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Published on: December 11, 2013
Postural control in Chiari I malformation: protocol for a paediatric prospective, observational cohort - potential
Irene Stella1,2,3, Thomas Remen4, Arthur Petel5,3
1EA 3450 DevAH - Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, Nancy, France i.stella@chru-nancy.fr.
Insights
This study investigates postural instability in children with Chiari I malformation (CM1), an anatomical abnormality affecting cerebellar tonsil position. Findings aim to clarify atypical symptoms and guide neurosurgical treatment for improved patient outcomes.
Area of Science:
- Neurology
- Pediatrics
- Biomedical Engineering
Background:
- Chiari I malformation (CM1) involves cerebellar tonsil descent below the foramen magnum, obstructing cerebrospinal fluid (CSF) flow and potentially causing neurological symptoms.
- Atypical symptoms, such as postural instability, can be challenging to link to CM1, complicating diagnosis and treatment decisions in pediatric patients.
- Current understanding of CM1's impact on balance and coordination in children is limited, particularly concerning objective, quantitative assessments.
Purpose of the Study:
- To investigate the relationship between Chiari I malformation (CM1) and postural instability in a pediatric population.
- To utilize Computerised Dynamic Posturography (CDP) to objectively assess balance deficits in children with CM1.
- To compare posturographic findings between children with and without surgical indications and evaluate pre- and post-operative changes.
Main Methods:
- A cohort of 45 children (aged 6-18) with radiologically confirmed CM1 and otolaryngological complaints will be enrolled over 3 years.
- Computerised Dynamic Posturography (EquiTest) will be used to measure postural stability.
- Posturographic results will be analyzed to describe the population, compare surgical vs. non-surgical groups, and assess pre- and post-operative changes, alongside other clinical parameters.
Main Results:
- The study will describe the posturographic performance of children with CM1.
- It will compare balance deficits in children with CM1 who require surgery versus those who do not.
- Pre- and postoperative posturographic data will be analyzed to assess surgical outcomes.
Conclusions:
- This research aims to establish a quantifiable link between CM1 and postural instability in children.
- Objective balance assessment using CDP may aid in diagnosing atypical CM1 presentations and guiding surgical intervention.
- Findings will contribute to a better understanding of CM1's impact on pediatric balance and inform neurosurgical management strategies.
Introduction:
Chiari I malformation (CM1) is an anatomical abnormality characterised by the cerebellar tonsils descending at least 5 mm below the foramen magnum. CM1 causes obstruction of cerebrospinal fluid (CSF) circulation as well as direct compression on the brainstem, thus causing typical consequences (syringomyelia), and typical clinical features (characteristic headaches and neurological impairment). Surgery is the only available treatment, indicated when symptomatology is present. However, sometimes patients have atypical complaints, which are often suggestive of otolaryngological (ears, nose and throat, ENT) involvement. This may be difficult for a neurosurgeon to explain. Our study aims to investigate the relationship between one of these atypical symptoms, for example, postural instability, in a paediatric population using a Computerised Dynamic Posturography (Equitest, NeuroCom, Clackamas, OR). To our knowledge, there are no previously published studies carried out on children with CM1, using dynamic posturography.
Methods And Analysis:
Forty-five children aged 6-18 years old presenting with radiologically confirmed CM1 and presenting ENT clinical complaints will be included in the study for a duration of 3 years. As primary endpoint, posturographic results will be described in the population study. Second, posturographic results will be compared between patients with and without indication for surgery. Finally, preoperative and postoperative posturographic results, as well as CSF circulation quality at foramen magnum level, syringomyelia, sleep apnoea syndrome, scoliosis and behaviour will be compared in the operated patient group.
Ethics And Dissemination:
This protocol received ethical approval from the Clinical Research Delegation of Nancy University Hospital, in accordance with the National Commission on Informatics and Liberties (Commission Nationale de l'Informatique et des Libertés) (protocol number 2019PI256-107). Our data treatment was in accordance with the Methodology of reference Methodology Reference-004 specification for data policy. The study findings will be disseminated via peer-reviewed publications and conference presentations, especially to the Neurosphynx's rare disease healthcare network.
Trial Registration Number:
NCT04679792; Pre-results.
