Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder characterized by persistent non-spinning dizziness, subjective unsteadiness, and symptom exacerbation induced by upright posture, movement, and complex visual motion....
✦ The floor
Discussion
Signed responses from readers of the wire.
No actionable change at this time — this is a mechanistic review; clinicians should monitor emerging pharmacological targets but no new treatment protocols are supported yet.
Understanding the neurotransmitter networks behind PPPD could open new pharmacological avenues for a condition that is notoriously difficult to treat and commonly seen in vestibular clinics.
- 01PPPD is a chronic functional vestibular disorder characterized by persistent dizziness and postural instability.
- 02The review maps neurotransmitter regulatory networks (e.g., serotonin, GABA, norepinephrine) implicated in PPPD.
- 03Disrupted sensory reweighting and maladaptive neural plasticity are proposed as core mechanisms.
- 04Therapeutic implications include potential roles for SSRIs/SNRIs and vestibular rehabilitation targeting these networks.
- 05No clinical trial data is presented; findings are mechanistic and theoretical.
Neurotransmitter dysregulation is a central mechanism underlying PPPD symptoms.
opinionpartially supportedTargeting specific neurotransmitter pathways may offer therapeutic benefit in PPPD.
opinionunclear- PMID
- 42775155
- DOI
- 10.3389/fneur.2026.1921702.
- Journal
- Frontiers in Neurology
- Publication type
- review
- Evidence level
- 5
- Population
- Not applicable — narrative/mechanistic review of PPPD literature
- Intervention
- Review of neurotransmitter regulatory networks in PPPD
Primary outcomes
Characterisation of neurotransmitter pathways implicated in PPPD; Identification of potential therapeutic targets