Acute Ataxia in Children: Approach to Clinical Presentation and Role of Additional Investigations

Abstract

Acute ataxia is a fairly common emergency that confronts the pediatric neurologist in daily life. The differential diagnosis of acute pediatric ataxia is wide, but informed history and careful clinical examination can narrow it and help target investigations. This review discusses various etiologies of acute pediatric ataxia, focusing on clinical presentation, diagnostic considerations, and approach to investigation. Aspects of treatment and prognosis are also mentioned. Diseases with potentially high morbidity and mortality, such as acute cerebellitis, opsoclonus-myoclonus syndrome, and cerebellar stroke, receive particular attention.

Keywords

acute ataxia - children - differential diagnosis - cerebellar ataxia - neuroimaging - acute cerebellitis

• References

• 1 Ryan MM, Engle EC. Acute ataxia in childhood. J Child Neurol 2003; 18 (5) 309-316
• 2 Baxter PS. Acute ataxia: epidemiology and differential diagnosis. In: Boltshauser E, Schmahmann JD, , eds. Cerebellar Disorders in Children. Oxford: Mac Keith Press; 2012: 361-363
• 3 Poretti A, Boltshauser E. Checklist about acute ataxia (Table 2). In: Boltshauser E, Schmahmann JD, , eds. Cerebellar Disorders in Children. London: Mac Keith Press; 2012: 401
• 4 Desai J, Mitchell WG. Acute cerebellar ataxia, acute cerebellitis, and opsoclonus-myoclonus syndrome. J Child Neurol 2012; 27 (11) 1482-1488
• 5 Jahn K, Langhagen T, Schroeder AS, Heinen F. Vertigo and dizziness in childhood—update on diagnosis and treatment. Neuropediatrics 2011; 42 (4) 129-134
• 6 Curthoys IS. The interpretation of clinical tests of peripheral vestibular function. Laryngoscope 2012; 122 (6) 1342-1352
• 7 Gieron-Korthals MA, Westberry KR, Emmanuel PJ. Acute childhood ataxia: 10-year experience. J Child Neurol 1994; 9 (4) 381-384
• 8 Connolly AM, Dodson WE, Prensky AL, Rust RS. Course and outcome of acute cerebellar ataxia. Ann Neurol 1994; 35 (6) 673-679
• 9 Nussinovitch M, Prais D, Volovitz B, Shapiro R, Amir J. Post-infectious acute cerebellar ataxia in children. Clin Pediatr (Phila) 2003; 42 (7) 581-584
• 10 Amlie-Lefond C, Jubelt B. Neurologic manifestations of varicella zoster virus infections. Curr Neurol Neurosci Rep 2009; 9 (6) 430-434
• 11 Sawaishi Y, Takada G. Acute cerebellitis. Cerebellum 2002; 1 (3) 223-228
• 12 Van Lierde A, Righini A, Tremolati E. Acute cerebellitis with tonsillar herniation and hydrocephalus in Epstein-Barr virus infection. Eur J Pediatr 2004; 163 (11) 689-691
• 13 Takanashi J, Miyamoto T, Ando N , et al. Clinical and radiological features of rotavirus cerebellitis. AJNR Am J Neuroradiol 2010; 31 (9) 1591-1595
• 14 Kato Z, Sasai H, Funato M, Asano T, Kondo N. Acute cerebellitis associated with rotavirus infection. World J Pediatr 2013; 9 (1) 87-89
• 15 Komatsu H, Kuroki S, Shimizu Y, Takada H, Takeuchi Y. Mycoplasma pneumoniae meningoencephalitis and cerebellitis with antiganglioside antibodies. Pediatr Neurol 1998; 18 (2) 160-164
• 16 Gayatri N, Tyagi A, Mahadevan U. Acute hydrocephalus in a child with Mycoplasma cerebellitis. Brain Dev 2009; 31 (8) 618-621
• 17 Matsukuma E, Kato Z, Orii K , et al. Acute mumps cerebellitis with abnormal findings in MRI diffusion-weighted images. Eur J Pediatr 2008; 167 (7) 829-830
