Clinical Neurophysiology in Dizzy Children: Which Tests do I Need?

Aims: Recent epidemiological studies have shown that vertigo and dizziness in children and adolescents is common and thereby represents one of the leading symptoms also in young patients. For episodic vertigo, vestibular migraine is the most common diagnosis. Migraine-related syndromes account for approximately 40% of diagnoses in dizzy children. With migraine and other episodic syndromes, the problem arises which tests are helpful to make the diagnosis in the asymptomatic interval?

Methods: Consecutive patients (n > 400; age, 3 months–18 years) who presented to the German Center for Vertigo and Balance Disorders in Munich (DSGZ) received standardized diagnostic tests including quantitative ocular-motor testing, determination of subjective visual vertical, vestibular-evoked myogenic potentials, caloric testing, video head impulses, and stabilometry.

Results: The mean age of all patients was 10 ± 3 years. Abnormal ocular motor function (saccadic pursuit and gaze-evoked nystagmus) was most often seen with central lesions, episodic ataxia, and cerebellar syndromes (> 80%), but also in vestibular migraine (> 30%). The abnormal semicircular canal function pointed to labyrinthitis, Menière disease, or vestibular paroxysmia (> 80%). Stabilometry was most helpful in phobic and functional dizziness with the typical finding of relative improvement in more difficult tasks. Results of vestibular-evoked myogenic potentials did not correlate to specific diagnoses.

Conclusion: In particular, testing of semicircular canal function and ocular motor testing helps in the differential diagnosis of dizzy children. Decision on further investigation (e.g., MRI) can be based on the results of these tests. Normal ocular motor function excludes central vestibular lesions. Stabilometry might help in the positive diagnosis of functional (somatoform) syndromes.

Keywords: vertigo, dizziness, migraine, episodic syndromes, diagnostic.