Seizure disorders brought on by neck instability and cervical spine ligament damage

Ross Hauser, MD.

In this video, I will cover seizure disorders and how seizure disorder, non-epileptic seizures (psychogenic seizures), dissociative disorder, depersonalization, derealization, and movement disorders, may have a common cause in ligamentous cervical instability (cervical ligament weakness and ligament damage in the cervical spine) that will cause the bones of the neck to wander out of place and compress and compromise the arteries, veins and nerves that pass through the upper cervical region. This compression can cause a block in the cerebral spinal fluid, the blood flow of the internal jugular veins, or distorted or compromised messages to and from the vagus nerves.

Below are explanatory notes and research for this video.

The importance of assessing cervical spine instability in seizure disorders cannot be over emphasized. There are so many people that have  movement or seizure episodes, whether it’s full on seizure or they just have blanking out episodes (or “absence seizure.” This is a seizure that can cause you to blank out or stare aimlessly or into space for a few seconds. They can also be called petit mal seizures.)

Some people who have these seizures or episodes feel like they’re not even in their own body. Correcting cervical spine instability may be a treatment for some people. By correcting the cervical spine, some people may find alleviation of symptoms and seizures by removing the compression on the veins, arteries and nerves that pass through the neck area. While this may not be the treatment answer for everyone, if we can help restore natural structure to the cervical spine, medications can be diminished or possibly, in some, discontinued.

The common etiology of dizziness, movement disorders, seizure, and changes in cognitive status or personality (episodes).

The image above demonstrates common factors in dizziness, movement disorders, seizure episodes (changes in cognitive status such as a lack of responding to environment and/or significant personality changes.)

  • Internal jugular vein compression.
  • Cerebrospinal fluid block.
    • In my article Chronic cerebrospinal venous insufficiency I describe problems of compression and slow or interrupted drainage or outflow of the blood from the brain via the internal jugular veins that may cause some neurologic-type symptoms.
  • Kinking of carotid or vertebral artery.
    • In my article dynamic carotid sheath compression, I explain that the carotid sheath encases the carotid artery, jugular vein, vagus nerve, and the sympathetic plexus of nerves. Instability of the cervical spine can cause compression on the carotid sheath due to its location around the vertebrae. The cervical compression can cause arterial ischemia (inadequate blood flow to the brain) leading to drop attacks, brain fog, seizures and other symptoms.

A link in some people can be made between movement disorders, dizziness depersonalization, personality changes, cognitive changes, and uncontrollable movement of an extremity or they have a blanking out episodes. All these symptoms can have a common etiology or cause. The common etiology is normally some fluid flow is blocked that go that relates to the fluid flow of the brain so obviously if blocked that relates to the fluid flow of the brain. If one or two of the arteries that supply the blood to the brain the carotid artery and the vertebral artery, if one of those or both are blocked, the brain may go into uncontrolled activity which we know as seizure. Also if the cerebral spinal fluid is blocked, or the internal jugular veins, which are the main drainage ports of the brain, if those get blocked the pressure in the brain goes up. If any segment of the brain senses increased pressure, that area might then start firing.

Sudden increased sensory awareness

For example, if it is the sensory part of the brain that in that has increased pressure because of a cerebral spinal fluid block or an internal jugular vein block, the person may suddenly have increased sensory awareness. They see things that are not there or smell things that are not there. If someone says “I am hearing things,” or “I smell things,” when there is nothing there to smell, maybe having overstimulation of a portion of the brain. If the part of the brain that relates to vision, like the occipital lobe, or that part of the brain responsible for hearing, has increased pressure, it  can cause that part of the brain to be stimulated.

The onset of blanking out episode and suddenly one part of their body will start contracting

Other people will have a blanking out episode and suddenly one part of their body will start contracting. The part of the brain that has to do with motion, that part of the brain is sensing increasing pressure because there’s a block in the fluid flow out of the brain so there’s increased pressure on the brain. There are ways to documenting blood flow problems, a block in the cerebral spinal fluid or a block in an internal jugular vein.

Neck ligament injury can cause seizures

Below we are going to explore a lot of research in upper cervical instability and damaged ligaments, which allow for wandering bones in the neck to crash against blood vessels and nerves. The suggestion in this article is that some people may experience seizure and movement disorders because of this neck instability. If the neck can be made more stable, symptoms may be alleviated. Now for the explanation.

Bland JH, Nakano KK. Neck Pain. In Kelley WN, et al, editors. Textbook of rheumatology. Ed1. Philadelphia 1981 W.B. Sanders. 

