Cervical spine structural causes of seizure and movement disorders

People contact our office after experiencing frightening episodes: staring or “blanking out,” involuntary shaking, unusual sensory experiences, changes in awareness, sudden cognitive difficulty, or a marked change in personality. Some have epilepsy. Others have been told that their events are nonepileptic, functional, psychological, or unexplained. Many also report neck pain, head pressure, dizziness, clicking, a history of head or neck trauma, or symptoms triggered by particular head positions.

If you or a loved one have been diagnosed with epilepsy or experience seizure-like episodes, you may have been told that the problem originates in the brain. While this is often true in traditional medical understanding, some patients find that their symptoms persist or don’t respond well to standard treatments. This raises an important question: could there be another underlying cause?

In this video and article summary Ross Hauser, MD., will explore an emerging perspective that connects certain seizure disorders, “blanking out” episodes, dissociative symptoms, and movement disorders to structural problems in the neck—specifically, cervical instability and ligament injury. While this approach doesn’t replace traditional neurological care, it may offer additional answers for those who haven’t found relief through standard treatments alone.

Common Seizure Symptoms and “Episodes”

A seizure is a temporary disturbance of brain function caused by abnormal electrical activity. Epilepsy is generally diagnosed when a person has an enduring tendency to experience recurrent unprovoked seizures. The International League Against Epilepsy provides the accepted practical definition used in clinical care. (1)

Seizures can be focal, beginning within one network or region of the brain, or generalized, engaging networks on both sides. Symptoms are not limited to full-body convulsions. Depending on the involved brain region, a focal seizure may cause staring, impaired awareness, repetitive movements, altered speech, unusual smells or sounds, visual phenomena, fear, tingling, or movement of one limb.

Not every seizure-like event is epileptic. Syncope, migraine aura, sleep disorders, metabolic disturbances, medication effects, panic attacks, transient ischemia, and several movement disorders can resemble seizures. Functional seizures—also called psychogenic nonepileptic seizures (PNES)—are genuine, involuntary events that are not produced by the epileptic electrical discharges seen in epilepsy. They are not “faking.” Epileptic and functional seizures can also coexist.

No single visible behavior reliably distinguishes the two. A meta-analysis found that certain clinical signs can change the probability of one diagnosis or the other, but the complete history and appropriate testing remain essential. (2) Expert assessment commonly relies on a detailed description, witness video when available, neurologic examination, and video-EEG capture of a typical event. Evidence-based guidance emphasizes a staged, careful diagnostic process rather than assigning a psychological explanation merely because an initial EEG is normal. (3)

When people experience seizure-like symptoms, they often describe them as “episodes.” These can include:

Loss of consciousness (though this doesn’t always happen).
Blanking out while still being aware of surroundings.
Inability to move or respond during the episode.
Strange sensory experiences: seeing colors, smelling scents, or hearing sounds that aren’t there.
Sudden tremors or movement disorders in one part of the body.
Personality changes or feeling disconnected from reality.
Dizziness, vertigo, or feeling lightheaded.
Many patients who come seeking answers describe episodes lasting as little as 30 seconds, during which they remain conscious but cannot interact with their environment.

Many conditions that appear very different on the surface may actually share a common underlying cause.

The underlying cause: Disrupted fluid flow to and from the brain, often stemming from structural problems in the upper cervical spine.

The conditions suspected of having a common underlying cause:

Seizure disorders (epilepsy)
Non-epileptic seizures (also called psychogenic or dissociative seizures)
Dissociative disorders
Depersonalization and derealization
Movement disorders (tremors, sudden involuntary movements)
Dizziness and vertigo
Sudden cognitive changes (memory problems, personality shifts)
The proposed common cause? Disrupted fluid flow to and from the brain, often stemming from structural problems in the upper neck.

