Cyclic Vertigo With Predictable Recurrence

Diurnal and twenty-four hour patterning of human diseases: acute and chronic common and uncommon medical conditions

The symptom intensity and mortality of human diseases, conditions, and syndromes exhibit diurnal or 24 h patterning, e.g., skin: atopic dermatitis, urticaria, psoriasis, and palmar hyperhidrosis; gastrointestinal: esophageal reflux, peptic ulcer (including perforation and hemorrhage), cyclic vomiting syndrome, biliary colic, hepatic variceal hemorrhage, and proctalgia fugax; infection: susceptibility, fever, and mortality; neural: frontal, parietal, temporal, and occipital lobe seizures, Parkinson's and Alzheimer's disease, hereditary progressive dystonia, and pain (cancer, post-surgical, diabetic neuropathic and foot ulcer, tooth caries, burning mouth and temporomandibular syndromes, fibromyalgia, sciatica, intervertebral vacuum phenomenon, multiple sclerosis muscle spasm, and migraine, tension, cluster, hypnic, and paroxysmal hemicranial headache); renal: colic and nocturnal enuresis and polyuria; ocular: bulbar conjunctival redness, keratoconjunctivitis sicca, intraocular pressure and anterior ischemic optic neuropathy, and recurrent corneal erosion syndrome; psychiatric/behavioral: major and seasonal affective depressive disorders, bipolar disorder, parasuicide and suicide, dementia-associated agitation, and addictive alcohol, tobacco, and heroin cravings and withdrawal phenomena; plus autoimmune and musculoskeletal: rheumatoid arthritis, osteoarthritis, axial spondylarthritis, gout, Sjögren's syndrome, and systemic lupus erythematosus. Knowledge of these and other 24 h patterns of human pathophysiology informs research of their underlying circadian and other endogenous mechanisms, external temporal triggers, and more effective patient care entailing clinical chronopreventive and chronotherapeutic strategies.

Is benign paroxysmal vertigo of childhood a migraine precursor?

INTRODUCTION

Benign Paroxysmal Vertigo of Childhood (BPVC) is a common cause of vertigo in children and it is characterized by recurrent attacks of vertigo without warning resolving spontaneously after minutes to hours. It has been considered the equivalent of migraine in childhood.

METHODS

Twenty-seven patients diagnosed with BPVC were recruited between 1991 and 1997 with a follow up of at least 15 years. The incidence of migraine, inner ear disorders and family medical history is analyzed.

RESULTS

The average age for the onset of the attacks of BPVC was 3 years and 11 months, and for spontaneous resolution, it was around 5 years and 7 months. The average age for follow up was 18 years. Nine patients developed migraine during adulthood. Nineteen of them had a family history of migraine.

CONCLUSION

We have observed that the prevalence of migraine in patients that had been diagnosed with BPVC is higher than in the general population, which leads us to propose BPVC as a precursor of migraine during childhood.

Vertigo and balance in children--diagnostic approach and insights from imaging

Common causes of vertigo and dizziness in childhood are vestibular migraine and associated syndromes (benign paroxysmal vertigo), unilateral vestibular failure due to labyrinthitis, positioning vertigo, and somatoform syndromes. Although the same spectrum of diseases as in adults can be found, the frequency differs widely. Further, balance disorders not related to vestibular function, like cerebral palsy, can present with dizziness. Vestibular function can reliably be addressed at the bedside by head impulses to test vestibulo-ocular reflex function, ocular motor testing of the central vestibular system, and balance tests for vestibulo-spinal function. Vestibulo-ocular reflex function can now be quantified by recording eye and head movements with high resolution video-oculography (256 Hz) and inertial sensors. Posturographic measures using artificial neuronal networks are used to classify dysbalance. Quantitative gait analysis further helps to distinguish balance disorders caused by e.g. sensory dysfunction or supraspinal disturbances. Recently, functional neuroimaging opened a view to the brain network for the control of posture and locomotion. From frontal cortex the locomotor signal is conveyed via the basal ganglia to the centers for locomotion and postural control in the brainstem tegmentum. The cerebellum is involved in sensory integration and rhythm generation during postural demands. To summarize, most syndromes causing dizziness, vertigo and imbalance can be diagnosed based on history and clinical tests. However, new data from neurophysiology and imaging help to understand the pathophysiology and the therapeutic principles in these disorders.

Electronystagmography in migraine equivalent syndrome

Objectives: The aim of the study was to determine the efficacy of electronystagmography testing in the diagnosis of vertigo in children with migraine equivalent syndrome.

Study Design: The investigation included 20 children with “migraine equivalent syndrome” (group A), characterized by benign paroxysmal vertigo of childhood. As a control group, 50 healthy children were identified.

Subjects and Methods: All the subjects underwent rotatory vestibular stimulation by stop test, optokinetic stimulation, and simultaneous postrotatory vestibular and optokinetic stimulations (VVOR).

Results: For the analysis of the results, we considered nystagmus mean gain and direction of visual-vestibular-ocular-reflex (VVOR) nystagmus. In group A, all the children presented a VVOR nystagmus homodirectional to vestibular-ocular reflex (VOR). In the control group, all the subjects presented a VVOR nystagmus homodirectional to optokinetic nystagmus (OKN).

Conclusion: In the healthy patients, VVOR nystagmus is always homodirectional to OKN and indicates the optokinetic system prevalence on VOR. The presence of a VVOR nystagmus homodirectional to VOR indicates the absence of the optokinetic system prevalence due to a central nervous system (CNS) modification and highlights a CNS disease. Our data highlight a possible correlation between CNS disorders and migraine equivalent syndrome.

Visual-vestibular interaction test in the diagnosis of vertigo in children

OBJECTIVE

The aim of this study has been to test to determine the diagnostic value of a visual-vestibular test with a rotatory cylindrical chamber in the diagnosis of peripheral and central vertigo in children.

METHODS

Ten children affected by posttraumatic and migrainous vertigo were enrolled (group A): as a control group 10 healthy children were identified. All the children underwent to electronystagmography (ENG) recording: the children, head blocked, sat on a "Tonnies rotatory chair Pro model", which was placed in the middle of a rotatory cylindrical chamber (2 m in diameter and 1.9 m in height), and underwent to rotatory vestibular stimulation by Stop test, to optokinetic stimulation and to contemporary rotatory vestibular and optokinetic stimulation (visual--vestibular-ocular-reflex): opening the light on the stop test, by an angular velocity of 90 degrees s(-1) obtained from a chair subliminal acceleration of 0.5 degrees s(-2), and making for 60s the optokinetic stimulation by rotation of the optical contrasts to determinate a nystagmus with a opposite direction to the postrotatory nystagmus and homodirectional to optokinetic nystagmus (in both clockwise and counterclockwise directions).

RESULTS

For the analysis of the results we have considered nystagmus mean gain and direction of visual-vestibular-ocular-reflex (VVOR) nystagmus. In group A, all the children presented a VVOR nystagmus homodirectional to vestibular-ocular-reflex (VOR). In control group, all the subjects presented a VVOR nystagmus homodirectional to optokinetic nystagmus.

CONCLUSIONS

In the healthy patients, VVOR nystagmus is always homodirectional to optokinetic nystagmus and indicates the optokinetic system prevalence on VOR. The presence of a VVOR nystagmus homodirectional to VOR indicates the absence of the optokinetic system prevalence due to a central nervous system (CNS) modification and highlights a CNS disease. These data show the diagnostic role of our visual-vestibular interaction test in children affected by vertigo.