Anterior drawing of the course of the vertebral artery from C6 to C1 through the boney rings of the foramina transversaria. Note the double U-turn the artery makes from C2-C1 and the posterior course around the lateral mass of the atlas (C1).

At the top of the above image is the Circle of Willis. The circle of Willis is a circle of arteries at the base of the brain that connects the blood flow from front to back of brain. The Circle of Willis is a “fail safe” system meaning that it provides alternate blood flow routes if one or more routes of the brain’s blood flow pathways are damaged. Many people that we see here at the Hauser Neck Center have an incomplete blood flow in the Circle of Willis (abnormalities of the Circle of Willis occur frequently.) This makes for compromised brain blood flow should one of the arteries get kinked or compressed. This can lead to symptoms of seizure in come and the development of epilepsy.

Symptoms of vertebral artery kinking are vertigo, dizziness, and various kinds of seizure disorder. The carotid arteries which supply the major portion of blood to the front of the brain, when one of the carotid arteries gets kinked you can have chronic, generalized seizure. When the Cerebrospinal fluid is blocked or the internal jugular veins are blocked you can develop psychogenic (from the brain) non-epileptic seizures. That means a person has seizure-like activity but it’s nonepileptic meaning that when an electroencephalogram (EEG) is performed doctors may not don’t pick up spontaneous activity that’s consistent with a seizure. In other words, the doctors see only normal brain activity.

I don’t like the term psychogenic because as we will discuss later, sometimes these seizures can come from cervical spine instability (ligamentous cervical instability). We know that Vegas nerve stimulation is FDA approved for refractory seizures so somebody has terrible seizures and drugs aren’t working, they continue to get breakthrough seizures, if you do vagus nerve stimulation then the seizure activity goes down. If in this case vagus nerve stimulation helps the seizure, maybe, vagus nerve degeneration from ligamentous cervical instability is actually one of the causes of the seizure.

In the diagram above we see: Potential mechanisms by which cervical ligament injury can cause seizures

Cervical ligament injury

  • Upper cervical (C1-C2) misalignment.
  • Upper cervical (C1-C2) instability.
  • Cervical dysstructure (breakdown of cervical curve).
  • Can lead to: Vagus nerve dysfunction.
    • Lower ability to handle stress.
    • Dissociative disorders.
    • Psychogenic nonepileptic seizures.
  • CSF of venous fluid flow blocked.
    • Increased brain pressure.
    • Partial (focal) seizures.
  • Vertebral artery compression.
    • Compromised blood supply to small area of the brain.
    • Partial (focal) seizures.
  • Carotid artery compression.
    • Decreased blood supply to large part of the brain.
    • Generalized seizures

Stress is a common aggravating factor

Stress is a common aggravating factor for seizures dissociative act disorders non-epileptic seizures so because stress makes it worse, it is possible some physicians will give people the diagnosis that it’s stress related, when in some, seizure disorder or psychogenic non-epileptic seizures can be suspected as coming from cervical neck structural reasons for the seizures. We can measure with ultrasound whether somebody’s vagus nerves is degenerated, with ultrasound we can find that the jugular veins are compressed and we can document that the  compression is from destructive changes because of ligament damage and the ligament damage we can diagnose by digital motion x-ray or motion x-ray.

Epilepsy is thought to be a brain disorder but is it?

Epilepsy is thought to be a brain disorder but is it? All fluids and neurologic input to and from the brain flows through the neck perhaps seizure disorder is not in your head but in your neck and I think this is especially important for parents when kids are diagnosed with some type of seizure disorder or there’s a personality change or the child is saying they’re hearing things or seeing things or they have blanking out episodes. Then they might have some movement disorders and nobody knows the cause, an examination should determine if the child’s challenges are a neck problem. The neck problem does not have to be the result of an acute injury. Children have small necks that need to hold up heavy heads. If they are looking down at tablets or phones all day, it can be easy for them to get ligament damage in their neck.

Are Ehlers-Danlos Syndrome Headaches and Migraines Caused by Cervical Spine and Neck Instability?

The symptoms of seizure – the question of unconsciousness

There there can be loss of consciousness, but that does not always happen.  In many cases you don’t lose consciousness and when people come to the Hauser Neck Center, they say “I’m getting episodes, I am aware of my surroundings but I can’t do anything about it.” A lot of these episodes can be short in duration. Why? Because, if this is a neck structure problem in origin, cervical vertebrae may temporarily out of place or move in a way they’re not supposed to cerebral spinal fluids blocked or the jugular veins are blocked and so they have a temporary increase in pressure on a certain part of the brain and if that part of the brain has to do with consciousness then it’s almost as if the person is unconscious even though they can hear everything and they’re aware of everything and that’s the episode.