• 18 Kato Z, Kozawa R, Teramoto T, Hashimoto K, Shinoda S, Kondo N. Acute cerebellitis in primary human herpesvirus-6 infection. Eur J Pediatr 2003; 162 (11) 801-803
• 19 Montenegro MA, Santos SL, Li LM, Cendes F. Neuroimaging of acute cerebellitis. J Neuroimaging 2002; 12 (1) 72-74
• 20 Soussan V, Husson B, Tardieu M. Description and prognostic value of cerebellar MRI lesions in children with severe acute ataxia. Arch Pediatr 2003; 10 (7) 604-607
• 21 De Bruecker Y, Claus F, Demaerel P , et al. MRI findings in acute cerebellitis. Eur Radiol 2004; 14 (8) 1478-1483
• 22 Kubota T, Suzuki T, Kitase Y , et al. Chronological diffusion-weighted imaging changes and mutism in the course of rotavirus-associated acute cerebellitis/cerebellopathy concurrent with encephalitis/encephalopathy. Brain Dev 2011; 33 (1) 21-27
• 23 de Ribaupierre S, Meagher-Villemure K, Villemure JG , et al. The role of posterior fossa decompression in acute cerebellitis. Childs Nerv Syst 2005; 21 (11) 970-974
• 24 Hennes E, Zotter S, Dorninger L , et al. Long-term outcome of children with acute cerebellitis. Neuropediatrics 2012; 43 (5) 240-248
• 25 Roulet Perez E, Maeder P, Cotting J, Eskenazy-Cottier AC, Deonna T. Acute fatal parainfectious cerebellar swelling in two children. A rare or an overlooked situation?. Neuropediatrics 1993; 24 (6) 346-351
• 26 Göhlich-Ratmann G, Wallot M, Baethmann M , et al. Acute cerebellitis with near-fatal cerebellar swelling and benign outcome under conservative treatment with high dose steroids. Eur J Paediatr Neurol 1998; 2 (3) 157-162
• 27 Burri SM, Krauss JK, Schroth G, Weis J, Steinlin M. Near-fatal cerebellar swelling caused by acute multifocal cerebellar necrosis. Eur J Paediatr Neurol 2003; 7 (3) 139-142
• 28 Kamate M, Chetal V, Hattiholi V. Fulminant cerebellitis: a fatal, clinically isolated syndrome. Pediatr Neurol 2009; 41 (3) 220-222
• 29 Hacohen Y, Niotakis G, Aujla A , et al. Acute life threatening cerebellitis presenting with no apparent cerebellar signs. Clin Neurol Neurosurg 2011; 113 (10) 928-930
• 30 Krupp LB, Banwell B, Tenembaum S. International Pediatric MS Study Group. Consensus definitions proposed for pediatric multiple sclerosis and related disorders. Neurology 2007; 68 (16) (Suppl. 02) S7-S12
• 31 Tenembaum S, Chitnis T, Ness J, Hahn JS. International Pediatric MS Study Group. Acute disseminated encephalomyelitis. Neurology 2007; 68 (16) (Suppl. 02) S23-S36
• 32 Parrish JB, Yeh EA. Acuted disseminated encephalomyelitis. Adv Exp Med Biol 2012; 724: 1-14
• 33 Hynson JL, Kornberg AJ, Coleman LT, Shield L, Harvey AS, Kean MJ. Clinical and neuroradiologic features of acute disseminated encephalomyelitis in children. Neurology 2001; 56 (10) 1308-1312
• 34 Tenembaum S, Chamoles N, Fejerman N. Acute disseminated encephalomyelitis: a long-term follow-up study of 84 pediatric patients. Neurology 2002; 59 (8) 1224-1231
• 35 Mikaeloff Y, Suissa S, Vallée L , et al; KIDMUS Study Group. First episode of acute CNS inflammatory demyelination in childhood: prognostic factors for multiple sclerosis and disability. J Pediatr 2004; 144 (2) 246-252
• 36 Pavone P, Pettoello-Mantovano M, Le Pira A , et al. Acute disseminated encephalomyelitis: a long-term prospective study and meta-analysis. Neuropediatrics 2010; 41 (6) 246-255
• 37 Rossi A. Imaging of acute disseminated encephalomyelitis. Neuroimaging Clin North Am 2008; 18 (1) 149-161 , ix
• 38 Callen DJ, Shroff MM, Branson HM , et al. Role of MRI in the differentiation of ADEM from MS in children. Neurology 2009; 72 (11) 968-973
