Vertiginous Epileptic Attacks and So‐Called “Vestibulogenic Seizures”

Abstract

SUMMARY Five epileptic patients who experienced vertiginous or showed rotatory phenomena during epileptic attacks were described. Peripheral vestibular stimulation was used as an activating EEG procedure. The observations described here, supported by data from the literature, led the author to the following conclusions: Different abnormal EEG patterns, focal or generalized, besides temporal foci, may be found in connection with vertiginous and other epileptic manifestations of vestibular dysfunction. In the observed cases with vertiginous and gyratory epileptic attacks no other EEG responses to the stimulation of the horizontal semicircular canals were séen, than otherwise occasionally observed in epileptic patients. The term “vestibulogenic seizures” therefore should be used with caution only in the sense of a reflex induction of an epileptic phenomenon. RÉSUMÉ Cinq malades épileptiques qui présentaient des sensations vertigineuses ou des mouvements giratoires pendant leurs crises ont subi une “activation” par la stimulation vestibulaire périphérique. Les resultats obtenus s'accordent avec ceux de la litterature et permettent les conclusions suivantes: Différentes anomalies EEGraphiques, focalisées ou généralisées, peuvent être rencontrées en dehors des foyers temporaux chez ces malades. La stimulation des canaux semi‐circulaires horizontaux ne provoque chez ces malades aucune autre réponse EEGraphique que celle qui est provoquée de temps en temps chez d'autres malades épileptiques. Le terme de “crise vestibulogène” ne peut done être utilisé avec précaution que dans le but de désigner la production réflexe d'un phénomène épileptique.

Psychopathology of Vestibular Aurae

“…Many case reports on 'vertigo epileptica' [16][17][18][19][20] agree with the view that there is increased neuronal activity in the superior temporal gyrus. Operative and electrophysiological cerebral interventions [21,22], clinical and (stereo-)encephalographic observations [7,8,23] as well as animal experiments [24] seem to indicate that me dial and posterior parts of the temporal supe rior gyrus together with the area o f the sulcus interparietalis may be the cortical represen tation of vertigo.…”

Central Vertigo and Dizziness

“…Vertigo can not be always seen during such evoked seizures. 58,59 Anticonvulsants such as diphenylhydantoin, carbamazepine, barbiturates, diazepam, primidone, and others can frequently cause dizziness, vertigo, imbalance, and double vision as an adverse effect. 2…”

Clinical and electrographic findings in epileptic vertigo and dizziness

“…A thorough diagnostic workup (brain MRI plus complete vestibular testing plus ictal EEG) was rarely performed. In the disease cohort, only 9/34 case series placed emphasis on vestibular symptoms in study design, 3,6,34,[43][44][45][46][47][48] which may explain why vestibular testing was infrequent in this cohort. Likewise, in the symptom cohort, seizures were just one of many differential diagnostic considerations, explaining a low rate of obtaining EEG.…”

“…These vestibular symptoms may be related to the seizure itself (i.e., representing an aura symptom), to side effects of antiepileptic drug (AED) therapy, or may be linked to a second, comorbid nonepileptic disorder (e.g., vestibular migraine). Episodic vestibular symptoms deemed to result directly from focal, intermittent epileptic discharges have been variously known as epileptic vertigo, 2 vestibular epilepsy, 3 vestibular seizures, 4 vertiginous seizures, [4][5][6] or epilepsia tornado. 7 In this article, we use the more inclusive term epileptic vertigo or dizziness (EVD).…”