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
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
Children with BPVC do not lose consciousness during episodes.[3] Headaches are not typical of this condition.[1]
Pathophysiology
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
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
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]
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 and 6 years of age and resolve by adolescence.[3]
Treatment
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
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]
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