Vestibular epilepsy: Clinical presentation, diagnosis, and management

Background: Vestibular epilepsy as a cause of vertigo is rare. This clinical entity occurs primarily due to epileptic activity in parts of the cortex that represents the vestibular system. It is often distinctive with sudden, brief episodes of vertigo followed by rapid recovery without sequelae. In vestibular epilepsy, vertigo is not simply an aura, but constitutes a part of the seizure, and maybe its only manifestation. Aim: The aim of this study was to describe the clinical profile of patients diagnosed with vestibular epilepsy who presented to the neurotology clinic in our hospital in the past 7 years from January 1, 2014, to May 1, 2020, and to present their clinical features, diagnosis, and management. Materials and Methods: This was a retrospective observational clinical study based on the medical records of all patients diagnosed with vestibular epilepsy who presented during the period January 1, 2014-May 1, 2020, to our neurotology clinics. Each patient's history and neurotological examination were documented. All investigations carried out such as audiovestibular tests, electroencephalogram, cardiac tests, and imaging were noted. Results: Ten patients were diagnosed with vestibular epilepsy in our clinic during this time period, with a prevalence of vestibular epilepsy being 0.001%. The main subjective aura in our patients was vestibular disturbance in the form of rotatory type of vertigo which lasted for a few seconds. These symptoms were followed by abnormal movements of limb and loss of consciousness (LOC) in six patients. The patients who experienced a LOC had cardiology workup. Electronystagmogram was abnormal in three patients, while magnetic resonance imaging showed an abnormality in three patients. All patients were started on anticonvulsant drugs and showed a good response to treatment. Conclusion: Vestibular epilepsy is a rare but treatable cause of transient dizziness. The diagnosis of vestibular epilepsy is often missed or delayed and should be considered when brief episodic spontaneous vertigo occurs with LOC and unresponsive to standard vestibular treatment. Treatment with anticonvulsants seems to give relief of symptoms.