A Practical Diagnostic Approach to Pediatric Episodic Vestibular Syndrome

Area of Science:

• Neurology
• Otolaryngology
• Pediatrics

Background:

• Pediatric episodic vestibular syndrome (pEVS) causes diagnostic uncertainty in children.
• Recurrent vertigo, dizziness, and unsteadiness have diverse underlying mechanisms and implications.
• Symptom descriptions are often vague, and examinations may be normal between episodes.

Purpose of the Study:

• To propose a clinician-oriented, phenotype-first framework for evaluating pEVS.
• To aid in classifying recurrent vestibular symptoms in children.
• To guide diagnostic testing and facilitate recognition of various pEVS disorders.

Main Methods:

• Structured history taking and focused bedside examination.
• Emphasis on core symptoms, attack duration, triggers, and associated features (migraine, auditory, autonomic, neurologic).
• Organizing recurrent attacks into clinically recognizable phenotypes based on established criteria.

Main Results:

• Identified phenotypes include migraine-related, auditory, trigger-related, orthostatic/autonomic, and anxiety-related presentations.
• The framework supports bedside classification and guides selective ancillary testing.
• Facilitates longitudinal reassessment and potential diagnostic reclassification over time.

Conclusions:

• A phenotype-driven approach improves diagnostic reasoning for pEVS.
• Supports more rational use of ancillary testing in pediatric vestibular disorders.
• Aids in earlier recognition of common and less frequent pEVS conditions.