Orthostatic dizziness and vertigo, functional and motion sickness
Abstract Introduction: dizziness in children hasn’t received enough attention in the medical literature, despite having a high prevalence. There are very frequent but less studied pathologies such as orthostatic vertigo, functional vertigo and motion sickness. This article aims was to present a revision, of the pathologies previously described. Materials and Methods: a narrative review was made, selecting articles between 2000 and 2023 in Pubmed, Scielo and Cochrane. Results: orthostatic dizziness appears with the incorporation, from lying to sitting, or from sitting to standing. Functional dizziness, currently known as persistent postural perceptual dizziness, is a chronic and functional disorder, in which, patients experience symptoms of dizziness, and is exacerbated by standing, with movement and/or with the exposure to complex visual stimuli. Motion sickness is a normal physiological response to an unusual perception of movement; either during a real movement or in its absence; when the symptomatology is significant it’s called disorder. All the pathologies studied present established criteria by the Bárány Society. The treatment is based on the profile of each patient. Conclusions: the causes of dizziness and instability in the pediatric population are diverse. It is important to know the most appropriate diagnostic criteria and treatments to improve the quality of life of our patients.
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Lipson S, Wang A, Corcoran M, Zhou G, Brodsky JR. Severe motion sickness in infants and children. Eur J Paediatr Neurol. 2020;28:176-9. https://doi.org/10.1016/j.ejpn.2020.06.010
Kim HA, Bisdorff A, Bronstein AM, Lempert T, Rossi-Izquierdo M, Staab JP, et al. Hemodynamic orthostatic dizziness/vertigo: Diagnostic criterio: : Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res. 2019;29(2-3):45-56. https://doi.org/10.3233/ves-190655
Bisdorff A, Von Brevern M, Lempert T, Newman-Toker DE. Classification of vestibular symptoms: towards an international classification of vestibular disorders. J Vestib Res. 2009;19(1-2):1-13. https://doi.org/10.3233/ves-2009-0343
Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69-72. https://doi.org/10.1007/s10286-011-0119-5
Stewart JM. Common syndromes of orthostatic intolerance. Pediatrics. 2013;131(5):968-80.
Novak P. Assessment of sympathetic index from the Valsalva maneuver. Neurology. 2011;76(23):2010-6. https://doi.org/10.1212/wnl.0b013e31821e5563
Zhang J, Zhu Q, Shen J, Chen J, Jin Y, Zhang Q, et al. Etiological classification and management of dizziness in children: A systematic review and meta-analysis. Front Neurol. 2023;14:1125488. https://doi.org/10.3389/fneur.2023.1125488
Lee H, Kim HA. Diagnostic approach of orthostatic dizziness/vertigo. Annals of Clinical Neurophysiology. 2020;22(2):75-81. https://doi.org/10.14253/acn.2020.22.2.75
Staab JP, Eckhardt-Henn A, Horii A, Jacob R, Strupp M, Brandt T, et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res. 2017;27(4):191-208. https://doi.org/10.3233/ves-170622
Association AP. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub. 2013. https://doi.org/10.1590/s2317-17822013000200017