• 39 Hahn CD, Miles BS, MacGregor DL, Blaser SI, Banwell BL, Hetherington CR. Neurocognitive outcome after acute disseminated encephalomyelitis. Pediatr Neurol 2003; 29 (2) 117-123
• 40 Mikaeloff Y, Caridade G, Husson B, Suissa S, Tardieu M. Neuropediatric KIDSEP Study Group of the French Neuropediatric Society. Acute disseminated encephalomyelitis cohort study: prognostic factors for relapse. Eur J Paediatr Neurol 2007; 11 (2) 90-95
• 41 Huppke P, Gärtner J. A practical guide to pediatric multiple sclerosis. Neuropediatrics 2010; 41 (4) 157-162
• 42 Banwell B, Ghezzi A, Bar-Or A, Mikaeloff Y, Tardieu M. Multiple sclerosis in children: clinical diagnosis, therapeutic strategies, and future directions. Lancet Neurol 2007; 6 (10) 887-902
• 43 Sadaka Y, Verhey LH, Shroff MM , et al; on behalf of the Canadian Pediatric Demyelinating Disease Network. 2010 McDonald criteria for diagnosing pediatric multiple sclerosis. Ann Neurol 2012; 72 (2) 211-223
• 44 Banwell B, Shroff M, Ness JM, Jeffery D, Schwid S, Weinstock-Guttman B. International Pediatric MS Study Group. MRI features of pediatric multiple sclerosis. Neurology 2007; 68 (16) (Suppl. 02) S46-S53
• 45 Martínez-González MJ, Martínez-González S, García-Ribes A, Mintegi-Raso S, Benito-Fernández J, Prats-Viñas JM. Acute onset ataxia in infancy: its aetiology, treatment and follow-up. Rev Neurol 2006; 42 (6) 321-324
• 46 Bridge TA, Norton RL, Robertson WO. Pediatric carbamazepine overdoses. Pediatr Emerg Care 1994; 10 (5) 260-263
• 47 Lifshitz M, Gavrilov V, Sofer S. Signs and symptoms of carbamazepine overdose in young children. Pediatr Emerg Care 2000; 16 (1) 26-27
• 48 Shroff R, Houston B. Unusual cerebellar ataxia: “worm wobble” revisited. Arch Dis Child 2002; 87 (4) 333-334
• 49 Kaleyias J, Faerber E, Kothare SV. Tacrolimus induced subacute cerebellar ataxia. Eur J Paediatr Neurol 2006; 10 (2) 86-89
• 50 Lin G, Lawrence R. Pediatric case report of topiramate toxicity. Clin Toxicol (Phila) 2006; 44 (1) 67-69
• 51 Daana M, Nevo Y, Tenenbaum A, Taustein I, Berger I. Lamotrigine overdose in a child. J Child Neurol 2007; 22 (5) 642-644
• 52 O'Brien MM, Lacayo NJ, Lum BL , et al. Phase I study of valspodar (PSC-833) with mitoxantrone and etoposide in refractory and relapsed pediatric acute leukemia: a report from the Children's Oncology Group. Pediatr Blood Cancer 2010; 54 (5) 694-702
• 53 Bonkowsky JL, Sarco D, Pomeroy SL. Ataxia and shaking in a 2-year-old girl: acute marijuana intoxication presenting as seizure. Pediatr Emerg Care 2005; 21 (8) 527-528
• 54 Mills F, MacLennan SC, Devile CJ, Saunders DE. Severe cerebellitis following methadone poisoning. Pediatr Radiol 2008; 38 (2) 227-229
• 55 Kohli U, Kuttiat VS, Lodha R, Kabra SK. Profile of childhood poisoning at a tertiary care centre in North India. Indian J Pediatr 2008; 75 (8) 791-794
• 56 Topcu M, Gucuyener K, Topaloglu H, Renda Y, Akyuz C, Kale G. Paraneoplastic syndrome manifesting as chronic cerebellar ataxia in a child with Hodgkin disease. J Pediatr 1992; 120 (2 Pt 1) 275-277
• 57 Hahn A, Claviez A, Brinkmann G, Altermatt HJ, Schneppenheim R, Stephani U. Paraneoplastic cerebellar degeneration in pediatric Hodgkin disease. Neuropediatrics 2000; 31 (1) 42-44
• 58 Gorman MP. Update on diagnosis, treatment, and prognosis in opsoclonus-myoclonus-ataxia syndrome. Curr Opin Pediatr 2010; 22 (6) 745-750
