Meniere’s disease is a chronic inner ear condition characterized by episodic vertigo, fluctuating low-frequency hearing loss, ringing in the ear (tinnitus), and a feeling of pressure or fullness. This disorder involves the balance and hearing structures within the labyrinth. Because Meniere’s attacks involve sudden, severe loss of balance and falls, many people wonder if the disorder can cause seizures or epilepsy. The alarming nature of these balance attacks prompts inquiry into a neurological origin, but the true cause is mechanical and vestibular.
Meniere’s Disease and Epilepsy
Meniere’s disease does not cause true epileptic seizures. Epilepsy is a neurological disorder defined by abnormal electrical activity in the brain, whereas Meniere’s disease is a peripheral disorder stemming from the inner ear. The symptoms of a severe Meniere’s episode, particularly the sudden loss of consciousness that can occur during a fall, may appear similar to a seizure.
However, the mechanism driving an epileptic seizure differs from that causing a Meniere’s attack. It is possible for a person to have both Meniere’s disease and epilepsy (a comorbidity), but the inner ear condition is not the direct cause of the seizure disorder. Diagnosing the precise cause of a sudden fall requires distinguishing between a peripheral vestibular event and a central neurological event.
Tumarkin’s Otolithic Crisis
The event most often mistaken for a seizure in Meniere’s patients is known as Tumarkin’s Otolithic Crisis, or a vestibular drop attack. This is a rare, sudden, and violent loss of posture that leads to the person falling to the ground, usually without any warning.
A key distinction between a Tumarkin’s crisis and an epileptic seizure is that consciousness is preserved. The person remains fully aware of what is happening, despite being unable to prevent the fall or maintain an upright posture. The duration of the crisis is extremely short, lasting only a few seconds, and the patient is usually able to get up immediately afterward.
This symptom occurs in a small subset of patients and is associated with the later stages of the condition. While the short duration and maintained awareness differentiate it from a seizure, the sudden fall carries a significant risk of severe injury, including fractures and head trauma. Because the event is so abrupt and disorienting, the lack of warning can make it appear to observers as if the person had a seizure.
The Role of the Vestibular System
The cause of Tumarkin’s Otolithic Crisis lies in the malfunction of the inner ear’s balance system, specifically the otolith organs. Meniere’s disease involves the accumulation of excess fluid, called endolymphatic hydrops, which builds pressure within the inner ear structures. This pressure fluctuation can cause a mechanical disturbance to the otoliths, which are tiny calcium carbonate crystals resting on sensory hair cells.
These otoliths sense linear movement and the pull of gravity, providing the brain with information about the body’s position relative to the ground. When the hydrops causes a sudden, aberrant stimulation or displacement of these otoliths, the inner ear sends an erroneous signal to the brain. This signal incorrectly tells the brain that the body is falling or tilting dramatically.
In response, the brain triggers a reflex, known as the vestibulo-spinal reflex, to correct the perceived fall. This reflex causes an abrupt, involuntary loss of muscle tone in the limbs, which is an overcompensation that results in the patient falling to the floor. The crisis is a mechanical failure of balance, not an electrical failure of the brain.
Safety and Treatment Strategies
Given the high risk of injury associated with these unpredictable drop attacks, patients need to implement safety and treatment strategies. Patients experiencing Tumarkin’s crises should take precautions to reduce fall risks, such as avoiding activities like driving during active periods and ensuring a safe environment free of trip hazards. Wearing a medical alert device can also be a helpful measure.
Treatment for Tumarkin’s crises focuses on managing the underlying Meniere’s disease to reduce the frequency and severity of symptoms. Medical management often includes diuretics and a low-salt diet to help reduce fluid pressure in the inner ear. For severe, intractable drop attacks that do not respond to conservative measures, more aggressive interventions may be considered.
Chemical Ablation
These interventions include chemical ablation, such as an intratympanic injection of the antibiotic gentamicin, which selectively damages the balance function of the affected ear.
Surgical Options
Other surgical options, such as endolymphatic sac decompression or a vestibular nerve section, may be employed to prevent falls when the risk of injury is too high. In some cases, the drop attacks may spontaneously remit as the disease progresses.