Strupp M, Kim JS, Murofushi T, Straumann D, Jen JC, Rosengren SM, et al. Bilateral vestibulopathy: Diagnostic criteria Consensus document of the Classification Committee of the Bárány Society. J Vestib Res. 2017;27(4):177-89. https://doi.org/10.3233/ves-170619
Gerschlager W, Brown P. Orthostatic tremor - a review. Handb Clin Neurol. 2011;100:457-62. https://doi.org/10.1016/b978-0-444-52014-2.00035-5
Pappas DG, Jr. Autonomic related vertigo. Laryngoscope. 2003;113(10):1658-71. https://doi.org/10.1097/00005537-200310000-00005
Lanier JB, Mote MB, Clay EC. Evaluation and management of orthostatic hypotension. Am Fam Physician. 2011;84(5):527-36. PMID: 21888303
Pilcher TA, Saarel EV. A teenage fainter (dizziness, syncope, postural orthostatic tachycardia syndrome). Pediatr Clin North Am. 2014;61(1):29-43. https://doi.org/10.1016/j.pcl.2013.09.009
Strupp M, Brandt T, Dieterich M. Functional Dizziness and Vertigo. In: Strupp M, Brandt T, Dieterich M, editors. Vertigo and Dizziness: Common Complaints. Cham: Springer International Publishing; 2023. p. 301-20. https://doi.org/10.1007/978-0-85729-591-0
Bisdorff AR, Staab JP, Newman-Toker DE. Overview of the International Classification of Vestibular Disorders. Neurol Clin. 2015;33(3):541-50, vii. https://doi.org/10.1016/j.ncl.2015.04.010
Dieterich M, Staab JP. Functional dizziness: from phobic postural vertigo and chronic subjective dizziness to persistent postural-perceptual dizziness. Curr Opin Neurol. 2017;30(1):107-13. https://doi.org/10.1097/wco.0000000000000417
Steensnaes MH, Knapstad MK, Goplen FK, Berge JE. Persistent Postural-Perceptual Dizziness (PPPD) and quality of life: a cross-sectional study. Eur Arch Otorhinolaryngol. 2023. https://doi.org/10.1007/s00405-023-08040-7
Wang A, Zhou G, Lipson S, Kawai K, Corcoran M, Brodsky JR. Multifactorial Characteristics of Pediatric Dizziness and Imbalance. Laryngoscope. 2021;131(4):E1308-e14. https://doi.org/10.1002/lary.29024
Wang A, Fleischman KM, Kawai K, Corcoran M, Brodsky JR. Persistent Postural-Perceptual Dizziness in Children and Adolescents. Otol Neurotol. 2021;42(8):e1093-e100. https://doi.org/10.1097/mao.0000000000003212
Kelly EA, Janky KL, Patterson JN. The Dizzy Child. Otolaryngol Clin North Am. 2021;54(5):973-87. https://doi.org/10.1016/j.otc.2021.06.002
Knight B, Bermudez F, Shermetaro C. Persistent Postural-Perceptual Dizziness. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2023, StatPearls Publishing LLC.; 2023. PMID: 35201726
Rossi M, Franco V. (2023). P.P.P.D. En ORL Guide. ISBN: 978-84-09-51490-8.
Staab JP, Ruckenstein MJ. Which comes first? Psychogenic dizziness versus otogenic anxiety. Laryngoscope. 2003;113(10):1714-8. https://doi.org/10.1097/00005537-200310000-00010
Popkirov S, Staab JP, Stone J. Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness. Pract Neurol 2018;18:5–13. https://doi.org/10.1136/practneurol-2017-001809
Staab JP, Ruckenstein MJ. Expanding the differential diagnosis of chronic dizziness. Arch Otolaryngol Head Neck Surg. 2007;133(2):170-6. https://doi.org/10.1001/archotol.133.2.170
Nada EH, Ibraheem OA, Hassaan MR. Vestibular Rehabilitation Therapy Outcomes in Patients With Persistent Postural-Perceptual Dizziness. Ann Otol Rhinol Laryngol. 2019;128(4):323-9. https://doi.org/10.1177/0003489418823017
