Vertigo, the false sensation of spinning or motion, is a common symptom that usually originates in the inner ear, but it can sometimes arise from the brain itself. Seizures are episodes of abnormal, synchronized electrical activity. Certain types of focal seizures can manifest with vertigo as a primary symptom, establishing a direct neurological link. This seizure-induced vertigo is a distinct clinical event rooted in the brain’s processing centers for balance and spatial awareness.
The Direct Link: Vertiginous Seizures
The vertigo sensation arising from a seizure is classified as an ictal event, meaning it occurs during the seizure itself, and is often termed a vertiginous seizure. These are focal onset seizures, where the electrical disturbance begins in a limited area of one brain hemisphere. The vertigo is typically a sudden, intense feeling of rotation or movement that is brief, often lasting only a few seconds to less than one minute.
This brief, spinning sensation can function as an aura, which is the initial symptom of a focal aware seizure that precedes a larger event, or it can be the entire seizure itself. When the vertigo is the sole manifestation, it is an isolated event occurring without loss of consciousness. The individual remains aware and alert, though they may feel disoriented.
Ictal vertigo must be distinguished from the dizziness that can follow a seizure. Dizziness, a feeling of lightheadedness or imbalance, is a non-specific symptom in the post-ictal phase. Vertiginous seizures, however, involve the illusion of rotational movement and are the direct result of the active electrical discharge, making the vertigo the symptom of the abnormal electrical activity itself.
Neurological Origin of Seizure-Induced Vertigo
The specific mechanism causing the spinning sensation is abnormal electrical firing within the brain’s vestibular cortex. This region processes information from the inner ear and other sensory systems to maintain balance and spatial orientation. When a seizure originates in or spreads to this area, the hyperactivity mimics the signals normally produced by the inner ear’s balance system.
Vertiginous seizures commonly arise from the temporal lobe, often involving the temporoparietal junction where the temporal and parietal lobes meet. This junction is a primary location for the cortical processing of vestibular information. Epileptic discharges here create a false perception of motion.
Seizures can also spread from the parietal or occipital lobes into the temporoparietal region. The precise nature of the vertigo can sometimes correlate with the exact location or spread of the electrical discharge.
Differentiating Seizure-Related Vertigo from Other Causes
Vertigo requires differentiation between seizure-related (central) vertigo and peripheral causes, such as inner ear disorders. Peripheral vertigo is often caused by conditions like Benign Paroxysmal Positional Vertigo (BPPV) or Meniere’s disease. BPPV is triggered by head position changes and lasts less than a minute, while Meniere’s causes episodes lasting hours, often accompanied by ear fullness, tinnitus, and hearing loss. Seizure-related vertigo is rarely triggered by head movement and is not associated with these hearing changes.
The primary diagnostic tool is the electroencephalogram (EEG), which records the brain’s electrical activity. An EEG can capture the abnormal electrical discharges originating in the temporoparietal region, confirming the seizure as the cause.
Patient history is also important, noting the sudden, spontaneous onset and brief duration. If the vertigo is isolated and does not respond to peripheral treatments, a neurological investigation is warranted. Diagnosis involves ruling out other causes like vestibular migraine or stroke, solidifying the finding by detecting the electrical signature of a focal seizure.