Benign paroxysmal vertigo of childhood
| Benign paroxysmal vertigo of childhood | |
|---|---|
| Specialty | ENT surgery |
Benign paroxysmal vertigo of childhood is a neurological disorder that causes vertigo, a type of dizziness, in children. It is one of the most common causes of vertigo in children and is considered a subtype of migraine. BPVC is characterized by repeated, sudden episodes of vertigo that stop without intervention, typically lasting a few minutes. It is thought to occur due to a decrease in blood flow to the vestibular system, which regulates the body's balance and sense of position in space. These episodes do not require treatment and typically resolve by adolescence.[1][2]
Presentation
[edit]BPVC presents as recurrent episodes of vertigo that occur without warning and cease spontaneously. These episodes typically last a few minutes, but some children experience episodes lasting for hours. Between episodes, children with BPVC are asymptomatic and function normally.[3][2][1] Episodes may be triggered by poor sleep or specific foods, although a trigger is not identified in every case.[1] Unlike in benign paroxysmal positional vertigo (BPPV), episodes are not triggered by a change in head position.[4]
These episodes may be associated with:
- Nystagmus - rapid, involuntary movements of the eye
- Ataxia - impaired balance and coordination
- Nausea and/or vomiting
- Pale skin
- Feeling of fearfulness
- Sensitivity to light and/or sound
- Visual aura[1]
Children with BPVC do not lose consciousness during episodes.[3] Headaches are not typical of this condition.[1]
Pathophysiology
[edit]Although the specific mechanism is not fully understood, BPVC is thought to occur due to a temporary impairment in blood flow to the inner ear, resulting in reduced oxygen supply to the vestibular system, which normally regulates balance and the body's sense of position.[1][3]
Diagnosis
[edit]BPVC is considered to be a type of migraine. [2][5]
The diagnosis of BPVC is made clinically. According to the International Classification of Headache Disorders ICHD-3 diagnostic criteria (ICHD-3), patients must have experienced at least five episodes of vertigo that occurred suddenly and resolved spontaneously. The episodes must be associated with nystagmus, ataxia, vomiting, pale skin, or a feeling of fearfulness, and cannot be accompanied by loss of consciousness. Hearing and neurologic function must be normal between episodes. [1]
An electroencephalogram is not needed for diagnosis but may be useful in ruling out other possible causes.[1]
Differential diagnosis
[edit]Although BPVC is one of the most common causes of vertigo in children, there are many other possible causes.
- Vestibular migraine (VM) - Another common cause of vertigo in the pediatric population. Similar to BPVC, VM is a type of migraine and episodic in nature; however, it is characterized by a migrainous headache during episodes of vertigo.[2]
- Benign paroxysmal positional vertigo (BPPV) - This is the most common cause of vertigo in adults, but it is rarer in children. Unlike BPVC, BPPV is provoked by changes in the head position.[4]
- Otitis media and Vestibular neuritis - Unlike BPVC, these conditions are both associated with ear pain or fullness, and the vertigo is not episodic.[3]
- Head trauma
- Brain tumor
- Autonomic dysfunction - This is characterized by light-headedness rather than dizziness.[1]
Epidemiology
[edit]BPVC is one of the most common causes of vertigo in children, with an estimated prevalence of 2.6% among the pediatric population.[1] Females are more likely to develop BPVC than males.[4] Episodes typically begin between 3 to 6 years of age and resolve by adolescence.[3]
Treatment
[edit]Avoiding any known triggers is crucial in managing BPV. Medical treatment is not usually indicated for BPVC because the episodes are brief and resolve a few years after onset. Children that experience longer episodes may benefit from anti-vertigo medications such as meclizine. There is little data examining the role of preventative medication or other management options such as physical therapy.[1]
Outcomes
[edit]BPVC typically resolves on its own prior to adolescence. However, children that have had BPVC are more likely to develop another migraine disorder in adolescence or adulthood.[1][3]
References
[edit]- ^ a b c d e f g h i j k l Gurberg, Joshua; Tomczak, Kinga K.; Brodsky, Jacob R. (2023), Benign paroxysmal vertigo of childhood, Handbook of Clinical Neurology, vol. 198, Elsevier, pp. 229–240, doi:10.1016/b978-0-12-823356-6.00004-4, ISBN 978-0-12-823356-6, PMID 38043965
- ^ a b c d Jahn, Klaus; Langhagen, Thyra; Heinen, Florian (2015-02-28). "Vertigo and dizziness in children". Current Opinion in Neurology. 28 (1): 78–82. doi:10.1097/WCO.0000000000000157. ISSN 1350-7540. PMID 25502049.
- ^ a b c d e f Gioacchini, Federico Maria; Alicandri-Ciufelli, Matteo; Kaleci, Shaniko; Magliulo, Giuseppe; Re, Massimo (2014-02-15). "Prevalence and diagnosis of vestibular disorders in children: A review". International Journal of Pediatric Otorhinolaryngology. 78 (5): 718–724. doi:10.1016/j.ijporl.2014.02.009. PMID 24612555.
- ^ a b c Galluzzi, Francesca; Garavello, Werner (2022-03-18). "Benign Paroxysmal Positional Vertigo in Children: A Narrative Review". The Journal of International Advanced Otology. 18 (2): 177–182. doi:10.5152/iao.2022.20087. PMC 9449967. PMID 35418367.
- ^ Abu-Arafeh, Ishaq; Gelfand, Amy A. (2021-07-17). "The childhood migraine syndrome". Nature Reviews Neurology. 17 (7): 449–458. doi:10.1038/s41582-021-00497-6. ISSN 1759-4758. PMID 34040231.
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