{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T05:30:23Z","timestamp":1792301423961,"version":"4.4.0"},"reference-count":32,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2020,9,28]],"date-time":"2020-09-28T00:00:00Z","timestamp":1601251200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Persistent postural\u2013perceptual dizziness (PPPD) is a chronic disorder with fluctuating symptoms of dizziness, unsteadiness, or vertigo for at least three months. Its pathophysiological mechanisms give theoretical support for the use of multimodal treatment. However, there are different therapeutic programs and principles available, and their clinical effectiveness remains elusive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A database of patients who participated in a day care multimodal treatment program was analyzed regarding the therapeutic effects on PPPD. Vertigo Severity Scale (VSS) and Hospital Anxiety and Depression Scale (HADS) were assessed before and 6\u00a0months after therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of a total of 657 patients treated with a tertiary care multimodal treatment program, 46.4% met the criteria for PPPD. PPPD patients were younger than patients with somatic diagnoses and complained more distress due to dizziness. 63.6% completed the follow\u2010up questionnaire. All patients showed significant changes in VSS and HADS anxiety, but the PPPD patients generally showed a tendency to improve more than the patients with somatic diagnoses. The change in the autonomic\u2013anxiety subscore of VSS only reached statistical significance when comparing PPPD with somatic diagnoses (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Therapeutic principles comprise cognitive\u2013behavioral therapy, vestibular rehabilitation exercises, and serotonergic medication. However, large\u2010scale, randomized, controlled trials are still missing. Follow\u2010up observations after multimodal interdisciplinary therapy reveal an improvement in symptoms in most patients with chronic dizziness. The study was not designed to detect diagnosis\u2010specific effects, but patients with PPPD and patients with other vestibular disorders benefit from multimodal therapies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.1864","type":"journal-article","created":{"date-parts":[[2020,9,28]],"date-time":"2020-09-28T22:36:32Z","timestamp":1601332592000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":81,"title":["Multimodal treatment of persistent postural\u2013perceptual dizziness"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3191-2796","authenticated-orcid":false,"given":"Hubertus","family":"Axer","sequence":"first","affiliation":[{"name":"Center for Vertigo and Dizziness Department of Neurology Jena University Hospital Jena Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigrid","family":"Finn","sequence":"additional","affiliation":[{"name":"Center for Vertigo and Dizziness Department of Neurology Jena University Hospital Jena Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Wassermann","sequence":"additional","affiliation":[{"name":"Center for Vertigo and Dizziness Department of Neurology Jena University Hospital Jena Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orlando","family":"Guntinas\u2010Lichius","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Jena University Hospital Jena Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten M.","family":"Klingner","sequence":"additional","affiliation":[{"name":"Center for Vertigo and Dizziness Department of Neurology Jena University Hospital Jena Germany"},{"name":"Biomagnetic Center Jena University Hospital Jena Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Otto W.","family":"Witte","sequence":"additional","affiliation":[{"name":"Center for Vertigo and Dizziness Department of Neurology Jena University Hospital Jena Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,9,28]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.2224\/sbp.1993.21.3.197"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2005.09.008"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.3233\/VES-160590"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/WCO.0000000000000417"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2018.00345"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2011.10.009"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-018-8894-8"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10608-012-9476-1"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-007-0499-6"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-005-0050-6"},{"key":"e_1_2_10_12_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3233\/VES-2007-17101","article-title":"Effects of fluvoxamine on anxiety, depression, and subjective handicaps of chronic dizziness patients with or without neuro\u2010otologic diseases","volume":"17","author":"Horii A.","year":"2007","journal-title":"Journal of Vestibular Research: Equilibrium & Orientation"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12955-015-0207-7"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.14089.1"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2014-307601"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nicl.2020.102216"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/papt.12177"},{"key":"e_1_2_10_18_1","first-page":"CD005397","article-title":"Vestibular rehabilitation for unilateral peripheral vestibular dysfunction","volume":"1","author":"McDonnell M. 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