Types of Seizures

Focal or Partial seizure

A focal seizure is just one part of the brain that has autonomic electrical activity, if you think about a heart arrhythmia it’s similar to that, it’s like an arrhythmia of the brain. An “arrhythmia of the brain” means the brain’s normal pacemaker messages to the heart is not working. Imagine this part of the brain has to do with motion of my left arm, then you may develop tremors in that arm. We see this more and more people in young people in their 40s.

Partial seizure

Simple Partial (focal) seizures – also known as focal onset seizures, are a common neurological disorder that occurs when abnormal electrical activity affects a specific area of the brain. They can manifest in many ways, from subtle sensory disturbances to more pronounced motor movements and altered consciousness. Can involve sensory, motor, psychic, or autonomic symptoms.

Complex Partial
Occurs in one part of the brain and during which the person experiences altered awareness. The person may appear dazed and confused.

Generalized seizure

Generalized absence seizures also known as “petit mal” seizures
Results in a blank stare usually lasting less than 10 seconds. The seizure starts and ends abruptly, and awareness is impaired during the seizure. Can be mistaken for daydreaming or inattention.
Tonic-clonic seizure
Has two phases; the tonic phase typically involves a crying out or groan, loss of awareness, and a fall as consciousness is lost, and muscles stiffen. The clonic phase typically involves conclusion and there is jerking and twitching in all four limbs.
Myoclonic seizure
Results in a sudden jerk of part of the body such as the arm or leg. The person may fall over.
Atonic seizure
Involves a sudden loss of muscle tone that can result in the person falling, dropping objects, or nodding the head involuntarily.

Psychogenic nonepileptic seizures

Also referred to as pseudoseizures, non-epileptic attack disorder, functional seizures, or dissociative seizures, are episodes resembling an epileptic seizure but without the characteristic electrical discharges associated with epilepsy.

Potential causes of seizures

  • Acute stroke  (hemorrhagic >nonhemorrhagic)
  • Alcohol withdrawal
  • Alzheimer’s disease
  • Cerebrovascular disease
  • Electrolyte disturbances (e.g., hypomagnesemia)
  • Endocrine disorders
  • Fever
  • Heatstroke
  • Hepatic failure
  • Hypoglycemia
  • Nonketotic hyperglycemia
  • Infections of the central nervous system (e.g., encephalitis, meningitis)
  • Medication use (e.g., phenothiazines)
  • Medication withdrawal (e.g., barbiturates, benzodiazepines)
  • Renal failure
  • Toxic conditions (e.g., uremia)
  • Traumatic brain injury
  • Tumor

In the article link below Migraine headaches in seizure disorders I cover the possible connections between migraine and seizure disorder. These two disorders may have a common cause in ligamentous cervical instability (cervical ligament weakness and ligament damage in the cervical spine) that will cause the bones of the neck to wander out of place and compress and compromise the arteries, veins and nerves that pass through the upper cervical region.

Migraine headaches in seizure disorders

Blanking out (staring aimlessly into space).

  • Generalized absence seizures
  • partial focal seizures
  • psychogenic non epileptic seizures people are conscious

We see these frequently at our center. People are not responsive for a short period of time less than 1 minute. These seizures can be caused by changes in neck structure that inhibit fluid flow into and out of the brain. Either a block of the cerebral spinal fluid or internal jugular vein. When you get ligament damage in the neck you get a broken down neck structure which I term cervical cervical dysstructure. The cause of cervical dysstructure generalized absence seizures are also known as Petit mal seizures.

there are a type of epilepsy that causes brief steering spells that can be mistaken for daydreaming or inattention so if you have a child or all of a sudden you notice you’re aware of your surroundings but you actually can’t do anything about it you need to be checked out for generalized absence seizures.

Partial focal seizures are a common neurologic disorder that occurs when abnormal electrical activity affects a specific area of the brain these are often tied to a blanking out episode but then you’ll actually get like a tremor in one part of the body or a movement disorder in a body part.

Psychogenic non-epileptic seizures are when they do an EMG and there’s no excessive electrical activity that’s seen

All of these episodes can appear to a doctor as the same problem where they have blanking out episodes where they’re staring they’re holding a position where they don’t seem to be with it and the way you distinguish these two from here is whether they have epileptic activity on an EEG.

Often people who have these blinking out episodes will get diagnosed with depersonalization, derealization, or dissociative disorder. We had a patient who had a loss of connection between thoughts memories feelings surroundings behavior and identity and he went through our curve correction process here at caring medical as well as Prolotherapy and had a dramatic change in his personality.