• 59 Pang KK, de Sousa C, Lang B, Pike MG. A prospective study of the presentation and management of dancing eye syndrome/opsoclonus-myoclonus syndrome in the United Kingdom. Eur J Paediatr Neurol 2010; 14 (2) 156-161
• 60 McCarthy VP, Zimmerman AW, Miller CA. Central nervous system manifestations of parainfluenza virus type 3 infections in childhood. Pediatr Neurol 1990; 6 (3) 197-201
• 61 Pranzatelli MR. The neurobiology of the opsoclonus-myoclonus syndrome. Clin Neuropharmacol 1992; 15 (3) 186-228
• 62 Ichiba N, Miyake Y, Sato K, Oda M, Kimoto H. Mumps-induced opsoclonus-myoclonus and ataxia. Pediatr Neurol 1988; 4 (4) 224-227
• 63 Crawford JR, Kadom N, Santi MR, Mariani B, Lavenstein BL. Human herpesvirus 6 rhombencephalitis in immunocompetent children. J Child Neurol 2007; 22 (11) 1260-1268
• 64 Huber BM, Strozzi S, Steinlin M, Aebi C, Fluri S. Mycoplasma pneumoniae associated opsoclonus-myoclonus syndrome in three cases. Eur J Pediatr 2010; 169 (4) 441-445
• 65 Krug P, Schleiermacher G, Michon J , et al. Opsoclonus-myoclonus in children associated or not with neuroblastoma. Eur J Paediatr Neurol 2010; 14 (5) 400-409
• 66 Raffaghello L, Conte M, De Grandis E, Pistoia V. Immunological mechanisms in opsoclonus-myoclonus associated neuroblastoma. Eur J Paediatr Neurol 2009; 13 (3) 219-223
• 67 Matthay KK, Blaes F, Hero B , et al. Opsoclonus myoclonus syndrome in neuroblastoma a report from a workshop on the dancing eyes syndrome at the advances in neuroblastoma meeting in Genoa, Italy, 2004. Cancer Lett 2005; 228 (1–2) 275-282
• 68 Haden SV, McShane MA, Holt CM. Opsoclonus myoclonus: a non-epileptic movement disorder that may present as status epilepticus. Arch Dis Child 2009; 94 (11) 897-899
• 69 Klein A, Schmitt B, Boltshauser E. Long-term outcome of ten children with opsoclonus-myoclonus syndrome. Eur J Pediatr 2007; 166 (4) 359-363
• 70 De Grandis E, Parodi S, Conte M , et al. Long-term follow-up of neuroblastoma-associated opsoclonus-myoclonus-ataxia syndrome. Neuropediatrics 2009; 40 (3) 103-111
• 71 Brunklaus A, Pohl K, Zuberi SM, de Sousa C. Outcome and prognostic features in opsoclonus-myoclonus syndrome from infancy to adult life. Pediatrics 2011; 128 (2) e388-e394
• 72 Tate ED, Allison TJ, Pranzatelli MR, Verhulst SJ. Neuroepidemiologic trends in 105 US cases of pediatric opsoclonus-myoclonus syndrome. J Pediatr Oncol Nurs 2005; 22 (1) 8-19
• 73 Rostásy K, Wilken B, Baumann M , et al. High dose pulsatile dexamethasone therapy in children with opsoclonus-myoclonus syndrome. Neuropediatrics 2006; 37 (5) 291-295
• 74 Ertle F, Behnisch W, Al Mulla NA , et al. Treatment of neuroblastoma-related opsoclonus-myoclonus-ataxia syndrome with high-dose dexamethasone pulses. Pediatr Blood Cancer 2008; 50 (3) 683-687
• 75 Wilken B, Baumann M, Bien CG, Hero B, Rostasy K, Hanefeld F. Chronic relapsing opsoclonus-myoclonus syndrome: combination of cyclophosphamide and dexamethasone pulses. Eur J Paediatr Neurol 2008; 12 (1) 51-55
• 76 Pranzatelli MR, Tate ED, Travelstead AL , et al. Rituximab (anti-CD20) adjunctive therapy for opsoclonus-myoclonus syndrome. J Pediatr Hematol Oncol 2006; 28 (9) 585-593
• 77 Bell J, Moran C, Blatt J. Response to rituximab in a child with neuroblastoma and opsoclonus-myoclonus. Pediatr Blood Cancer 2008; 50 (2) 370-371
