Vestibular paroxysmia in children: a treatable cause of short vertigo attacks

Abstract

BPPV Benign paroxysmal positional vertigoVestibular paroxysmia due to neurovascular compression is a syndrome consisting of frequent short episodes of vertigo in adults that can be easily treated. Here we describe the initial presentation and follow-up of three children (one female, 12y; two males, 8y and 9y) who experienced typical, brief, vertiginous attacks several times a day. Nystagmus was observed during the episodes. Cranial magnetic resonance imaging revealed arterial compression of the eighth cranial nerve. The attacks ceased after administration of low-dose carbamazepine (2-4mg/kg daily). Vestibular paroxysmia must be considered in the differential diagnosis of children with brief vertiginous episodes.Vestibular paroxysmia is a disabling but, in most cases, medically treatable disorder. Individuals present with brief and frequent vertiginous attacks. 1 It is assumed that they are caused by neurovascular cross-compression at the root entry zone of the eighth cranial nerve.2 Positive diagnostic criteria for vestibular paroxysmia include the occurrence of frequent episodes that last seconds to minutes, which occur at rest and with certain head positions or position changes, and which respond to treatment with low-dose sodium channel-blocking antiepileptics such as carbamazepine (Table I). 1,3 The occurrence of vestibular paroxysmia in children has not yet been reported. Consequently, most paediatric neurologists are unfamiliar with this relevant and treatable condition. We report in detail on three children who presented to our tertiary referral outpatient child dizziness clinic and were subsequently diagnosed as having vestibular paroxysmia. Further, we summarize our experience in children with this condition seen at the German Center for Vertigo and Balance Disorders. CASE REPORTOut of the 400 children and adolescents (under 20y old) seen at our centre over a 10-year period, 16 (nine males, seven females) fulfilled the adult diagnostic criteria 1,3 for definitive or probable vestibular paroxysmia. The first symptoms occurred at mean age 13 years 11 months (SD 4y 0mo, range 5-19y). On average, the diagnosis was established 16 to 17 months after the initial onset of the symptoms. Three children from this cohort are described in this case report. They were chosen for their characteristic presentation and course. The patients and their parents consented to publication. Patient 1A 12-year-old female presented with a 6-month history of to-and-fro attacks of vertigo with blurred vision lasting 30 seconds and occurring 5 to 10 times daily. The bouts were provoked by headshaking, but they also occurred spontaneously while at rest. She did not experience headaches or any other neurological or audiological symptoms during the episodes. The child and her parents were worried that the symptoms might have a serious cause, even a brain tumour. Before presentation at our centre, they had consulted various medical specialists, including several paediatricians, a neurologist, an ear, nose, and throat specialist, an ophth...

Vestibular paroxysmia: Diagnostic criteria

“…Although the prevalence of VP is not known, it should be considered a rare disease (<1 in 2000 people), since only small case series and single cases have been published [3,5,10,13,14,25,39]. There are no data on the life-time prevalence of VP.…”

“…Vestibular paroxysmia was also described in children with features similar to those in adults [25] and appears to have often a good long term prognosis with spontaneous remission with age [7]. From the three studies mentioned above [6,14,25] of a total number of 63 patients, 32 were female. There is no epidemiological evidence of a genetic contribution.…”

Benign Paroxysmal Positional Vertigo in 2 Children: A Case Series

“…A third potential diagnosis for pediatric vertigo is vestibular paroxysmia, which presents with brief and frequent vertiginous attacks, thought to be caused by neurovascular cross-compression at the root entry zone of cranial nerve VIII. 24 Diagnostic criteria for vestibular paroxysmia include the occurrence of at least 5 episodes lasting seconds to minutes, occurring at rest and with certain head positions or position changes (not BPPV-specific positions) and which respond to treatment with low-dose sodium channel-blocking antiepileptics such as carbamazepine. 24 Patients with vestibular paroxysmia have normal results for neuro-otological examinations (including the DH test) ( Table 2).…”

“…24 Diagnostic criteria for vestibular paroxysmia include the occurrence of at least 5 episodes lasting seconds to minutes, occurring at rest and with certain head positions or position changes (not BPPV-specific positions) and which respond to treatment with low-dose sodium channel-blocking antiepileptics such as carbamazepine. 24 Patients with vestibular paroxysmia have normal results for neuro-otological examinations (including the DH test) ( Table 2). Lehnen et al 24 report this diagnosis accounts for about 4% of children.…”

Management of vertigo in children

“…Tanı nöro-radyolojik inceleme ile konulur. Antiepiletik bir ilaç olan karbamezepin yakınmaların sona ermesini sağ-lanabilir (19) .…”