Often when people get diagnosed with derealization, depersonalization, and dissociative disorder they’re often told the treatment options are limited. It is possible in some patients when there’s a structural cause obviously if you resolve the structural cause and you decrease the pressure in the brain and the brain fluid flow is restored back to normal there’s a good chance that the brain’s going to function more normally and then the person’s personality gets back to normal.

Depersonalization is observing oneself from outside one’s body. The person feels like they’re living their life but they’re viewing it from the outside.

Derealization is a person’s surroundings feel like they are not real, disconnected from people they care about. When there is a change in personality it may be that it’s not a brain problem it’s a neck problem and neck problems can be you know can be treated you can change neck structure.

Vagus Nerve Stimulation

The FDA approved Vagus nerve stimulation for chronic intractable migraine, seizure disorder and the Vegas nerve has many many effects on the nervous system it there’s many different ways that the Vegas nerve affects the brain. It helps the brain resist over electrical stimulation. If Vegas nerve stimulation controls refractory seizures , it may be that Vegas nerve degeneration is  the cause and the way we document this is through ultrasounds of the vagus nerve and we find that people with seizure disorders and tremors they almost always have degeneration of the Vagus nerve.

If vagus nerve stimulation controls refractory seizures could vagus nerve degeneration be the cause?

An October 2024 study in the medical journal Epilepsia Open (4) reviewed the effect of Vagus nerve stimulation (VNS) on seizure control, cognitive function, and quality of life in individuals with drug-resistant epilepsy. The researchers reviewed data from eleven previously published studies  on vagus nerve stimulation (VNS) therapy, with patients ranging from 11 to 33 years old and follow-up durations of 6-36 months. The average response rate after Vagus nerve stimulation (VNS) therapy was 56.94%.

An October 2024 study in The Journal of the Pakistan Medical Association (5) of 150 patients more than 10 years after vagal nerve stimulation devices, found, overall, 80 (53.3%) patients had partial seizures with secondary generalization, 70 (46.7%) had refractory seizure attacks for less than 5 years, 78 (52%) had attack frequency of 2-5 per day. All 150(100%) patients had had vagal nerve stimulation for more than two years. Post-intervention, 80(53.3%) patients had less than 2 attacks per day. There was evidence of improvement with respect to patient characteristics predictive of vagal nerve stimulation-related cognition and neuropsychological responsiveness in refractory epilepsy.

A September 2024 study in the journal Therapeutic advances in neurological disorders (6) demonstrated that vagus nerve stimulation exerts significant long-term effects on EEG aperiodic activity (offset and exponent – the parameters that indicate eradicate activity in the brain) in patients with drug-resistant epilepsy. Specifically, patients who responded to VNS therapy exhibited significant reductions in both offset and exponent during long-term follow-up. These reductions were correlated with decreases in seizure frequency,

In Japan, a September 2024 study (7) published in the journal Epilepsia Open looked at patients and clues for helping patients achieve long-term seizure free periods.

  • The study included 362 patients with drug-resistant epilepsy, 147 were female (40.6%), and the average age at vagus nerve stimulation implant was 23.0 years.
  • A total of 225 patients reported focal seizures and 184 patients reported tonic-clonic seizures (TCS).
  • After 36 months of adjunctive vagus nerve stimulation, 11% (38/356) of the patients experienced at least 1 year of complete seizure freedom with an average duration of seizure freedom of 19.4 months.
  • In patients with focal seizures, 25% (57/225) experienced at least 1 year of freedom from focal seizures with an average duration of 24.8 months.
  • Higher cumulative rates of freedom from tonic-clonic seizures (TCS) were observed: 55% (101/184) experienced at least 1 year without tonic-clonic seizures (TCS) with an average duration of tonic-clonic seizures-free periods of 28.9 months.

With VNS treatment, about 2 out of 4 patients with tonic-clonic seizures and 1 out of 4 patients with focal seizures had more time without these seizure types. Without seizures, patients felt better about their daily lives. Even patients who still had seizures felt better about their daily lives after 3 years of VNS treatment.

Movement Disorders

These disorders are a group of neurological conditions that cause the body to make abnormal movements.

