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Epilepsy and the cortical vestibular system: tales of dizziness and recent concepts.

Hewett R, Bartolomei F - Front Integr Neurosci (2013)

Bottom Line: Most often these symptoms are associated with other subjective manifestations.The cortical origin of these symptoms will be discussed and compared with the known "vestibular" cortical representations.This condition affects young subjects with a frequent family history and most often a benign evolution, raising the possibility of a form of idiopathic epilepsy (Hewett etal., 2011).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology and Neurophysiology, Institute of Neurological Sciences, Southern General Hospital Glasgow, UK.

ABSTRACT
Cortical representations of the vestibular system are now well recognized. In contrast, the fact that epilepsy can affect these systems, provoking transient vestibular symptoms, is less known. Focal seizures may nonetheless manifest by prominent vestibular changes ranging from mild unsteadiness to true rotational vertigo. Most often these symptoms are associated with other subjective manifestations. In pure vestibular forms, the diagnosis may be more difficult and is often delayed. The cortical origin of these symptoms will be discussed and compared with the known "vestibular" cortical representations. In addition, the existence of a specific "vestibular epilepsy" has been suggested in some publications. This condition affects young subjects with a frequent family history and most often a benign evolution, raising the possibility of a form of idiopathic epilepsy (Hewett etal., 2011).

No MeSH data available.


Related in: MedlinePlus

Vestibular areas defined from direct electric cortical stimulations in epileptic patients. Green and purple open circles represent the location of epileptogenic lesions responsible for vestibular sensations. Filled symbols represent the site at which focal electrical stimulation of the cortex evoked vestibular illusions in awake epileptic patients(reproduced from Lopez and Blanke, 2011).
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Figure 1: Vestibular areas defined from direct electric cortical stimulations in epileptic patients. Green and purple open circles represent the location of epileptogenic lesions responsible for vestibular sensations. Filled symbols represent the site at which focal electrical stimulation of the cortex evoked vestibular illusions in awake epileptic patients(reproduced from Lopez and Blanke, 2011).

Mentions: More recently a new insight has been gained from a retrospective systematic study of intracranial electrical stimulation using depth electrodes in 44 refractory epilepsy patients (Kahane et al., 2003). It reported a wide distribution of anatomical sites from which vestibular sensations were electrically induced though confirmed that most sites were in the temporal and parietal areas. The authors suggested the presence of a human temporo-peri-Sylvian vestibular cortex (TPSVC), a possible equivalent to the monkey’s polysensory PIVC, but involving the insula less as stimulation of the insula infrequently evoked conscious vestibular sensations (Isnard et al., 2004). Stimulation of the parietal lobe more posteriorly, in area 39 near the angular gyrus has elicited non-specific vestibular sensations (Blanke et al., 2002). The angular gyrus has been previously proposed as the “epicenter of the vestibulo-psychic area” on the basis of lesional studies in epileptic patients (Smith, 1960). The data obtained from human stimulation studies are summarized in Figure 1.


Epilepsy and the cortical vestibular system: tales of dizziness and recent concepts.

Hewett R, Bartolomei F - Front Integr Neurosci (2013)

Vestibular areas defined from direct electric cortical stimulations in epileptic patients. Green and purple open circles represent the location of epileptogenic lesions responsible for vestibular sensations. Filled symbols represent the site at which focal electrical stimulation of the cortex evoked vestibular illusions in awake epileptic patients(reproduced from Lopez and Blanke, 2011).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3822407&req=5

Figure 1: Vestibular areas defined from direct electric cortical stimulations in epileptic patients. Green and purple open circles represent the location of epileptogenic lesions responsible for vestibular sensations. Filled symbols represent the site at which focal electrical stimulation of the cortex evoked vestibular illusions in awake epileptic patients(reproduced from Lopez and Blanke, 2011).
Mentions: More recently a new insight has been gained from a retrospective systematic study of intracranial electrical stimulation using depth electrodes in 44 refractory epilepsy patients (Kahane et al., 2003). It reported a wide distribution of anatomical sites from which vestibular sensations were electrically induced though confirmed that most sites were in the temporal and parietal areas. The authors suggested the presence of a human temporo-peri-Sylvian vestibular cortex (TPSVC), a possible equivalent to the monkey’s polysensory PIVC, but involving the insula less as stimulation of the insula infrequently evoked conscious vestibular sensations (Isnard et al., 2004). Stimulation of the parietal lobe more posteriorly, in area 39 near the angular gyrus has elicited non-specific vestibular sensations (Blanke et al., 2002). The angular gyrus has been previously proposed as the “epicenter of the vestibulo-psychic area” on the basis of lesional studies in epileptic patients (Smith, 1960). The data obtained from human stimulation studies are summarized in Figure 1.

Bottom Line: Most often these symptoms are associated with other subjective manifestations.The cortical origin of these symptoms will be discussed and compared with the known "vestibular" cortical representations.This condition affects young subjects with a frequent family history and most often a benign evolution, raising the possibility of a form of idiopathic epilepsy (Hewett etal., 2011).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology and Neurophysiology, Institute of Neurological Sciences, Southern General Hospital Glasgow, UK.

ABSTRACT
Cortical representations of the vestibular system are now well recognized. In contrast, the fact that epilepsy can affect these systems, provoking transient vestibular symptoms, is less known. Focal seizures may nonetheless manifest by prominent vestibular changes ranging from mild unsteadiness to true rotational vertigo. Most often these symptoms are associated with other subjective manifestations. In pure vestibular forms, the diagnosis may be more difficult and is often delayed. The cortical origin of these symptoms will be discussed and compared with the known "vestibular" cortical representations. In addition, the existence of a specific "vestibular epilepsy" has been suggested in some publications. This condition affects young subjects with a frequent family history and most often a benign evolution, raising the possibility of a form of idiopathic epilepsy (Hewett etal., 2011).

No MeSH data available.


Related in: MedlinePlus