{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:28:58Z","timestamp":1789000138312,"version":"build-2803163510"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Persistent postural\u2013perceptual dizziness (PPPD) is characterized by maladaptive central sensory processing and frequent psychiatric comorbidity. Prospective outcome data, particularly from low- and middle-income settings, remain limited. This study evaluated clinical characteristics, psychiatric comorbidity, objective balance findings, and treatment response in patients with PPPD, with emphasis on neurologist-delivered diagnostic explanation within a multimodal treatment framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Seventy-five consecutive patients fulfilling B\u00e1r\u00e1ny Society criteria for PPPD were prospectively assessed using the Dizziness Handicap Inventory (DHI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Balance Rehabilitation Unit posturography. All patients received structured, neurologist-delivered diagnostic explanation and education. Treatment consisted of vestibular rehabilitation and cognitive behavioral therapy for all patients, with low-dose antidepressant therapy prescribed when PHQ-9 or GAD-7 scores were\u2009\u2265\u20095. Outcomes were reassessed at 3\u00a0months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Psychiatric comorbidity was present in 88% of patients, most commonly combined anxiety and depression. Despite moderate to severe subjective disability, objective balance measures were largely normal, demonstrating a characteristic subjective\u2013objective dissociation. Following treatment, median DHI scores improved from 40.4 to 8.0, PHQ-9 from 8.0 to 0.0, and GAD-7 from 8.0 to 0.0 (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PPPD is associated with high psychiatric comorbidity and marked subjective\u2013objective dissociation yet shows substantial 3-month\u00a0clinical improvement with a structured multimodal treatment approach. Structured diagnostic explanation and education may facilitate treatment engagement and recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-13927-6","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T14:32:38Z","timestamp":1781101958000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Persistent postural\u2013perceptual dizziness: subjective\u2013objective dissociation and response to neurologist-led multimodal therapy"],"prefix":"10.1007","volume":"273","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6647-6713","authenticated-orcid":false,"given":"Sudhir","family":"Kothari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darshan","family":"Bhansali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4225-8010","authenticated-orcid":false,"given":"Deepak S.","family":"Phalgune","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilesh","family":"Bhandari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay Kumar","family":"Vats","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0591-646X","authenticated-orcid":false,"given":"Diego","family":"Kaski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"13927_CR1","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1136\/practneurol-2017-001809","volume":"18","author":"S Popkirov","year":"2018","unstructured":"Popkirov S, Staab JP, Stone J (2018) Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness. 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The authors certify that they have obtained all appropriate patient consent. Patients provided consent for publication of anonymized clinical information. Names and identifying details have been omitted, and reasonable efforts were made to ensure anonymity.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}],"article-number":"386"}}