vestibular testing, dizziness handicap inventory for patient caregiver (DHI-pc) scores, and treatment recommendations. Parents of patients were contacted for a follow up survey to assess treatment adherence and outcomes including changes in symptoms and return to activity.

RESULTS
A series of 9 adolescent patients were referred from a multidisciplinary long-COVID clinic and diagnosed with PPPD. Recommended treatment included vestibular physical therapy, selective serotonin reuptake inhibitor medication, and cognitive behavioral therapy. The majority of patients experienced an improvement in their symptoms, and all patients had improved activity levels and DHI-pc scores after treatment.

CONCLUSIONS
To the best of our knowledge, no previous reports exist discussing PPPD in long-COVID patients. This case series provides insight into symptom evolution and treatment efficacy in this patient population.

Link | PDF (International Journal of Pediatric Otorhinolaryngology)

 

On balance I think this paper belongs in the psychosomatic section. Treated with physiotherapy, SSRIs and CBT - without success it would seem. Summary quotes —

Results

• None of the patients experienced new symptoms at the time of the follow-up questionnaire. All but 2 patients (patient 5 and 8) continued to experience dizziness to some degree, although this symptom improved in 75% of patients and remained stable in 25% of patients

• From the 6 patients who continued to experience some degree of dizziness, triggering factors included exercise or exertion in all patients, moving visual stimuli and complex patterns in 5/6 patients, and motion, loud sounds and light in 4/6 patients. All but 2 patients experienced set-backs during the follow-up time, and these occurred after an illness or viral infection (n = 4), after a seizure (n = 1), after going back to school (n = 1) and after overdoing activity (n = 1).

Discussion

• PPPD in children is also associated with functional gait disorders, migraines, and anxiety, all of which impact daily living and performance in school.

• In this series, 6 patients had been diagnosed with POTS prior to evaluation but suffered from ongoing dizziness despite medical management of POTS.

• The areas of the brain that are important for compensation and coping seem to be affected in PPPD patients as evidenced by functional magnetic resonance imaging […] found to have reduced connectivity between areas involved in multisensory vestibular processing and spatial cognition, while increased connectivity was seen between visual and emotional processing networks

 

The comment about ongoing neurological symptoms despite "medical management of POTS" just reinforces the idea to me that HR is a red herring and the key issue is cerebral blood flow.

I think these children likely have ME given that "triggering factors included exercise or exertion in all patients" but their particular specialist was ORL because of the dizziness. We're still stuck with nobody knowing what to do or often having the first clue with a proper overview.

 

I think they latched onto HR as an explanation because it was the only objective abnormality they could see during an office visit. In actuality people with ME/CFS with and without HR spike can’t be upright.

 

Those papers are so bizarre. Well, actually, their purpose is obvious: it's a paper. That's it.

They describe what they did, without much reason or evidence for it, and... what? Should clinicians use those treatments? They sure don't look any effective. What is the imagined value of such a paper besides fulfilling academic obligations to publish papers?