Epileptic Vertigo???

[Trinity]

Well I just read about this yesterday (Sunday) after an episode I had. Now I don't know if what happened had anything to do with my Epilepsy or if it was the food I ate or what. However, I was eating lunch (left over spaghetti bolognaise from Friday night). I wasn't even halfway through eating and I started to feel a bit dizzy. I just sat still expecting it to pass but everything just got faster and faster so I called out to my husband who didn't hear me at all. I sent my daughter to get him and he came and asked me what was up. I said that I felt really dizzy and everything was spinning fast around me and that I felt nauseas. Just then I realised I was going to vomit so hubby told me to go outside, as it was clear I wouldn't make it to the bathroom (by the time I did vomit it was probably 2-3 minutes into the 'episode'. Now I realise it could have been the food but after being sick and laying down a while I was okay so if it was it was the quickest hitting and passing food poisoning. I ate pancakes for afternoon tea and then I had lamb and salad for dinner so it didn't effect my appetite at all
So anyway I guess i'm just wondering if this could be E related as I am thinking of keeping a journal (never have done before in over 30 years of E) as i've had other experiences which I thought may be seizures (i've always thought until recently that I have only had tonic clonic seizures). Should I put this down or is it irrelevant.

[brain]

Epilepsy with Vertigo

Epileptic Vertigo and related conditions

Timothy C. Hain, MD Page last modified: August 11, 2008

The following list of conditions will be briefly reviewed:

* Epileptic vertigo
* Reflex epilepsy
* Vestibular neuralgia
* Cortical modulation of hearing or tinnitus

While epilepsy is commonly accompanied by dizziness or vertigo, vertigo is only rarely caused by epilepsy (Bladin 1998 ). 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, the postero-medial parietal lobe (Wiest et al, 2004), the temporal parietal border regions (Penfield, 1954; Blanke et al 2000; Kahane et al, 2003), V5 (Laff et al. 2003), and frontal cortex -- left middle frontal gyrus (Kluge et al, 2000).

A related phenomenon is "reflex epilepsy" (Xue et al, 2006). These are epileptic seizures precpiated by general sensory stimuli - -such as light, thinking, decision making. The "focal" reflex epilepsies may be provoked by reading, writing, startle, somatosensory stimulation, proprioception, auditory stimuli, immersion in hot water, eating, and vestibular stimulation. Thus, certain sounds or types of movement can provoke cortical seizures.

Another electrical disorder, which can overlap with these possibilities, is vestibular neuralgia. Although a misnomer (algia means pain and there is no pain here), 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", which is a more vague but somewhat more appropriate term.

Rarely, epilepsy is accompanied by tinnitus. Stimulation of human auditory cortex can suppress hearing or enhance tinnitus (Fenoy et al, 2006). In persons who have bilateral synchronous hearing symptoms, clinicians usually consider electrical or vascular cortical phenomena such as migraine aura as the cause.

Epileptic vertigo is generally 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.

Reflex vestibular epilepsy can be difficult to diagnose as most EEG labs are unable to provide vestibular stimulation during their recordings. This can be accomplished in a lab equipped for both caloric and EEG testing.

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 oxcarbamazine and related medications. Oxcarbamazine also treats vestibular paroxysmia. According to Xue, generalized reflex seizures usually respond to valproate treatment (Xue, 2006). Valproate also treats migraine.
Case:

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:

