Distinguishing isolated epileptic vertigo/dizziness from vestibular paroxysmia: Clinical clues from a retrospective comparative study

Recurrent brief vestibular attacks are often evaluated as peripheral disorders, but some reflect epileptic vestibular seizures requiring electroencephalographic (EEG) assessment. We sought to identify clinical clues distinguishing isolated epileptic vertigo/dizziness (iEVD) from vestibular paroxysmia (VP).

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Clinicians managing patients with recurrent brief vestibular attacks should consider the distinguishing clinical clues identified in this retrospective series, but findings need prospective validation before they should alter diagnostic algorithms.

Accurate differentiation between epileptic vestibular seizures and vestibular paroxysmia directly affects treatment choice — anticonvulsants versus microvascular decompression or sodium-channel blockers — making reliable clinical markers highly valuable.

1. 01Retrospective comparative study identified clinical features that differentiate epileptic vestibular seizures from vestibular paroxysmia.
2. 02Both conditions present with recurrent brief episodes of vertigo or dizziness, making clinical distinction challenging.
3. 03Published in the journal Seizure.
4. 04Correct diagnosis is critical as treatments differ substantially between the two conditions.
5. 05Retrospective design limits the strength of conclusions; prospective studies are needed.

PMID

42659991

DOI

10.1016/j.seizure.2026.08.012.

Journal

Seizure

Publication type

research_article

Evidence level

3

Population

Patients with recurrent brief vestibular attacks, including those with isolated epileptic vestibular seizures and vestibular paroxysmia

Intervention

Retrospective clinical feature analysis

Comparator

Vestibular paroxysmia patients vs. isolated epileptic vertigo/dizziness patients