Vertigo in Children - A Clinical Approach
NATIONAL JOURNAL OF HOMOEOPATHY 2004 Jul / Aug VOL VI NO 4.
Dr Fatema A Chimthanawala
'Morphinum / Phos / Carc

Dizziness, reeling, whirling, or simply light-headedness - all these are synonyms for a single problem called Vertigo. Children comprise only a small percentage of total vertigo patients and yet this is an important problem a homoeopath has to face.

Vertigo results from problems that affect the inner ear apparatus and/or the parts of the brain that receive and use vestibular information and/or a pathology in the vestibulo-cochlear cranial nerve. It should be differentiated from closely mimicking symptoms fainting and syncope. Vestibular disorders may either be congenital or acquired. They may have disorders in which the vestibular symptoms are only a part of a systemic problem. Most of the information on vertigo in Children is based on clinical observations. Some common nosological causes can be summed up as follows:

1. Functional

         1.        Behavioural - attention seeking disorder

         2.        Middle ear Infections

                i.        Labyrinthitis - viral/bacterial

               ii.        Acute suppurative otitis media - ASOM

             iii.        Cholesteatoma - CSOM

         3.        Temporal lobe epilepsy

         4.        Atypical Migraine involving Basilar Artery.

         5.        Benign paroxysmal or positional vertigo of Children - BPPV

         6.        Meniere's disease

         7.        Drug induced Ototoxicity

         8.        Paroxysmal recurrent torticollis of early childhood

2. Structural

         1.        SOL - Cerebellar tumour or Acoustic neuroma

         2.        Perilymph fistula- surgical/head injury causing temporal bone fracture

Clinical Presentation Describing vestibular disorder or loss of function is at times difficult and may not be possible in case of children, more so in young ones. It is here that the responses of a child to the sensations and manifestations may differ considerably from those of adults. A child’s response to vestibular symptoms is quite often interpreted, unfortunately, as behavioural disorder or insignificant. Such interpretation results in under diagnosis of vestibular disorders in children.

Since the ear is responsible for both hearing and balance, a defect/ disorder / disease may affect both these functions. Children with vestibular symptoms may have impairment of hearing, tinnitus, sound distortion, or fullness in ear, or a child with a hearing loss may be found to have vestibular loss. Hearing loss is easier to identify than vestibular symptoms, but it can pass unnoticed by the family for a long time. Since all children are unable to describe what they experience, vertigo could be more common than currently thought. There are several accompanying symptoms, some of which may be misleading, which are as follows:

1. Behavioural changes - Irritability, groping for words
2. Gait Disorders - Inclination to fall, hesitancy to play outdoor games, staggering in the dark, motion sickness
3. Impaired vision- Difficulty in concentrating, eye jerking
4. Ear complaints - Fullness/ringing in the ears (tinnitus), changed response to spoken commands, hearing loss, deafness.
5. Faintness, lightheadedness, heavy head, Headache
6. Nausea and/or vomiting

Diagnosis Vertigo can be diagnosed only after a complete history taking through parents or family, clinical examination and testing.

History: An accurate history is of great help, with most of the information obtained through the parents. Child in activity should be observed closely to find out if there is something that induces symptoms. History taking should aim to answer the following: Are the symptoms persistent or episodic? How long do they last? Can the child hear while symptomatic? Does the child lose balance or consciousness? Does the child seem less alert or pass urine or vomit during an episode? If the child is mature enough, let him answer the questions.

Clinical Examination: The vestibular examination generally involves looking at eye movements and body response to movement and balance. A child's cooperation is necessary. A family member must accompany him.

An infant's exam should involve checking the eye movements when the child is still and while being moved, when following an object such as a toy with the eyes, and the infant's response to being held in certain position or being moved.

Older children should be observed while they move their eyes and head standing with their eyes open / closed. They should allow the doctor to move his/her head or body, and to do tasks such as touching the nose or shrugging the shoulders.

