|
|
Epileptic Vertigo
Timothy C. Hain, MD 
Page last modified:
January 5, 2008
While epilepsy is commonly accompanied by dizziness or vertigo, vertigo is only rarely caused by epilepsy. This arises primarily because vertigo is much more commonly caused by ear conditions. Epileptic vertigo is felt to be cause by abnormal stimulation of parts of the cortex that represent the vestibular system -- parietal, temporal and frontal cortex. Specific areas include the superior lip of the intraparietal sulcus, the posterior superior temporal lobe, and the temporal parietal border regions (Penfield, 1954) as well as V5 (Laff et al. 2003).
Another electrical disorder is vestibular neuralgia. Although somewhat of a misnomer (algia means pain), this is a condition in which the vestibular nerve becomes irritable and spontaneously produces an abnormal sensation of movement. There is very little known about vestibular neuralgia. In some instances, it may be caused by microvascular compression syndrome. It is sometimes called "vestibular paroxysmia".
Rarely, epilepsy is accompanied by tinnitus.
Epileptic vertigo is only a diagnostic problem when the person does not have a full seizure -- in other words, they do not have the convulsions, psychomotor symptoms or twitching characteristic of classic partial or generalized seizures.
In most instances, it presents as a "quick spin" type symptom. The person notes that the world makes a quick horizontal movement, lasting roughly 1-2 seconds at most. Quick spins must be differentiated from a variety of other conditions including vestibular neuralgia due to microvascular compression, Meniere's syndrome, and BPPV among others. Occasional people also develop this symptom who have ectatic basilar arteries.
Rapidly generalized seizures are generally incompatible with epileptic vertigo as persons with generalized seizures will not remember their aura.
Diagnostic tests that are particularly helpful include the EEG and MRI scan of the head. In essence when these tests are normal, a response to an anticonvulsant medication is suggestive of vestibular neuralgia. When the EEG is definitely abnormal, vestibular epilepsy is diagnosed. One must be cautious here as many otherwise normal persons have mildly abnormal EEG tests. When there is no response to medication, then the probability of one of the other disorders mentioned above is increased.
TREATMENT
Epileptic and neuralgic vertigo generally responds well to traditional anticonvulsants such as carbamazepine and related medications.
In the case illustrated below, a child became dizzy, developed nystagmus, and briefly became unresponsive.
 |
| EEG of child with a vestibular seizure. On the bottom right the electrical activity of the brain changes markedly (Tusa et al, 1990). |
REFERENCES:
| © Copyright May 22, 2008 , Timothy C. Hain, M.D. All rights reserved. Last saved on May 22, 2008 |