Why we examine the cervical spine

The upper cervical spine surrounds and neighbors important neurologic and vascular structures. The vertebral arteries pass through the cervical vertebrae before entering the skull. The internal jugular veins are major drainage pathways for the brain. The vagus nerves descend through the carotid sheaths alongside the carotid arteries and jugular veins. Cerebrospinal fluid (CSF) circulates around the brain and spinal cord.

The cervical ligaments normally guide and limit motion. Injury or laxity can permit abnormal movement and contribute to neck pain and cervical instability. Capsular-ligament laxity has been described as a potential source of chronic neck pain and excessive cervical motion. (4)

Our clinical hypothesis is that, in a subset of patients, abnormal alignment or excessive motion may alter nearby arterial, venous, neural, or CSF-related physiology. This does not mean that cervical instability is a proven general cause of epilepsy, functional seizures, psychiatric illness, or personality change. Direct clinical evidence connecting cervical ligament treatment to seizure control is currently insufficient. The potential relationship should be considered investigational and patient-specific.

Potential mechanism 1: position-dependent vertebral artery compromise

Rotational vertebral artery syndrome, sometimes called Bow Hunter syndrome, is a recognized but rare condition in which head rotation dynamically narrows or occludes a vertebral artery. Typical manifestations include positional vertigo, presyncope, fainting, imbalance, visual symptoms, or other signs of posterior-circulation ischemia. Osteophytes are one documented cause; a 2024 systematic review emphasized that this is an uncommon, mechanically produced vascular disorder requiring appropriate vascular imaging and specialist management. (5)

This established syndrome supports the limited proposition that neck structure and position can sometimes alter blood flow to the brain. It does not establish that common cervical instability causes epilepsy. In a patient whose transient symptoms occur reproducibly with head rotation or extension, however, positional vascular compromise belongs in the differential diagnosis. Such symptoms warrant medical evaluation; they should not be repeatedly provoked at home.

At our center, transcranial and extracranial Doppler ultrasound may be used as one component of an evaluation when the history suggests position-sensitive blood-flow changes. Ultrasound findings must be interpreted in clinical context and do not, by themselves, diagnose the cause of a seizure-like event.

Potential mechanism 2: jugular outflow and intracranial pressure

The brain must continuously receive arterial blood and drain venous blood. Posture changes which venous pathways carry that outflow. A 2024 review described the craniospinal venous system as dynamic and posture-dependent, with meaningful effects on intracranial pressure. (6)

Recent invasive investigations in selected patients with suspected cerebral venous outflow disorders add further support for the principle that head position matters. A 2025 study found substantial changes in cerebral venous pressures, venous pressure gradients, and intracranial pressure with head position. (7) A 2026 study similarly reported that head rotation and dynamic jugular narrowing affected lumbar-puncture opening pressure in the studied group. (8)

These studies do not show that jugular compression causes epilepsy or functional seizures, and their findings cannot be generalized to everyone with neck symptoms. They do show that venous physiology can be dynamic. In a carefully selected patient with head pressure, pulsatile tinnitus, visual symptoms, positional cognitive changes, or reproducible symptoms during head rotation, venous outflow may deserve investigation alongside neurologic care. We discuss this framework in more detail in our article on brain venous drainage and “brain toilet obstruction”.

Potential mechanism 3: vagus nerve dysfunction

The vagus nerve helps regulate autonomic functions and carries extensive sensory information from the body to the brainstem. Implanted vagus nerve stimulation is an established adjunctive treatment for selected people with drug-resistant epilepsy. A 2024 systematic review reported evidence of reduced seizure burden and possible quality-of-life benefits, while also noting variation among patients and the need for further high-quality research. (9)

The effectiveness of electrical vagus nerve stimulation does not prove that cervical vagus nerve compression causes epilepsy. These are different propositions. It does, however, demonstrate that vagal pathways can influence seizure networks.

In our 2025 narrative review, we proposed “cervicovagopathy” as a possible framework in which cervical instability, abnormal alignment, or carotid-sheath crowding could contribute to vagus nerve dysfunction in selected patients. (10) This is a proposed mechanism, not proof of causation. When clinically indicated, our evaluation of vagus nerve structure and function may include ultrasound and autonomic measures. These tests supplement rather than replace neurologic assessment.