• 78 Corapcioglu F, Mutlu H, Kara B , et al. Response to rituximab and prednisolone for opsoclonus-myoclonus-ataxia syndrome in a child with ganglioneuroblastoma. Pediatr Hematol Oncol 2008; 25 (8) 756-761
• 79 Leen WG, Weemaes CM, Verbeek MM, Willemsen MA, Rotteveel JJ. Rituximab and intravenous immunoglobulins for relapsing postinfectious opsoclonus-myoclonus syndrome. Pediatr Neurol 2008; 39 (3) 213-217
• 80 Battaglia T, De Grandis E, Mirabelli-Badenier M , et al. Response to rituximab in 3 children with opsoclonus-myoclonus syndrome resistant to conventional treatments. Eur J Paediatr Neurol 2012; 16 (2) 192-195
• 81 Gohil JR, Munshi SS. Post concussion ataxia following minor head injury. Indian Pediatr 2006; 43 (9) 829
• 82 Yeoh HK, Lind CR, Law AJ. Acute transient cerebellar dysfunction and stuttering following mild closed head injury. Childs Nerv Syst 2006; 22 (3) 310-313
• 83 Lückhoff C, Starr M. Minor head injuries in children—an approach to management. Aust Fam Physician 2010; 39 (5) 284-287
• 84 Adaletli I, Sirikci A, Ulus S, Yilmaz MH, Kervancioglu S, Kurugoglu S. Traumatic bilateral vertebral artery dissection at the dural entry point site in a 10-year-old boy. Pediatr Surg Int 2006; 22 (5) 468-470
• 85 Mortazavi MM, Verma K, Tubbs RS, Harrigan M. Pediatric traumatic carotid, vertebral and cerebral artery dissections: a review. Childs Nerv Syst 2011; 27 (12) 2045-2056
• 86 Kristoffersen S, Vetti N, Morild I. Traumatic dissection of the vertebral artery in a toddler following a short fall. Forensic Sci Int 2012; 221 (1–3) e34-e38 [Epub ahead of print]
• 87 Fullerton HJ, Johnston SC, Smith WS. Arterial dissection and stroke in children. Neurology 2001; 57 (7) 1155-1160
• 88 Hasan I, Wapnick S, Tenner MS, Couldwell WT. Vertebral artery dissection in children: a comprehensive review. Pediatr Neurosurg 2002; 37 (4) 168-177
• 89 van der Knaap MS, Pronk JC, Scheper GC. Vanishing white matter disease. Lancet Neurol 2006; 5 (5) 413-423
• 90 Jen JC, Graves TD, Hess EJ, Hanna MG, Griggs RC, Baloh RW. CINCH investigators. Primary episodic ataxias: diagnosis, pathogenesis and treatment. Brain 2007; 130 (Pt 10) 2484-2493
• 91 Ganesan V, Chong WK, Cox TC, Chawda SJ, Prengler M, Kirkham FJ. Posterior circulation stroke in childhood: risk factors and recurrence. Neurology 2002; 59 (10) 1552-1556
• 92 Mackay MT, Prabhu SP, Coleman L. Childhood posterior circulation arterial ischemic stroke. Stroke 2010; 41 (10) 2201-2209
• 93 Edlow JA, Newman-Toker DE, Savitz SI. Diagnosis and initial management of cerebellar infarction. Lancet Neurol 2008; 7 (10) 951-964
• 94 Poretti A, Boltshauser E. Checklist about intermittent ataxia (Table 3). In: Boltshauser E, Schmahmann JD, , eds. Cerebellar Disorders in Children. London: Mac Keith Press; 2012: 402
• 95 Simon E, Flaschker N, Schadewaldt P, Langenbeck U, Wendel U. Variant maple syrup urine disease (MSUD)—the entire spectrum. J Inherit Metab Dis 2006; 29 (6) 716-724
• 96 Jan W, Zimmerman RA, Wang ZJ, Berry GT, Kaplan PB, Kaye EM. MR diffusion imaging and MR spectroscopy of maple syrup urine disease during acute metabolic decompensation. Neuroradiology 2003; 45 (6) 393-399
• 97 Di Rocco M, Biancheri R, Rossi A, Allegri AE, Vecchi V, Tortori-Donati P. MRI in acute intermittent maple syrup urine disease. Neurology 2004; 63 (6) 1078
• 98 Barnerias C, Saudubray JM, Touati G , et al. Pyruvate dehydrogenase complex deficiency: four neurological phenotypes with differing pathogenesis. Dev Med Child Neurol 2010; 52 (2) e1-e9
