Rotary Chair Testing Predicts Progression of Childhood Vestibular Disorders

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Balance impairments were assessed in 11 patients with benign paroxysmal torticollis of infancy and 21 patients with benign paroxysmal vertigo of childhood.
Balance impairments were assessed in 11 patients with benign paroxysmal torticollis of infancy and 21 patients with benign paroxysmal vertigo of childhood.

The risk for progression of vestibular disorders in children, specifically from benign paroxysmal torticollis of infancy (BPTI) to benign paroxysmal vertigo of childhood (BPVC), was largely determined by abnormal rotary chair testing results. In addition, a high incidence of motor delay and balance impairment in children with torticollis was associated with a higher risk for progression from BPTI to BPVC, according to a study published in the European Journal of Paediatric Neurology.

The study population included individuals treated at the Balance and Vestibular Program at Boston Children's Hospital between January 2012 and December 2016. Of the subjects, 14 were diagnosed with BPTI, 39 with BPVC, and 100 with vestibular migraine, according to the International Classification of Headache Disorders, 3rd edition. A retrospective review was conducted of the patients' medical records; in particular, results from sinusoidal harmonic rotary chair testing and cervical vestibular evoked myogenic potential testing were compared, along with other balance and motor function data.

Many of the study participants demonstrated progression from BPTI to BPVC and from BPVC to vestibular migraine. Rotary chair testing was the most consistent test performed among this group. Of the 14 children with BPTI, 12 underwent rotary chair testing: 1 out of 7 patients with normal results developed BPVC (14%); 4 out of the 5 children who reported abnormal results progressed to BPVC (80%). Thus, the association between abnormal rotary chair results and BPTI to BPVC progression is statistically significant (P=.045). However, an association between the progression from BPVC to vestibular migraine with vestibular testing results was not deemed significant.

Limitations of the study included a small sample population and insufficient long-term patient follow-up data. A retrospective study design offers other limitations like inconsistencies in data documentation, as well as inconsistencies in metrics due to testing being varied among the study population, depending on clinical presentation and age.

This retrospective study sought to evaluate a phenomenon referred to as the “vestibular march,” in which children demonstrate a progression from BPTI to BPVC and from BPVC to vestibular migraine. Past studies have reported on the progression observed between vestibular disorders and a link to migraine, but these reports “have not described the actual incidence and risk factors for such progression.”

These results suggest that physicians treating individuals with BPTI should perform rotary chair testing, especially in the presence of otitis media or prolonged torticollis episodes, and screen for motor delay and balance impairment. Individuals who report abnormal results in rotary chair and other vestibular testing should be recommended for early intervention programs, occupational therapy, or other support services.

Reference

Brodsky J, Kaur K, Shoshany T, Lipson S, Zhou G. Benign paroxysmal migraine variants of infancy and childhood: transitions and clinical features [published online March 30, 2018]. Eur J Paediatr Neurol. doi: 10.1016/j.ejpn.2018.03.008

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