Forward head posture, cervical dysstructure, and brain-based symptoms

Prolonged face-down screen use can increase mechanical loading on the cervical spine. In our 2024 review, we proposed that a forward head–facedown lifestyle may contribute over time to ligamentous strain, loss of cervical curve, cervical instability, and altered fluid movement into or out of the brain. (11) This publication presents a mechanistic model and clinical perspective; it is not a controlled trial demonstrating that screen posture causes seizures.

Our 2026 retrospective, cross-sectional study described 227 young adults evaluated at our neck center for persistent “brain-based” symptoms. Neck pain, brain fog, concentration difficulty, headache, anxiety, structural cervical findings, and ultrasound abnormalities were common in this highly selected clinic population. (12) Because the study had no healthy control group for its main symptom analysis, was conducted at a specialty clinic, and was cross-sectional, it can identify associations but cannot establish that the cervical findings caused the symptoms or predict that treatment will resolve them.

Those limitations matter. Our findings support further research and help define a patient population for prospective study. They should not be used to conclude that every patient with brain fog, anxiety, abnormal movements, or seizure-like symptoms has a neck-generated disorder.

What an evaluation may include

Our role is not to replace the neurologist or discontinue antiseizure medication. Patients should not stop or reduce medication without the prescribing clinician. Depending on the presentation, standard evaluation may include:

Neurologic history and examination
Brain MRI or CT when indicated
Routine, ambulatory, or inpatient video-EEG monitoring
Blood tests for metabolic, toxic, infectious, endocrine, or autoimmune causes
Cardiac testing when fainting or arrhythmia is possible
Neuropsychological or psychiatric evaluation when clinically appropriate
Movement-disorder consultation for tremor, dystonia, chorea, or episodic dyskinesia

When that workup leaves unresolved questions and symptoms have a strong cervical pattern, we may additionally assess posture, cervical alignment, ligament integrity, and symptom response to carefully controlled positioning. Digital motion X-ray can evaluate motion between cervical segments, while other cases may require CT, MRI, vascular imaging, or referral to a vascular or neurosurgical specialist. No single neck test proves the origin of seizure-like activity.

Clues that may justify considering a cervical component include concurrent neck pain; a history of whiplash, repetitive head impacts, or connective-tissue laxity; reproducible symptoms with head rotation or extension; occipital headache or head pressure; pulsatile tinnitus; dizziness or near-fainting; and a cluster of autonomic symptoms. These clues are nonspecific and must be interpreted cautiously.

Treatment

Confirmed epilepsy is treated according to seizure type and cause, often with antiseizure medication. Drug-resistant cases may be evaluated for epilepsy surgery, dietary therapy, implanted vagus nerve stimulation, responsive neurostimulation, or deep brain stimulation. Functional seizures are treated differently, commonly through clear diagnostic communication, education, psychotherapy adapted to the patient, treatment of coexisting conditions, and coordinated neurologic and behavioral care.

If evaluation identifies a cervical musculoskeletal problem, conservative care may include individualized ergonomics, activity modification, physical therapy, and cervical curve correction when appropriate. Forceful self-manipulation should be avoided, particularly when symptoms include fainting, neurologic deficits, or reproducible vascular-type events.

At Caring Medical, Prolotherapy may be discussed for selected patients in whom clinical examination and imaging support painful ligament injury or cervical instability. Prolotherapy is intended to address ligament and joint instability; it is not an established treatment for epilepsy, functional seizures, personality disorders, or other primary neurologic disease. Evidence that cervical Prolotherapy reduces seizure frequency is presently limited, and controlled clinical trials are needed. Any neurologic improvement observed alongside treatment must be interpreted carefully because association does not establish mechanism or causation.