Marambio G J, Segui V G, Cortés F I, Breinbauer K H. Mareo postural perceptual persistente: La causa más frecuente de mareo crónico es fácil de tratar. Revista de otorrinolaringología y cirugía de cabeza y cuello. 2019;79:323-8. http://dx.doi.org/10.4067/S0718-48162019000300323
Popkirov S, Stone J, Holle-Lee D. Treatment of Persistent Postural-Perceptual Dizziness (PPPD) and Related Disorders. Curr Treat Options Neurol. 2018 Oct 13;20(12):50. PMID: 30315375 https://doi.org/10.1007/s11940-018-0535-0
Keshavarz B, Golding JF. Motion sickness: current concepts and management. Curr Opin Neurol. 2022;35(1):107-12. https://doi.org/10.1097/wco.0000000000001018
Koch A, Cascorbi I, Westhofen M, Dafotakis M, Klapa S, Kuhtz-Buschbeck JP. The Neurophysiology and Treatment of Motion Sickness. Dtsch Arztebl Int. 2018;115(41):687-96. https://doi.org/10.3238/arztebl.2018.0687
Schmäl F. Neuronal mechanisms and the treatment of motion sickness. Pharmacology. 2013;91(3-4):229-41. https://doi.org/10.1159/000350185
Cha YH, Golding JF, Keshavarz B, Furman J, Kim JS, Lopez-Escamez JA, et al. Motion sickness diagnostic criteria: Consensus Document of the Classification Committee of the Bárány Society. J Vestib Res. 2021;31(5):327-44. https://doi.org/10.3233/ves-200005
Paillard AC, Quarck G, Paolino F, Denise P, Paolino M, Golding JF, et al. Motion sickness susceptibility in healthy subjects and vestibular patients: effects of gender, age and trait-anxiety. J Vestib Res. 2013;23(4-5):203-9. https://doi.org/10.3233/ves-130501
Leung AK, Hon KL. Motion sickness: an overview. Drugs Context. 2019;8. https://doi.org/10.7573/dic.2019-9-4
Shupak A, Gordon CR. Motion sickness: advances in pathogenesis, prediction, prevention, and treatment. Aviat Space Environ Med. 2006;77(12):1213-23. PMID: 17183916
Brainard A, Gresham C. Prevention and treatment of motion sickness. Am Fam Physician. 2014;90(1):41-6. PMID: 25077501
Chu H, Li MH, Juan SH, Chiou WY. Effects of transcutaneous electrical nerve stimulation on motion sickness induced by rotary chair: a crossover study. J Altern Complement Med. 2012;18(5):494-500. https://doi.org/10.1089/acm.2011.0366
Lee A, Fan LT. Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev. 2009(2):Cd003281. https://doi.org/10.1002/14651858.cd003281.pub3
Cha YH, Deblieck C, Wu AD. Double-Blind Sham-Controlled Crossover Trial of Repetitive Transcranial Magnetic Stimulation for Mal de Debarquement Syndrome. Otol Neurotol. 2016;37(6):805-12. https://doi.org/10.1097/mao.0000000000001045
Kim HA, Bisdorff A, Bronstein AM, Lempert T, Rossi-Izquierdo M, Staab JP, et al. Hemodynamic orthostatic dizziness/vertigo: Diagnostic criterio: : Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res. 2019;29(2-3):45-56. https://doi.org/10.3233/ves-190655
Bisdorff A, Von Brevern M, Lempert T, Newman-Toker DE. Classification of vestibular symptoms: towards an international classification of vestibular disorders. J Vestib Res. 2009;19(1-2):1-13. https://doi.org/10.3233/ves-2009-0343
Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69-72. https://doi.org/10.1007/s10286-011-0119-5
Stewart JM. Common syndromes of orthostatic intolerance. Pediatrics. 2013;131(5):968-80.
