Trastornos vestibulares y del equilibrio en niños y adolescentes mexicanos: revisión de registros clínicos de 8 años / Vestibular and balance disorders in Mexican children and adolescents: Review of 8-year clinical records

Introducción: El vértigo es un síntoma poco estudiado en la población pediátrica, donde la prevalencia es inferior al 1%. Los trastornos vestibulares en el niño no son equiparables a los del adulto y a menudo son subdiagnosticados. Identificar las principales causas de estos trastornos proporcionaría datos fidedignos y precisos de las enfermedades en ciertos grupos de edad, mejorando el proceso de diagnóstico.Material y métodosEstudio observacional, transversal y retrospectivo. Se revisaron los expedientes consecutivos de pacientes, de entre 3 y 17años, atendidos por síntomas vestibulares, del equilibrio y asociados (vértigo, mareo, hipoacusia, alteraciones del equilibrio y cefalalgia) en el servicio de Otoneurología de un hospital de tercer nivel de atención entre septiembre de 2010 y septiembre de 2018. Se utilizó estadística descriptiva e inferencial para el análisis. Todos los valores de p informados de estos análisis fueron de dos colas con un nivel de significación <0,05.ResultadosSe registraron 212 casos entre 6.444 consultas, por lo que la frecuencia fue del 3,3%. La proporción entre hombres y mujeres fue similar. La edad media del grupo fue de 14,5 (±3,9) años, la mediana de la edad de inicio de los síntomas fue de 11 (RIC 8-14) años y la de la primera consulta fue de 13 (RIC 10-15) años. Como síntoma cardinal, el 51,9% acudieron por vértigo, el 25,5% por mareo, el 9,9% por inestabilidad de la marcha, el 7,5% por hipoacusia y el 5,2% por cefalalgia. El 61,8% de los episodios de vértigo tuvieron un origen periférico, el 32,5% central y el 5,7% fuera del sistema vestibular. El vértigo paroxístico benigno de la infancia, la disfunción y migraña vestibular representaron más del 65% de los casos. No se encontraron diferencias entre los diagnósticos con respecto al sexo y la edad de los participantes (p>0,05). (AU)

Introduction: Vertigo is a seldom studied symptom in the paediatric population, where the prevalence is less than 1%. Vestibular disorders in children are not comparable to those of adults and are often underdiagnosed. Identifying the main causes of these disorders would provide reliable and accurate data of the diseases in certain age groups, improving the diagnostic process.Material and methodsObservational, cross-sectional, and retrospective study. Consecutive records of patients, aged 3 to 17years, attended due to vestibular, balance and associated symptoms (vertigo, dizziness, hearing loss, balance disorders and headache), attended by the otoneurology service of a tertiary hospital, between September 2010 and September 2018, were included. Descriptive and inferential statistics were used for the analysis. All p-values reported from these analyses were two-tailed with a significance level <.05.Results212 cases were registered from 6,444 consultations (3.3%). The proportion between males and females was similar. The mean age of the group was 14.5 (±3.9) years, the median age of onset of symptoms was 11 (IQR 8-14) years and that of the first consultation was 13 (IQR 10-15) years. As a cardinal symptom, 51.9% attended due to vertigo, 25.5% due to dizziness, 9.9% due to gait instability, 7.5% due to hearing loss and 5.2% due to headache. Of the episodes of vertigo, 61.8% were of peripheral origin, 69 32.5% central and 12 5.7% outside the vestibular system. Benign paroxysmal vertigo of childhood, dysfunction and vestibular migraine accounted for more than 65% of cases. No differences were found between the diagnoses regarding the sex and age of the participants (P>.05).ConclusionVestibular and balance disorders are rare in the study population and most of the causes are benign and potentially self-limited disorders. (AU)

Vestibular and balance disorders in Mexican children and adolescents: Review of 8-year clinical records. / Trastornos vestibulares y del equilibrio en niños y adolescentes mexicanos: revisión de registros clínicos de 8 años.

