Vertiginous epilepsy
Vertiginous epilepsy is infrequently the first symptom of a seizure, characterized by a feeling of vertigo. When it occurs, there is a sensation of rotation or movement that lasts for a few seconds before full seizure activity. While the specific causes of this disease are speculative there are several methods for diagnosis, the most important being the patient's recall of episodes. Most times, those diagnosed with vertiginous seizures are left to self-manage their symptoms or are able to use anti-epileptic medication to dampen the severity of their symptoms.[citation needed]
Vertiginous epilepsy has also been referred to as epileptic vertigo, vestibular epilepsy, vestibular seizures, and vestibulogenic seizures in different cases, but vertiginous epilepsy is the preferred term.[1]
Signs and Symptoms
The signs of vertiginous epilepsy often occur without a change in the subject’s consciousness so that they are still aware while experiencing the symptoms.[2] It is often described as a sudden onset of feeling like one is turning in one direction, typically lasting several seconds.[2] Although subjects are aware during an episode, they often cannot remember specific details due to disorientation, discomfort, and/or partial cognitive impairment.[2] This sensation of rotational movement in the visual and auditory planes is also known as a vertiginous aura (symptom), which can precede a seizure or may constitute a seizure itself.[3] Auras are a “portion of the seizure that occur before consciousness is lost and for which memory is retained afterwards.”[4] Auras can be focused in different regions of the brain and can thus affect different functions. Some such symptoms that may accompany vertiginous epilepsy include:
- Auditory hallucination[2]
- Cognitive impairment
- Motor activity
- Ictal behavior[2]
- Limbic auras[2]
Many people tend to mistake dizziness as vertigo, and although they sound similar, dizziness is not considered a symptom of vertiginous epilepsy. Dizziness is the sensation of imbalance or floating, impending loss of consciousness, and/or confusion.[2] This is different from vertigo which is characterized by the illusion of rotational movement [2] caused by the “conflict between the signals sent to the brain by balance- and position-sensing systems of the body”.[5]
Mechanism
Although a specific cause has not been identified to always induce vertiginous epilepsy there have been a number of supported hypotheses to how these seizures come about, the most common being traumatic injury to the head. Other causes include tumor or cancers in the brain, stroke with loss of blood flow to the brain, and infection. A less tested hypothesis that some believe may play a larger role in determining who is affected by this disease is a genetic mutation that predisposes the subject for vertiginous epilepsy.[4] This hypothesis is supported by occurrences of vertiginous epilepsy in those with a family history of epilepsy.[6]
Vertiginous epilepsies are included in the category of the
Diagnosis
The most important factor in diagnosing a patient with vertiginous epilepsy is the subject’s detailed description of the episode.
Other means used in diagnosis of vertiginous epilepsy include:
- Electroencephalography (EEG)[3]
- Magnetic resonance imaging (MRI)[3]
- Positron emission tomography (PET) [2]
- Neuropsychological testing[2]
The EEG measures electrical activity in the brain, allowing a physician to identify any unusual patterns. While EEGs are good for identifying abnormal brain activity it is not helpful in localizing where the seizure originates because they spread so quickly across the brain.[3] MRIs are used to look for masses or lesions in the temporal lobe of the brain, indicating possible tumors or cancer as the cause of the seizures.[2] When using a PET scan, a physician is looking to detect abnormal blood flow and glucose metabolism in the brain, which is visible between seizures, to indicate the region of origin.[2]
Management
There is no real way to prevent against vertiginous episodes out of the means of managing the disease. As head trauma is a major cause for vertiginous epilepsy, protecting the head from injury is an easy way to avoid possible onset of these seizures. With recent advances in science it is also possible for an individual to receive
There are a range of ways to manage vertiginous epilepsy depending on the severity of the seizures. For
Epidemiology
Vertiginous epilepsy onset can happen between the ages of 4–50, although typically symptoms will begin occurring in adolescence or young adulthood.[4] Research studies have shown no inclination for this disease between sexes.[citation needed]
History
In the late 19th century and early 20th century,
Research
There have been early and consistent strategies for measurement to better understand vertiginous epilepsy including caloric reflex test, posture and gait, or rotational experimentation.[9]
In Japan, Kaga et al prepared a longitudinal study of rotation tests comparing congenital deafness and children with delayed acquisition of
Research in this area of medicine is limited due to its lacking need for urgent attention. But, the American Hearing Research Foundation (AHRF) conducts studies in which they hope to make new discoveries to help advance treatment of the disease and possibly one day prevent vertiginous seizures altogether.[citation needed]
References
- ^ Nielsen, J. M., MD. "Tornado Epilepsy Simulating Ménière's Syndrome." Neurology 9.11 (1959): 794. Neurology. Web. 23 Mar. 2014. <http://www.neurology.org/content/9/11/794.extract>.
- ^ a b c d e f g h i j k l m n o p q r s t Stern, John M. "Focal Vertiginous Epilepsy." Atlas of Epilepsies. (2010): 463–465. Print.
- ^ a b c d e Benbadis, Selim. Wolters Kluwer Health. (2013): Web. 23 Mar. 2014. <http://www.uptodate.com/contents/localization-related-partial-epilepsy-causes-and-clinical-features>.
- ^ a b c d Ottman, R. United States. NCBI. Autosomal Dominant Partial Epilepsy with Auditory Features. Seattle: University of Washington, 2007. Web.
- ^ "Dizziness: Lightheadedness and Vertigo Topic Overview." WebMD. N.p., 2 Jan 2013. Web. 23 Mar 2014. <http://www.webmd.com/brain/tc/dizziness-lightheadedness-and-vertigo-topic-overview>.
- ^ a b c Kogeorgos, J., D.F. Scott, and M Swash. "Epileptic Dizziness." British Medical Journal . 282. (1981): n. page.
- ^ Erbek, Seyra H., Selim S. Erbek, Ismail Yilmaz, Ozgal Topal, Nuri Ozgirgin, Levent N. Ozluoglu, and Fusun Alehan. "Vertigo in childhood: A clinical experience ." International Journal of Pediatric Otorhinolaryngology. 70. (2006): 1547–1554.
- ^ a b c Choung, Yun-Hoon, Keehyun Park, Sung-Kyun Moon, Chul-Ho Kim, and Sang Jun RYu. "Various causes and clinical characteristics in vertigo in children with normal eardrums." Journal of Pediatric Otorhinolaryngology. 67. (2003): 889–894.
- ^ a b c d Snashall S. The history of balance in children: a review. Audiological Medicine [serial online]. October 2009;7(3):132–137. Available from: CINAHL with Full Text, Ipswich, MA.
- ^ Jackson H., Diagnosis of epilepsy. Medical Times and Gazette 1879; 1:29.
- ^ Gowers WR., The borderlands of epilepsy. London: Churchill, 1907: 40–75.