• 99 Strassburg HM, Koch J, Mayr J, Sperl W, Boltshauser E. Acute flaccid paralysis as initial symptom in 4 patients with novel E1alpha mutations of the pyruvate dehydrogenase complex. Neuropediatrics 2006; 37 (3) 137-141
• 100 Debray FG, Lambert M, Gagne R , et al. Pyruvate dehydrogenase deficiency presenting as intermittent isolated acute ataxia. Neuropediatrics 2008; 39 (1) 20-23
• 101 Brockmann K. The expanding phenotype of GLUT1-deficiency syndrome. Brain Dev 2009; 31 (7) 545-552
• 102 Leen WG, Klepper J, Verbeek MM , et al. Glucose transporter-1 deficiency syndrome: the expanding clinical and genetic spectrum of a treatable disorder. Brain 2010; 133 (Pt 3) 655-670
• 103 Pons R, Collins A, Rotstein M, Engelstad K, De Vivo DC. The spectrum of movement disorders in Glut-1 deficiency. Mov Disord 2010; 25 (3) 275-281
• 104 Verrotti A, D'Egidio C, Agostinelli S, Gobbi G. Glut1 deficiency: when to suspect and how to diagnose?. Eur J Paediatr Neurol 2012; 16 (1) 3-9
• 105 Freeman JM, Kossoff EH, Hartman AL. The ketogenic diet: one decade later. Pediatrics 2007; 119 (3) 535-543
• 106 Livingstone IR, Gardner-Medwin D, Pennington RJ. Familial intermittent ataxia with possible X-linked recessive inheritance. Two patients with abnormal pyruvate metabolism and a response to acetazolamide. J Neurol Sci 1984; 64 (1) 89-97
• 107 Smith W, Kishnani PS, Lee B , et al. Urea cycle disorders: clinical presentation outside the newborn period. Crit Care Clin 2005; 21 (4) (Suppl): S9-S17
• 108 Swango KL, Demirkol M, Hüner G , et al. Partial biotinidase deficiency is usually due to the D444H mutation in the biotinidase gene. Hum Genet 1998; 102 (5) 571-575
• 109 Tanaka K. Isovaleric acidemia: personal history, clinical survey and study of the molecular basis. Prog Clin Biol Res 1990; 321: 273-290
• 110 Deodato F, Boenzi S, Santorelli FM, Dionisi-Vici C. Methylmalonic and propionic aciduria. Am J Med Genet C Semin Med Genet 2006; 142C (2) 104-112
• 111 Poretti A, Boltshauser E. Checklist about episodic ataxia (Table 4). In: Boltshauser E, Schmahmann JD, , eds. Cerebellar Disorders in Children. London: Mac Keith Press; 2012: 403
• 112 Zuberi SM, Eunson LH, Spauschus A , et al. A novel mutation in the human voltage-gated potassium channel gene (Kv1.1) associates with episodic ataxia type 1 and sometimes with partial epilepsy. Brain 1999; 122 (Pt 5) 817-825
• 113 Jen J, Kim GW, Baloh RW. Clinical spectrum of episodic ataxia type 2. Neurology 2004; 62 (1) 17-22
• 114 Bertholon P, Chabrier S, Riant F, Tournier-Lasserve E, Peyron R. Episodic ataxia type 2: unusual aspects in clinical and genetic presentation. Special emphasis in childhood. J Neurol Neurosurg Psychiatry 2009; 80 (11) 1289-1292
• 115 Jen JC, Baloh RW. Familial episodic ataxia: a model for migrainous vertigo. Ann N Y Acad Sci 2009; 1164: 252-256
• 116 Miyahara M, Hirayama M, Yuta A, Takeuchi K, Inoki T. Too young to talk of vertigo?. Lancet 2009; 373 (9662) 516
• 117 Balatsouras DG, Kaberos A, Assimakopoulos D, Katotomichelakis M, Economou NC, Korres SG. Etiology of vertigo in children. Int J Pediatr Otorhinolaryngol 2007; 71 (3) 487-494
• 118 Humphriss RL, Hall AJ. Dizziness in 10 year old children: an epidemiological study. Int J Pediatr Otorhinolaryngol 2011; 75 (3) 395-400
