Vestibular Epilepsy

1. A D E W I J A Y A , M D – M A R C H 2 0 2 3
Vestibular Epilepsy

2. Introduction
 Rare
 Epileptic activity in parts of the cortex that
represents the vestibular system
 Known by various terminologies such as epileptic
vertigo, vestibular seizures, vertiginous seizures, or
epilepsia tornado
 It can manifest as an aura to a partial seizure episode
or may be the sole manifestation of an epileptic
event.
Brandt T. Vertigo: Its Multisensory Syndrome. London: Springe; 1991.
Barac B. Vertiginous epileptic attacks and so-called “vestibulogenic seizures. Epilepsia 1968;9:137-44.
Alpers BJ. Vertiginous epilepsy. Laryngoscope 1960;70:631-7.

3. Epidemiology
 The prevalence of vestibular epilepsy in our neurotology
clinic was found to be 0.001%.
 Most of our patients presented in the second decade of
life (7 patients out of 10 were below the age of 25 years).
 Patients 4 and 10 had a positive paternal history of
seizures.
 Currie et al. found that 19% of temporal lobe epilepsy
presented solely with vertiginous symptoms.
Currie S, Heathfield KW, Henson RA, Scott DF. Clinical course and prognosis of temporal lobe epilepsy. A
survey of 666 patients. Brain 1971;94:173-90.
Hewett R, Bartolomei F. Epilepsy and the cortical vestibular system: Tales of dizziness and recent concepts.
Front Integr Neurosci 2013;7:73

4. Clinical Presentation
 Distinctive with sudden, brief episodes of symptoms
followed by rapid recovery without sequelae
 It can manifest as an aura to a partial seizure episode
or may be the sole manifestation of an epileptic event
Barac B. Vertiginous epileptic attacks and so-called “vestibulogenic seizures. Epilepsia 1968;9:137-44.
Alpers BJ. Vertiginous epilepsy. Laryngoscope 1960;70:631-7.
Tarnutzer AA, Lee SH, Robinson KA, Kaplan PW, Newman-Toker DE. Clinical and electrographic findings in epileptic
vertigo and dizziness: A systematic review. Neurology 2015;84:1595-604.

5. Clincal Presentation, Diagnosis, and Treatment
Philip A, Haripriya GR, Mammen MD, Lepcha A, Augustine AM. Vestibular epilepsy: Clinical presentation, diagnosis, and management. Indian Journal of
Otology. 2020 Jul 1;26(3):147.

6. Differential Diagnosis
 Basilar migraine
 Presyncopal
 Arrhythmic conditions

7. Summary
 Extremely rare condition
 The diagnosis of vestibular epilepsy should be borne
in mind when patients present with short-lived
vertigo spells with LOC and not responding to
stereotypical regimens
 Diagnosis: MRI dan EEG
 Treatment: anticonvulsant

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