Novak P. Assessment of sympathetic index from the Valsalva maneuver. Neurology. 2011;76(23):2010-6. https://doi.org/10.1212/wnl.0b013e31821e5563
Zhang J, Zhu Q, Shen J, Chen J, Jin Y, Zhang Q, et al. Etiological classification and management of dizziness in children: A systematic review and meta-analysis. Front Neurol. 2023;14:1125488. https://doi.org/10.3389/fneur.2023.1125488
Lee H, Kim HA. Diagnostic approach of orthostatic dizziness/vertigo. Annals of Clinical Neurophysiology. 2020;22(2):75-81. https://doi.org/10.14253/acn.2020.22.2.75
Staab JP, Eckhardt-Henn A, Horii A, Jacob R, Strupp M, Brandt T, et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res. 2017;27(4):191-208. https://doi.org/10.3233/ves-170622
Association AP. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub. 2013. https://doi.org/10.1590/s2317-17822013000200017
Strupp M, Kim JS, Murofushi T, Straumann D, Jen JC, Rosengren SM, et al. Bilateral vestibulopathy: Diagnostic criteria Consensus document of the Classification Committee of the Bárány Society. J Vestib Res. 2017;27(4):177-89. https://doi.org/10.3233/ves-170619
Gerschlager W, Brown P. Orthostatic tremor - a review. Handb Clin Neurol. 2011;100:457-62. https://doi.org/10.1016/b978-0-444-52014-2.00035-5
Pappas DG, Jr. Autonomic related vertigo. Laryngoscope. 2003;113(10):1658-71. https://doi.org/10.1097/00005537-200310000-00005
Lanier JB, Mote MB, Clay EC. Evaluation and management of orthostatic hypotension. Am Fam Physician. 2011;84(5):527-36. PMID: 21888303
Pilcher TA, Saarel EV. A teenage fainter (dizziness, syncope, postural orthostatic tachycardia syndrome). Pediatr Clin North Am. 2014;61(1):29-43. https://doi.org/10.1016/j.pcl.2013.09.009
Strupp M, Brandt T, Dieterich M. Functional Dizziness and Vertigo. In: Strupp M, Brandt T, Dieterich M, editors. Vertigo and Dizziness: Common Complaints. Cham: Springer International Publishing; 2023. p. 301-20. https://doi.org/10.1007/978-0-85729-591-0
Bisdorff AR, Staab JP, Newman-Toker DE. Overview of the International Classification of Vestibular Disorders. Neurol Clin. 2015;33(3):541-50, vii. https://doi.org/10.1016/j.ncl.2015.04.010
Dieterich M, Staab JP. Functional dizziness: from phobic postural vertigo and chronic subjective dizziness to persistent postural-perceptual dizziness. Curr Opin Neurol. 2017;30(1):107-13. https://doi.org/10.1097/wco.0000000000000417
Steensnaes MH, Knapstad MK, Goplen FK, Berge JE. Persistent Postural-Perceptual Dizziness (PPPD) and quality of life: a cross-sectional study. Eur Arch Otorhinolaryngol. 2023. https://doi.org/10.1007/s00405-023-08040-7
Wang A, Zhou G, Lipson S, Kawai K, Corcoran M, Brodsky JR. Multifactorial Characteristics of Pediatric Dizziness and Imbalance. Laryngoscope. 2021;131(4):E1308-e14. https://doi.org/10.1002/lary.29024
Wang A, Fleischman KM, Kawai K, Corcoran M, Brodsky JR. Persistent Postural-Perceptual Dizziness in Children and Adolescents. Otol Neurotol. 2021;42(8):e1093-e100. https://doi.org/10.1097/mao.0000000000003212
Kelly EA, Janky KL, Patterson JN. The Dizzy Child. Otolaryngol Clin North Am. 2021;54(5):973-87. https://doi.org/10.1016/j.otc.2021.06.002
Knight B, Bermudez F, Shermetaro C. Persistent Postural-Perceptual Dizziness. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2023, StatPearls Publishing LLC.; 2023. PMID: 35201726
Rossi M, Franco V. (2023). P.P.P.D. En ORL Guide. ISBN: 978-84-09-51490-8.