• 119 Lewis D, Ashwal S, Hershey A, Hirtz D, Yonker M, Silberstein S. American Academy of Neurology Quality Standards Subcommittee; Practice Committee of the Child Neurology Society. Practice parameter: pharmacological treatment of migraine headache in children and adolescents. Report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society. Neurology 2004; 63 (12) 2215-2224
• 120 Ralli G, Atturo F, de Filippis C. Idiopathic benign paroxysmal vertigo in children, a migraine precursor. Int J Pediatr Otorhinolaryngol 2009; 73 (Suppl. 01) S16-S18
• 121 Krams B, Echenne B, Leydet J, Rivier F, Roubertie A. Benign paroxysmal vertigo of childhood: long-term outcome. Cephalalgia 2011; 31 (4) 439-443
• 122 Fernandez-Alvarez E. Transient movement disorders in children. J Neurol 1998; 245 (1) 1-5
• 123 Ryan MM. Guillain-Barré syndrome in childhood. J Paediatr Child Health 2005; 41 (5–6) 237-241
• 124 Incecik F, Ozlem Hergüner M, Altunbasak S. Guillain-Barré syndrome in children. Neurol Sci 2011; 32 (3) 381-385
• 125 Delanoe C, Sebire G, Landrieu P, Huault G, Metral S. Acute inflammatory demyelinating polyradiculopathy in children: clinical and electrodiagnostic studies. Ann Neurol 1998; 44 (3) 350-356
• 126 Lee JH, Sung IY, Rew IS. Clinical presentation and prognosis of childhood Guillain-Barré syndrome. J Paediatr Child Health 2008; 44 (7–8) 449-454
• 127 Hicks CW, Kay B, Worley SE, Moodley M. A clinical picture of Guillain-Barré syndrome in children in the United States. J Child Neurol 2010; 25 (12) 1504-1510
• 128 Nachamkin I. Campylobacter enteritis and the Guillain-Barré syndrome. Curr Infect Dis Rep 2001; 3 (2) 116-122
• 129 Kalra V, Chaudhry R, Dua T, Dhawan B, Sahu JK, Mridula B. Association of Campylobacter jejuni infection with childhood Guillain-Barré syndrome: a case-control study. J Child Neurol 2009; 24 (6) 664-668
• 130 Nachamkin I, Barbosa PA, Ung H , et al. Patterns of Guillain- Barré syndrome in children: results from a Mexican population. Neurology 2007; 69 (17) 1665-1671
• 131 Ito M, Matsuno K, Sakumoto Y, Hirata K, Yuki N. Ataxic Guillain-Barré syndrome and acute sensory ataxic neuropathy form a continuous spectrum. J Neurol Neurosurg Psychiatry 2011; 82 (3) 294-299
• 132 Zuccoli G, Panigrahy A, Bailey A, Fitz C. Redefining the Guillain-Barré spectrum in children: neuroimaging findings of cranial nerve involvement. AJNR Am J Neuroradiol 2011; 32 (4) 639-642
• 133 Patwa HS, Chaudhry V, Katzberg H, Rae-Grant AD, So YT. Evidence-based guideline: intravenous immunoglobulin in the treatment of neuromuscular disorders. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2012; 78 (13) 1009-1015
• 134 Bennett HS, Selman JE, Rapin I, Rose A. Nonconvulsive epileptiform activity appearing as ataxia. Am J Dis Child 1982; 136 (1) 30-32
• 135 Bisht J, Sankhyan N, Kaushal RK, Sharma RC, Grover N. Clinical profile of pediatric somatoform disorders. Indian Pediatr 2008; 45 (2) 111-115
• 136 Ahmed MA, Martinez A, Yee A, Cahill D, Besag FM. Psychogenic and organic movement disorders in children. Dev Med Child Neurol 2008; 50 (4) 300-304
• 137 Ferrara J, Jankovic J. Psychogenic movement disorders in children. Mov Disord 2008; 23 (13) 1875-1881
• 138 Schwingenschuh P, Pont-Sunyer C, Surtees R, Edwards MJ, Bhatia KP. Psychogenic movement disorders in children: a report of 15 cases and a review of the literature. Mov Disord 2008; 23 (13) 1882-1888
• 139 Edwards MJ, Bhatia KP. Functional (psychogenic) movement disorders: merging mind and brain. Lancet Neurol 2012; 11 (3) 250-260