Practice of Treatment of vertigo

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Slide 1: 

Unité de Vestibulométrie Audiophonologie Hôpital Pédiatrique Robert Debré 48 Bld Sérurier 75019 PARIS FRANCE TREATMENT FOR VERTIGO IN CHILDREN S.R. Wiener-Vacher

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Treatment of the crisis and post crisis symptoms” drugs and reassurance Administration mode depends on the tolerance to vertigo and the intensity of the neurovegetative associated symptoms Intraveinously or lyophilisat or pills Specific to symptoms Antivertiginous Antiemetic Antalgic Symptomatic treatments

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VERTIGO CRISIS Tanganil R: alpha acetyle leucine Dose per day: 200 mg/kg/jour, pills or amp. 500 mg x3 Intraveinously: 500mg every 4 to 6 hours VOGALENE R: metoprimazine Dose per day: 7.5 to 15 mg/day (lyophilisat) > 6yo, 1 mg/kg/day < 6yo PRIMPERAN R:metochlopramide Dose per day: children: 0.4 mg/kg/d (every 6 hours- < 0.1mg each)

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Alpha leucine (Tanganil R), episodic ataxia, recurrent invalidant vertigo Used also for cinetosis with success (but it is not vertigo) Betahistine (SERC R): : Menière Propanolol (B Blockers): migrainous equivalents Antihistaminics H1 (Agyrax..) acute vertigo, used also for cinetose 1h before the trip), TREATMENT OF RECURRENT VERTIGO

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Labyrintitis Traumatisms Ocular disorders Inner ear malformations Vestibular neuritis Benign paroxysmal vertigo Chronic otitis Psychiatric disorders CNS disorders Orthostatic hypotension BPPV (canalolithiasis) Delayed vertigo Epilepsy Autoimmune disorders Ménière’s disease % of patients Migraine Equivalent VERTIGO in children

Migraine equivalent : 

Migraine equivalent Treatment of the crisis AINS (ibuprofen 500mg) + paracetamol Acetyl salicylate Pracetamol+cafeine+codeine Triptan : nasal spray (10mg) above the age of 10 years Prevention of the crisis: correction of ophtalmologic associated disorders: glasses and or orthoptic reeducation Regular shedule and sufficient sleep No overstimulation (TV, noisy environment)

Migraine equivalent and episodic ataxia : 

Migraine equivalent and episodic ataxia Treatment by acetazolamide: diagnosis test, regular control for blood K+ concentration , risk for kidney stones Long term treatment with acetyl leucine (200mg/kg/day) Long term treatment with propanolol

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OCULAR DISORDERS GIVE VERTIGO Vergence insufficiency (delays in saccade amplitude or latency with problems of eye movement coordination) Refraction problems (hypermetropia, astigmatism, myopia) eyeglasses orthoptic dynamic reeducation Vertigo disappears Treatment

Post traumatic vertigo : 

Post traumatic vertigo VPPB: classic manoeuver adapted to the canal involved Perilymphatic fistulae: Surgical exploration of the ovale and round windows area and patching the area with perichondrium of the tragus and biologic glue

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Thank you for your attention THANKS TO MY COLLABORATORS Françoise Toupet Sylvie Imbaud Genies Dominique Antolini Isaac N’Diaye Anissa Bensemman Etienne Jacot Maha Abou Elew Rima Isaac sylvette.wiener@rdb.aphp.fr

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