* Bladin, P. F. (1998 ). "History of "epileptic vertigo": its medical, social, and forensic problems." Epilepsia 39(4): 442-7.
* Blanke, O., S. Perrig, et al. (2000). "Simple and complex vestibular responses induced by electrical cortical stimulation of the parietal cortex in humans." J Neurol Neurosurg Psychiatry 69(4): 553-6.
* Fenoy, A. J., M. A. Severson, et al. (2006). "Hearing suppression induced by electrical stimulation of human auditory cortex." Brain Res 1118(1): 75-83.
* Kahane, P., D. Hoffmann, et al. (2003). "Reappraisal of the human vestibular cortex by cortical electrical stimulation study." Ann Neurol 54(5): 615-24.
* Kluge M, and others. Epileptic vertigo: evidence for vestibular representation in human frontal cortex. Neurology 2000;55:1906-1908
* Penfield W, Jasper H. Epilepsy and functional anatomy of the human brain. Boston: Little, Brown, 1954
* Laff R, Mesad S and Devinsky O (2003). "Epileptic kinetopsia: Ictal illusory motion perception." Neurology 61(9): 1262-4.
* Antonio Pizzuti, Elisabetta Flex, Carlo Di Bonaventura, Tania Dottorini, Gabriella Egeo, Mario Manfredi, Bruno Dallapiccola, Anna Teresa Giallonardo. Epilepsy with auditory features: A LGI1 gene mutation suggests a loss-of-function mechanism . Annals of Neurology, 53:3, p396-399, 2003
* Tusa RJ, Kaplan PW, Hain tonic clonic, Naidu S: Ipsiversive eye deviation and epileptic nystagmus. Neurology. 1990.
* Wiest, G., F. Zimprich, et al. (2004). "Vestibular processing in human paramedian precuneus as shown by electrical cortical stimulation." Neurology 62(3): 473-5.
* Xue, L. Y. and A. L. Ritaccio (2006). "Reflex seizures and reflex epilepsy." Am J Electroneurodiagnostic Technol 46(1): 39-48.

Emphasis, Italics, Underling, Bold are mine.

[walksalot]

I read all the information you posted, Brain, and it's really informative, but here's my situation. I have "dizzy spells" according to my doctors. My last doctor called it benign positional vertigo. However, the dizzy isn't spinning dizzy, it's a rolling dizzy. When it begins, my legs and arms go limp, I cann't walk, and I slurr my speech so bad, no-one can understand a word I say. That really makes me angry. My husband or son, or whoever is here, takes me to bed and I lay there for several hours until it passes and then I am fine. On occasions when I have been home alone and this has happened, I slither on the floor to a carpeted area and lay there until it passes. One doctor ordered an MRI/MRA and it showed evidence of a TIA sometime in the past, but my neurologist didn't seem to believe that was of any consequence to the dizziness. He never suggested that epilepsy might be involved.

This is more information I will be taking to my new doctor December 2.

[sparkiesuze]

I have been suffering with vertigo for a while, very frustrating as my GP didn't seem to be taking it seriously (giving me pills telling me to come back in 2 weeks then doing the same thing again)
It feels like I've been pushed hard from the side, and causes me to stumble about.
More recently I've been feeling very heavy and lethargic, and while at work a few days ago I sat up at my desk, as if a trigger in my head had gone off, stumbled for help and after grabbing the phone and calling for help, I fell to the floor and became mostly unresponsive, but still concious. On arrival to A&E I had multiple seizures, involving numbness of my entire body, and no control over my left arm. I'd never had a seizure before and I was terrified!
My sister and uncle both have epilepsy and they have pretty much given me the verdict without having had an EEG. You should always question your GP if in doubt

[walksalot]

I've had a lot of dizziness lately a lot of the time. It starts early in the morning after I take my first dose of medicine and lasts all day. I make sure that I'm close enough to grab onto something to keep myself from falling down, it's so bad. My doctor changed my medicine, but it was even reduced from a higher dose of another one. I read in the book "Don't Swallow Your Gum" written by Dr. Arron Carroll and Dr. Rachell Vreeman "So, when a doctor tells you to do something, it's just his best guess". I think it's just the wrong medicine for me. I don't know how long these side effects are supposed to last before I get used to this, but I sure don't like it.

[Meetz1064]

a REALLY GOOD quote, Walksalot! I think I may keep it........

I hope you can get things worked out soon....