Epileptic Vertigo and Dizziness - A Systematic Review of the Literature (P3.227)

Abstract

OBJECTIVE: Characterize vestibular symptoms due to seizures using systematic literature review. BACKGROUND: Little is known about the frequency and clinical characteristics of epileptic vertigo and dizziness (EVD). Dizziness as part of a larger seizure-like presentation (non-isolated EVD) is readily identified as epileptogenic, but when vestibular symptoms are the only manifestation (isolated EVD), differentiation from otologic causes may be difficult. DESIGN/METHODS: Electronic (MEDLINE) and manual search for English-language studies (1966-2012) of vertigo or dizziness due to seizures. Two independent reviewers selected studies. Study characteristics and clinical features were abstracted. We defined three article types based on the population studied: (1) seizures, some experiencing dizziness/vertigo (disease cohort); (2) vertigo/dizziness, some due to seizures (symptom cohort); and (3) seizures and vertigo/dizziness in all patients described (combined cohort). RESULTS: We identified 75 studies describing 10,227 patients (disease cohort=7,924; symptom cohort=2,058; combined cohort=245). Thorough diagnostic workups (brain MRI plus vestibular testing plus ictal EEG) was rare (<0.1%). Confirmatory (ictal) EEG was reported in 409 (4.0%). Complete neuro-otologic assessment was reported in 1,106 (10.8%). Non-isolated EVD was diagnosed in 919 patients (9.0%); isolated EVD was identified in 84 patients (0.8%). Localized EEG abnormalities (observed in 321 EVD cases) were most frequently temporal (87.2%); parietal involvement was noted in just 5.6%. Duration of episodic vestibular symptoms varied, but was very brief (<30sec) in 71.1% of isolated EVD vs. 6.9% of non-isolated EVD. CONCLUSIONS: Non-isolated EVD may be fairly common, but isolated EVD appears to be rare. EVD is primarily associated with temporal lobe seizures; whether this reflects greater epidemiologic prevalence of temporal lobe seizure or a tighter clinical association with dizziness and vertigo than other brain regions remains unknown. Consistent with clinical wisdom, isolated EVD spells often last just seconds, although many patients have longer spells. A preponderance of lower-quality studies suggests further research is needed. Study Supported by: Swiss National Science Foundation; Koetser Foundation for Brain Research; Zurich Center for Integrative Human Physiology, Switzerland

Disclosure: Dr. Tarnutzer has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Robinson has nothing to disclose. Dr. Kaplan has received personal compensation for activities with Schering-Plough Corporation, GlaxoSmithKline, Inc., UCB Pharma, and Ortho-McNeil Pharmaceutical, Inc., as a consultant and speaker. Dr. Kaplan has received research support from Schwarz Biosciences and Ortho-McNeil Pharmaceutical, Inc. Dr. Newman-Toker has received personal compensation for activities with Janssen Pharmaceuticals. Dr. Newman-Toker has received compensation for serving on the board of Society to Improve Diagnosis in Medicine. Dr. Newman-Toker has received research support from GN Otometrics.