engleski

The differential diagnosis of vertigo and epilepsy

Vertigo is most commonly a feeling of spinning, usually due to the disturbance in the balance (vestibular) system. It may result from a dysfunction of the vestibular system at any point from the ear to the cerebral cortex. Epileptic vertigo is a rare form of partial seizures, due to epileptic activity in parts of the cortex that represent the vestibular system: the parietal, temporal and frontal cortex. The episodes usually last no more than seconds or minutes. Unconsciousness will follow only if the seizure becomes generalized. Diagnostic tests include EEG and MRI scans of the head. Further diagnostic evaluation in the case of medical intractability would include: video EEG monitoring, intracarotid amytal testing, ictal SPECT, neurophysiogical evaluation and intracranial EEG monitoring. An abnormal EEG is a major criterion for diagnosis. In most patients the abnormality consists of temporal or bitemporal sharp or slow wave foci. In some cases there are associated generalized seizure discharges. Treatment of epileptic vertigo is usually successful with traditional anticonvulsants such as carbamazepine and its relatives. If, after a reasonable trial with appropriate antiepileptic drugs, seizures remain inadequately controlled, a surgery can be considered. Differential diagnosis of epileptic vertigo includes: a basilar type migraine, confusional migraine, benign paroxysmal vertigo of childhood and an aura without a headache. The main differential diagnosis of neocortical temporal lobe seizures is a mesial temporal lobe seizure. Ictal SPECT scanning and MRI can provide diagnostic data not otherwise obtainable. In addition, proton MR spectroscopy and PET studies can be helpful to distinguish the mesial from neocortical temporal lobe seizures.

epilepsy; epileptic vertigo; partial epilepsy; neocortical epilepsy

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