Tests: Only selected grown-up children should be subjected to vestibular tests. All vestibular tests available for adults are technically possible in children. However it requires a cooperative child who is alert and able to answer questions. Most children are not good candidates for the test. The rotary chair test may be done with a parent sitting on the slowly moving chair while holding the child. For a parent, it is important to be physically and mentally relaxed during the test to encourage the child. The rotary chair test is available in India only at selected centers. Also it is advisable to subject the patients to additional tests as EEG, CT scan - head or ear MRI etc.

Here we present an interesting case of Vertigo in a child and its homoeopathic management. 12 yr/M was brought on 10-2-01 with C/o Intermittent E/o Dizziness for past 3 yrs.

Diagnosis: Left Acoustic Neuroma.
The tumor was excised followed by radiation (7-9-99). Pt was better for 11 months and symptoms relapsed. Re-operated after a repeat MRI Brain, showed increase in tumor size. Vertigo restarted after 5 months. Initially once in 15-20 days then once in 3-4 days. Pt stopped going to school. Pain in Lt ear- dull stitching to throbbing type, extending to vertex and Rt ear. Antihistaminics did not relieve. It was then that the parents opted for homoeopathy. Pt was hospitalized and the following drugs were thought of: Bryonia, Tabacum, Plantago, China, Morphinum, Carbo-veg and Theridion.

Bry 200 was given 1 hrly - no relief
Morphinum 30 given 2 hrly for 2 days relieved the episode of dizziness & pain. Pt was discharged after 3 days. Three more such episodes (6-4-01, 31-5-01), all managed with Morphinum in low potency and freq repetition.

Life Space: A lean thin, fair looking, lively, intelligent boy, had h/o Rec attacks of cold since birth, epistaxis during summer and freq bed wetting since 10 yr of age. He was an over pampered child both because of his sickness and being the only son. Regularly vaccinated. H/o delayed and troublesome dentition. Suffered from recurrent boils and impetigo from 1-5 yrs of age. Slightest change in diet resulted in loose stools.

Appetite: Good
Craving: Fried, cold drinks
Sleep: Talks in sleep
Temperament: Sensitive, Angry on slightest contradiction, Loves company especially of elders, fearful of being alone. Intelligent with good grasp, but concentration difficult esp while studying. Day dreaming while alone, Moody. Frequently. used to comment that his disease shall take toll of him but when counseled he would be assured.

Family History: M: Neurofibromatosis,,Fibroid Uterus. Both Paternal uncles: HT and DM. PGF- Ca-esophagus.

Repertorial Analysis: several remedies which came forward
Phosphorous, Lyco, Nux-vomica, Tarentula and Calcarea-carb

Treatment
Phos 200 1 dose given on 6/6/01 x 1 month.
13/07/01 Eruptions on/round groins - ringworm. SL x 1 month
19/09/01 One Episode of vertigo < position change - Phos 1M 1 dose and SL x 2 months
16/10/01 Severe coryza, hoarseness of voice, fever x 2 days < cold air. Recovered without medicines.
9/12/01 Follow- up >>, concentration in studies +++, indolence SL
2/01/02 Coryza, sneezing +++, thin watery nasal discharge,nose block, low grade fever x 7 days. Allium-cepa 30 x 2 days. Recovered.
18/3/02 Carcinocin 1 M 1 dose given.

For 2 yrs, the pt is under regular follow-up. 3 Repeat MRI scans have not shown any signs of relapse. No episode of vertigo reported.

Discussion

1. Morphinum was selected as a symptomatic prescription to tide over the acute crises when Bryonia failed, on the basis of Vertigo << slightest movement, bursting headache and earache >. The patient did respond well.
2. Phosphorus was his constitutional. It was given on the following rubrics: Fear, being alone, happen something will. Concentration difficult, Thoughts wandering studying. Ideas, Abundant, fancies-vivid. Indolence; Sympathy, Compassion, desire for. Mood changeable. Capriciousness. Timidity. Somnambulism. Chronic loose stools. As expected, it paid rich dividends and till date there is no relapse of either the tumor nor the symptoms.
3. Carcinocin was administered as the deep acting polycrest nosode to prevent relapse of the tumor on the basis of the family history.