Benign temporo-parieto-occipital junction epilepsy with vestibular disturbance: an underrecognized form of epilepsy?

We describe a series of adolescents and adults who share the electroclinical characteristics of a nonlesional, pharmacoresponsive epilepsy manifesting as prominent vestibular disturbances, suggesting a temporo-parieto-occipital (TPO) junction origin. We retrospectively reviewed a database of consecutive patients referred to the epilepsy clinic over a 10-year period with respect to the following criteria: recurrent episodes of paroxysmal vestibular symptoms, normal MRI, and interictal EEG changes over the posterior regions. Fourteen patients were finally selected (10 males, 4 females). Mean age at onset was 26.5 (range: 12-59). The diagnosis of epilepsy was usually delayed until after cardiology and/or otorhinolaryngology workup. The predominant features on interictal scalp EEGs were abnormalities over the posterior areas. All patients responded well to antiepileptic medication. We propose that although further characterization is needed to label it a syndrome, this underdiagnosed form of epilepsy merits recognition.