A Practical Diagnostic Approach to Pediatric Episodic Vestibular Syndrome

Mar Rey-Berenguel1, Juan Manuel Espinosa-Sanchez1,2,3,4

  • 1Division of Otoneurology, Department of Otolaryngology, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain.

Insights

Pediatric episodic vestibular syndrome (pEVS) presents diagnostic challenges due to varied causes. A new framework classifies pEVS symptoms into distinct phenotypes to guide diagnosis and management.

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.