Staab JP, Ruckenstein MJ. Which comes first? Psychogenic dizziness versus otogenic anxiety. Laryngoscope. 2003;113(10):1714-8. https://doi.org/10.1097/00005537-200310000-00010
Popkirov S, Staab JP, Stone J. Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness. Pract Neurol 2018;18:5–13. https://doi.org/10.1136/practneurol-2017-001809
Staab JP, Ruckenstein MJ. Expanding the differential diagnosis of chronic dizziness. Arch Otolaryngol Head Neck Surg. 2007;133(2):170-6. https://doi.org/10.1001/archotol.133.2.170
Nada EH, Ibraheem OA, Hassaan MR. Vestibular Rehabilitation Therapy Outcomes in Patients With Persistent Postural-Perceptual Dizziness. Ann Otol Rhinol Laryngol. 2019;128(4):323-9. https://doi.org/10.1177/0003489418823017
Marambio G J, Segui V G, Cortés F I, Breinbauer K H. Mareo postural perceptual persistente: La causa más frecuente de mareo crónico es fácil de tratar. Revista de otorrinolaringología y cirugía de cabeza y cuello. 2019;79:323-8. http://dx.doi.org/10.4067/S0718-48162019000300323
Popkirov S, Stone J, Holle-Lee D. Treatment of Persistent Postural-Perceptual Dizziness (PPPD) and Related Disorders. Curr Treat Options Neurol. 2018 Oct 13;20(12):50. PMID: 30315375 https://doi.org/10.1007/s11940-018-0535-0
Keshavarz B, Golding JF. Motion sickness: current concepts and management. Curr Opin Neurol. 2022;35(1):107-12. https://doi.org/10.1097/wco.0000000000001018
Koch A, Cascorbi I, Westhofen M, Dafotakis M, Klapa S, Kuhtz-Buschbeck JP. The Neurophysiology and Treatment of Motion Sickness. Dtsch Arztebl Int. 2018;115(41):687-96. https://doi.org/10.3238/arztebl.2018.0687
Schmäl F. Neuronal mechanisms and the treatment of motion sickness. Pharmacology. 2013;91(3-4):229-41. https://doi.org/10.1159/000350185
Cha YH, Golding JF, Keshavarz B, Furman J, Kim JS, Lopez-Escamez JA, et al. Motion sickness diagnostic criteria: Consensus Document of the Classification Committee of the Bárány Society. J Vestib Res. 2021;31(5):327-44. https://doi.org/10.3233/ves-200005
Paillard AC, Quarck G, Paolino F, Denise P, Paolino M, Golding JF, et al. Motion sickness susceptibility in healthy subjects and vestibular patients: effects of gender, age and trait-anxiety. J Vestib Res. 2013;23(4-5):203-9. https://doi.org/10.3233/ves-130501
Leung AK, Hon KL. Motion sickness: an overview. Drugs Context. 2019;8. https://doi.org/10.7573/dic.2019-9-4
Shupak A, Gordon CR. Motion sickness: advances in pathogenesis, prediction, prevention, and treatment. Aviat Space Environ Med. 2006;77(12):1213-23. PMID: 17183916
Brainard A, Gresham C. Prevention and treatment of motion sickness. Am Fam Physician. 2014;90(1):41-6. PMID: 25077501
Chu H, Li MH, Juan SH, Chiou WY. Effects of transcutaneous electrical nerve stimulation on motion sickness induced by rotary chair: a crossover study. J Altern Complement Med. 2012;18(5):494-500. https://doi.org/10.1089/acm.2011.0366
Lee A, Fan LT. Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev. 2009(2):Cd003281. https://doi.org/10.1002/14651858.cd003281.pub3
Cha YH, Deblieck C, Wu AD. Double-Blind Sham-Controlled Crossover Trial of Repetitive Transcranial Magnetic Stimulation for Mal de Debarquement Syndrome. Otol Neurotol. 2016;37(6):805-12. https://doi.org/10.1097/mao.0000000000001045
Invencio-Da-Costa, L. F., Sánchez-Blanco, C., Yáñez-González, R., Sánchez-Gómez, H., Peña-Navarro, P., Pacheco-López, S., Marcos-Alonso, S., Almeida-Ayerve, C. N., Cabrera-Pérez, L., & Díaz-Sánchez, V. (2023). Orthostatic dizziness and vertigo, functional and motion sickness. Revista ORL, e31540. https://doi.org/10.14201/orl.31540
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