Prevalence and treatment outcomes of persistent postural-perceptual dizziness after traumatic brain injury

Background: Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder that is a potential sequela of traumatic brain injury (TBI). Currently, little is known about how patients with TBI associated PPPD respond to typical PPPD treatment modalities. Objective: To investigate the prevalence of TBI as a precipitant for PPPD and assess outcomes of usual treatment. Design: Retrospective cohort study. Setting: Electronic medical records from a tertiary care center. Participants: Patients >= 18 years of age diagnosed with PPPD secondary to TBI between January 2015 and December 2022 who underwent 6 months of treatment with at least one return clinic visit. Interventions: Not applicable. Main Outcome Measure(s): Patients' best clinical global impression-improvement scale (CGI-I) score following 6 months of treatment were collected and then compared with previously published literature, with CGI-I scores of 1or 2 (indicating the patient was "very much" or "much" improved, respectively) considered treatment responders. Results: In total, 134 (8.9%) of 1503 patients had a TBI as the triggering event for PPPD. The mean age of this cohort was 47.6 years with most of these cases occurring after a mild TBI (85.8%). The proportion of females with post-TBI PPPD (58.2%) was significantly lower than the proportion with PPPD due to all causes (p < .037). The most common treatment prescribed was vestibular therapy (82.2%), and 53.3% of patients were considered treatment responders after 6 months. Patients with TBI-induced PPPD had a significantly worse mean CGI-I score (2.49 +/- 1.1) when compared to prior literature (1.71 +/- 0.83) (p < .001). Conclusions: This study found a 9% prevalence of PPPD following TBI in the largest cohort studied to date. Patients who developed PPPD following TBI did not respond as well to standard treatments as patients with other causes of the disorder, and thus may require closer clinical follow-up to assess treatment efficacy.