What should you know about epileptic vertigo?

A seizure affecting brain areas involved in balance or sensation may produce vertigo as an aura or part of a larger seizure. It may begin suddenly, feel highly similar each time, and occur with altered awareness, unusual smells, staring, memory gaps or jerking. Vertigo from benign paroxysmal positional vertigo is more often triggered by turning the head, while Meniere's Disease may include hearing symptoms. Migraine and Middle Ear Infection can also affect balance.

A symptom alone cannot identify its cause. A clinician considers the timing, triggers, hearing symptoms, medications, previous seizures and any loss of awareness. A description from someone who witnessed the episode can be especially useful.

Keep a record of when episodes start, how long they seem to last, what you were doing, whether head movement triggered them, and any changes in awareness, vision, hearing or speech. Arrange medical assessment if episodes recur, are stereotyped, or occur alongside seizure features. Do not drive, climb or use machinery while an unexplained attack could make you unsafe. Treatment depends on the cause; an Epley Manoeuvre is relevant only when positional vertigo has been diagnosed.

Call emergency services for a first suspected seizure, an episode that does not stop, repeated seizures without recovery, serious injury, breathing difficulty, or persistent confusion. Sudden vertigo with weakness, facial drooping, trouble speaking, severe imbalance or a new severe headache also needs emergency assessment because it may signal a stroke or another urgent problem.

Could the timing and associated symptoms fit a seizure, an inner-ear problem or migraine? Do I need a neurological or hearing assessment? What activities should I avoid until the cause is clear? What should a witness do if awareness changes?