Vestibular epilepsy: clinical and electroencephalographic characteristics with the proposed diagnostic criteria

Background: Focal seizures may encompass vestibular sensations in their symptomatology. When these manifestations occur in isolation or constitute the predominant symptom, they prompt consideration for diagnosing recurrent paroxysmal vertigo. However, the characterization of "vestibular epilepsy" remains debated and underexplored. Our objective is to characterize the clinical and electrophysiological criteria of vestibular epilepsy.

Methods: We retrospectively analyzed data from a cohort of outpatients treated in the epileptology department of Marseille University Hospital. The study focused on patients presenting with vestibular symptoms without focal abnormalities on brain MRI, and with interictal epileptic abnormalities on wake or sleep EEG.

Results: 31 patients (15 men and 16 women) were included in the study. Visual, auditory, and dysautonomic symptoms were frequently associated with vestibular symptoms. The mean time to diagnosis was 3 years. The duration of attacks was generally short, ranging from a few seconds to a few minutes, with variable frequency. Most patients responded well to antiseizure medication. Some patients showed interictal phenomena, such as permanent instability, raising the possibility of inter/postictal disturbances. Seizures could be triggered by peripheral vestibular stimuli. Interictal EEG abnormalities were observed only during sleep in 25% of patients and predominated in the posterior temporoparietal regions.

Discussion: We propose clinical-electro-radiological criteria for defining vestibular epilepsy. These diagnostic criteria overlap with the criteria for vestibular paroxysmia, suggesting the possibility of a single nosological entity.