Tarnutzer Alexander A, Lee Seung-Han, Robinson Karen A, Kaplan Peter W, Newman-Toker David E
From the Department of Neurology (A.A.T.), University Hospital Zurich and the University of Zurich, Switzerland; the Department of Neurology (S.-H.L.), Chonnam National University Medical School, Gwangju, South Korea; the Departments of Medicine (K.A.R.), Neurology (D.E.N.-T.), and Otolaryngology Head & Neck Surgery (D.E.N.-T.), The Johns Hopkins University School of Medicine; and the Department of Neurology (P.W.K.), Johns Hopkins Bayview Medical Center, Baltimore, MD.
Neurology. 2015 Apr 14;84(15):1595-604. doi: 10.1212/WNL.0000000000001474. Epub 2015 Mar 20.
Seizures can cause vestibular symptoms, even without obvious epileptic features. We sought to characterize epileptic vertigo or dizziness (EVD) to improve differentiation from nonepileptic causes, particularly when vestibular symptoms are the sole manifestation.
We conducted a systematic review with electronic (Medline) and manual search for English-language studies (1955-2014). Two independent reviewers selected studies. Study/patient characteristics were abstracted. We defined 3 study population types: (1) seizures, some experiencing vertigo/dizziness (disease cohort); (2) vertigo/dizziness, some due to seizures (symptom cohort); (3) vertigo/dizziness due to seizures in all patients (EVD-only cohort).
We identified 84 studies describing 11,354 patients (disease cohort = 8,129; symptom cohort = 2,965; EVD-only cohort = 260). Among 1,055 EVD patients in whom a distinction could be made, non-isolated EVD was present in 8.5%, isolated EVD in 0.8%. Thorough diagnostic workups (ictal EEG, vestibular testing, and brain MRI to exclude other causes) were rare (<0.1%). Ictal EEG was reported in 487 (4.3%), formal neuro-otologic assessment in 1,107 (9.7%). Localized EEG abnormalities (n = 350) were most frequently temporal (79.8%) and uncommonly parietal (11.8%). Duration of episodic vestibular symptoms varied, but was very brief (<30 seconds) in 69.6% of isolated EVD and 6.9% of non-isolated EVD.
Non-isolated EVD is much more prevalent than isolated EVD, which appears to be rare. Diagnostic evaluations for EVD are often incomplete. EVD is primarily associated with temporal lobe seizures; whether this reflects greater epidemiologic prevalence of temporal lobe seizures or a tighter association with dizziness/vertigo presentations than with other brain regions remains unknown. Consistent with clinical wisdom, isolated EVD spells often last just seconds, although many patients experience longer spells.
癫痫发作可导致前庭症状，即使没有明显的癫痫特征。我们试图对癫痫性眩晕或头晕（EVD）进行特征描述，以改善与非癫痫病因的鉴别，尤其是当前庭症状为唯一表现时。
我们通过电子检索（Medline）和手工检索对1955 - 2014年的英文研究进行了系统评价。两名独立评审员筛选研究。提取研究/患者特征。我们定义了3种研究人群类型：（1）癫痫发作，部分患者有眩晕/头晕（疾病队列）；（2）眩晕/头晕，部分由癫痫发作引起（症状队列）；（3）所有患者的眩晕/头晕均由癫痫发作引起（仅EVD队列）。
我们识别出84项研究，涉及11354例患者（疾病队列 = 8129例；症状队列 = 2965例；仅EVD队列 = 260例）。在1055例可区分的EVD患者中，非孤立性EVD占8.5%，孤立性EVD占0.8%。全面的诊断检查（发作期脑电图、前庭测试和脑部MRI以排除其他病因）很少见（<0.1%）。487例（4.3%）报告了发作期脑电图，1107例（9.7%）进行了正式的神经耳科学评估。局限性脑电图异常（n = 350）最常见于颞叶（79.8%），罕见于顶叶（11.8%）。发作性前庭症状的持续时间各不相同，但69.6%的孤立性EVD和6.9%的非孤立性EVD症状持续时间非常短暂（<30秒）。
非孤立性EVD比孤立性EVD更为普遍，孤立性EVD似乎很罕见。EVD的诊断评估往往不完整。EVD主要与颞叶癫痫发作相关；这是反映颞叶癫痫发作在流行病学上更为普遍，还是与头晕/眩晕表现的关联比与其他脑区更紧密，仍不清楚。与临床经验一致，孤立性EVD发作通常仅持续数秒，尽管许多患者发作时间更长。
