Room tilt illusion in epilepsy

Room tilt illusion is a rare phenomenon in which a person transiently perceives the surrounding environment as tilted to one side. Epilepsy is one of the presumed causes of room tilt illusion, but this has never been proven. We present a case of room tilt illusion that is epileptic in nature, documented by video- EEG monitoring. Our Patient is a 30-year-old woman with 11 years history of bi-monthly spells of sudden tilt of the whole environment counterclockwise for a duration of one to two seconds. These spells were initially diagnosed as psychogenic. She was then admitted to our video-EEG monitoring unit. She had three of her typical spells during monitoring, with corresponding changes of brief generalized spike-wave burst on EEG that coincided temporarily with her symptoms. The video otherwise did not reveal any sway or tilt of the patient herself. She was started on topiramate with resolution of her symptoms. She remained spell-free when seen during follow-up, six months later. This case illustrates a first example of room tilt illusion that is documented to be epileptic in nature. This case adds to the varied nature of how epilepsy can manifest in patients, which may support improved diagnosis and treatment of epileptic patients.