INTRODUCTION: Vertigo is a seldom studied symptom in the paediatric population, where the prevalence is less than 1%. Vestibular disorders in children are not comparable to those of adults and are often underdiagnosed. Identifying the main causes of these disorders would provide reliable and accurate data of the diseases in certain age groups, improving the diagnostic process. MATERIAL AND METHODS: Observational, cross-sectional, and retrospective study. Consecutive records of patients, aged 3 to 17years, attended due to vestibular, balance and associated symptoms (vertigo, dizziness, hearing loss, balance disorders and headache), attended by the otoneurology service of a tertiary hospital, between September 2010 and September 2018, were included. Descriptive and inferential statistics were used for the analysis. All p-values reported from these analyses were two-tailed with a significance level <.05. RESULTS: 212 cases were registered from 6,444 consultations (3.3%). The proportion between males and females was similar. The mean age of the group was 14.5 (±3.9) years, the median age of onset of symptoms was 11 (IQR 8-14) years and that of the first consultation was 13 (IQR 10-15) years. As a cardinal symptom, 51.9% attended due to vertigo, 25.5% due to dizziness, 9.9% due to gait instability, 7.5% due to hearing loss and 5.2% due to headache. Of the episodes of vertigo, 61.8% were of peripheral origin, 69 32.5% central and 12 5.7% outside the vestibular system. Benign paroxysmal vertigo of childhood, dysfunction and vestibular migraine accounted for more than 65% of cases. No differences were found between the diagnoses regarding the sex and age of the participants (P>.05). CONCLUSION: Vestibular and balance disorders are rare in the study population and most of the causes are benign and potentially self-limited disorders.

Utilidad de los potenciales evocados visuales con patrón invertido en el diagnóstico de la dislexia / Utility of pattern-reversal visual evoked potentials in the diagnosis of dyslexia

Antecedentes: En los disléxicos se ha demostrado que existe una alteración de la vía magnocelular, lo cual ha sido corroborado con estudios electrofisiológicos. El objetivo de este estudio fue determinar la utilidad de los potenciales evocados visuales con patrón invertido (PEVp) en el diagnóstico de la dislexia. Método: Estudio comparativo en el que se estudiaron 16 niños disléxicos del Instituto Nacional de Rehabilitación en México D.F. El diagnóstico de dislexia se efectuó con la prueba ENI; se realizaron estudios de agudeza visual, la prueba WISC-R y PEVp. Los disléxicos ingresaron a un programa de terapia de aprendizaje durante 6 meses, de esta manera se obtuvieron y compararon mediciones neuropsicológicas y neurofisiológicas al inicio y al concluir el programa terapéutico. Resultados: En la batería neuropsicológica se encontraron puntuaciones superiores al 75% en las áreas de lectura, escritura y habilidades espaciales. Al aplicar la prueba t-Student se encontraron diferencias significativas para las amplitudes de N2 en PEVp mono y binocular con una p < 0,05; no así en las latencias de N1, P100 y N2. Conclusiones: Las amplitudes en los PEVp se deben tomar en cuenta para poder entender los mecanismos de procesamiento visual y de compensación cerebral en pacientes con dislexia. Se recomienda una terapia específica para los problemas de lectoescritura de acuerdo con el sujeto disléxico (AU)

Background: Dyslexics have been shown to have an impaired magnocellular pathway, a finding that has been corroborated by electrophysiological studies. The aim of this study was to determine the utility of pattern-reversal visual evoked potentials (pVEP) in the diagnosis of dyslexia. Methods: A comparative study was performed in 16 dyslexic children in the National Rehabilitation Institute in Mexico City. The diagnosis of dyslexia was performed with the child neuropsychological assessment battery. Tests of visual acuity and the WISC-R and pVEP tests were also performed. Dyslexics entered a learning therapy program for 6 months. Neuropsychological and neurophysiological measurements were conducted at the beginning and end of the therapeutic program. Results: The neuropsychological battery scores were above 75% in the areas of reading, writing and spatial skills. Student’s t-test showed significant differences in mono and binocular pVEP N2 amplitudes (P < .05). No significant differences were found in N1, N2 and P100 latencies. Conclusions: pVEP amplitudes should be taken into account to understand the mechanisms of visual processing and stroke clearing in patients with dyslexia. Specific therapy is recommended for reading and writing problems in individual dyslexic persons (AU)