Summary

Seizure-like episodes, involuntary movements, altered awareness, and abrupt cognitive or personality changes deserve a serious, broad medical evaluation. The first obligation is to identify epilepsy and exclude dangerous neurologic, vascular, metabolic, cardiac, infectious, autoimmune, toxic, and structural causes.

For a smaller group—particularly those with neck injury, marked cervical symptoms, or position-dependent events—it may also be reasonable to ask whether the cervical spine is affecting nearby vascular, venous, autonomic, or CSF-related physiology. Research confirms that head position can alter vertebral arterial flow in rare mechanical syndromes and can influence jugular venous and intracranial pressures in selected patients. The broader claim that cervical instability commonly causes seizures remains unproven.

References

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Medical disclaimer: This article is for educational purposes and does not provide individual medical advice. Seizures, loss of consciousness, new neurologic deficits, or sudden personality changes require prompt medical assessment. Do not stop antiseizure medication or alter treatment without the prescribing clinician.

How Could the Cervical Spine Instability Cause Seizure-Like Symptoms?

Cervical spine instability, the wandering of the neck bones our of their normal position can lead to compression, herniation, and impingment of nerves, arteries and veins. Let’s see what the impact could bee.

1. Blood Supply to the Brain
Two major arteries supply blood to your brain:

The carotid arteries (supplying the front 75% of the brain)
The vertebral arteries (supplying the back portion of the brain)

These arteries travel through the cervical vertebrae. If neck ligaments are injured and the bones move excessively, these arteries can become kinked or compressed, reducing blood flow to the brain.

2. Dynamic carotid sheath compression (DCSC)

Dynamic carotid sheath compression (DCSC) occurs when certain head and neck positions cause compression of the carotid sheath, affecting the structures it contains, including the internal jugular vein, carotid artery, vagus nerve, sympathetic nerve fibers, and nearby cranial nerves such as the glossopharyngeal and spinal accessory nerves. Because these structures play critical roles in blood flow and autonomic nervous system function, compression may contribute to a wide range of neurological and systemic symptoms.

3. Cerebrospinal Fluid (CSF) Flow

CSF is the clear fluid that bathes and protects your brain and spinal cord. It must flow freely in and out of the skull. If there is a block in the neck, CSF pressure can rise in the brain.

Many of the patients we see have symptoms of intracranial hypertension, including headaches, dizziness, light sensitivity, vision changes, tinnitus, neck pain, and tremors. While treatment often focuses on managing these individual symptoms, the underlying cause may go unrecognized. In some patients, cervical spine instability may contribute to impaired venous drainage and elevated intracranial pressure. Identifying this underlying problem may explain why symptoms persist despite conventional treatment.

4. Internal Jugular Veins (Brain Drainage)

The internal jugular veins are the main drainage pathways for blood and waste products leaving the brain. If these veins are compressed in the neck, pressure builds up inside the skull.

5. The Vagus Nerve

The vagus nerve is one of the most important nerves in the body. It:

Controls inflammation
Helps regulate the nervous system
Carries sensory information from the body to the brain
Helps the body repair itself, feel joy, and manage stress

The vagus nerve runs right alongside the jugular vein in the neck, passing in front of the top vertebra (the atlas). If the atlas is misaligned or unstable, the vagus nerve can be compressed or damaged.

What Happens When Brain Pressure Increases?

If any of the above systems are compromised—blood flow, CSF flow, jugular drainage, or vagus nerve function—the result can be increased pressure in one area of the brain.

When a specific area of the brain senses this increased pressure, it can become overactive. Depending on which part of the brain is affected, you might experience:

Sensory (visual) cortex: Seeing colors, lights, or objects that aren’t there.
Sensory (auditory/olfactory) cortex: Hearing or smelling things that aren’t present.
Motor cortex: Sudden tremor or contraction of a limb.
Consciousness centers: “Blanking out” while still aware.
Personality/cognitive regions: Sudden personality changes, memory loss, depersonalization.

This means what looks like epilepsy or a psychological condition may, in some cases, be caused by localized brain pressure related to neck structure.