There are two main types of abnormal movements:

  • Hyperkinetic movements
  • Hypokinetic movements

Different types of Movement Disorders

  • Huntington’s disease: A genetic condition that affects your brain, causing uncontrollable and unsteady movements in your hands, feet, and face, worsening over time.
  • Multiple system atrophy (MSA): A rare condition in which certain areas of the brain deteriorate, which can cause ataxia and parkinsonism.
  • Parkinson’s disease: A brain disorder that leads to unintended or uncontrollable movements and difficulty with balance and coordination as well as cognitive decline.
  • Periodic limb movement disorder (PLMD): Repetitive limb movements that occur during sleep.
    • A March 2021 paper published in the journal Epilepsy and behavior (8) suggested that Periodic limb movements in sleep may or may not be found frequently in people with epilepsy. The researchers suggested that limited amount of research and data up until the point of publication called for more research into the prevalence of sleep disturbances in epilepsy.
    • Published in September 2024 in the Journal of clinical sleep medicine, (9) the American Academy of Sleep Medicine  suggests against the use of triazolam (Conditional recommendation, very low certainty of evidence). and valproic acid (Conditional recommendation, very low certainty of evidence).
  • Progressive supranuclear palsy (PSP): A rare neurodegenerative disorder damaging certain areas of your brain; affecting how you walk, think, swallow and move your eyes.
  • Restless leg syndrome (RLS): A sleep disorder that causes an intense, often irresistible urge to move your legs (arms or body) occurring along with other sensations in the limbs like pulling, creeping, tugging, throbbing, itching, aching, burning, or crawling. Restless leg syndrome, it is possible that the structural cause of restless leg is that there’s neural tension somewhere from the neck or the lower back. When it’s a structural cause is a loss of the neck curve and a loss of the lumbar curve.
  • Rett syndrome: A rare genetic condition affecting speech, purposeful hand use and coordination.
  • Tardive dyskinesia: Due to taking antipsychotic medications for many years, results in involuntary facial tics and can cause uncontrollable movements like lip-smacking.
  • Tourette syndrome: A neurological disorder that affects your brain and nerves, causing you to make sudden movements or sounds (tics), and is often accompanied by anxiety, ADHD, and OCD.
    • An April 2016 paper in the journal Research in developmental disabilities (10) provided the first and strong evidence that Tourette syndrome is associated with a higher risk of epilepsy. The research was conducted with over one-thousand children (under age 18) with Tourette Syndrome who demonstrated an eighte4en times higher risk for developing epilepsy compared to controls.
  • Wilson disease: A rare genetic condition occurring due to high levels of copper, specifically in the brain and liver. It can cause stiff muscles, tremors, and uncontrolled body movements.

Anything that helps the brain function better, opening up the jugular veins, getting the vagus nerve healthier it’s likely going to decrease the symptoms of these condition conditions.

Two most common noninvasive tests that we do for intracranial hypertension is we check the pulsatile index of the middle cerebral arteries, the pulsatile index is the pressure against which the arteries in the brain have to push against to get a heartbeat. When the pulsatile index is high that’s a sign of intracranial hypertension.

I have a very extensive article: Dynamic Analysis of Blood Flow Measurements to the Brain, Brainstem, Cervical Spinal Cord, and Cranial Nerves, I discuss how we can utilize transcranial doppler (TCD) and extracranial doppler (ECD) ultrasound examination to assess proper blood flow during positional changes of the neck.

The second is optic nerve sheath diameter. When the diameter of the eye nerve is increased it means that there’s fluid around the eye nerve, that fluid is the cerebral spinal fluid. Why is the cerebral spinal fluid accumulating? One cause is that there is internal jugular vein compression.

 

Measuring components of a clogged brain drainage system

  • Motion Arterial Obstruction Mapping – utilizing B-mode and color duplex high-resolution doppler ultrasound of the head and neck in various positions and motions, brain arterial obstructions can be observed and mapped. These obstructions may be inside the cranial cavity, at the neck, or at the craniocervical junction.
  • Motional Venous Obstruction Mapping – by doing the same procedure on the venous drainage of the brain, the problems of brain venous obstruction can be revealed. Venous obstructions are typically at the craniocervical junctions or in the neck.
  • Optic Nerve Measurements – increased intracranial pressure (hypertension) can be seen by swelling of the optic nerves under high-resolution ultrasound. Optic nerve diameters of >5 mm are indicative of an intracranial pressure greater than 20 mmHg.
  • Cine phase-contrast MRI – imaging of the brain and brainstem in the supine and upright positions. This can show obstructions of cerebrospinal fluid (CSF) flow, as well as the accumulation of CSF in various parts of the brain and brainstem, compressing these structures and, thus, damaging them.

Seizures from neck pain

Prolotherapy injections are done to the injured ligaments, the most common ligaments in the neck that are injured are the capsular ligaments so if you have movement disorder seizure, disorder, blinking out episodes, tremors, it may be that your problem is in your neck and it’s not in your brain. If it is in your neck, restorative treatments may improve your cervical neck curve and if there’s ligament injury Prolotherapy to those ligaments may tighten and strengthen them so you can get your ligament instability resolved and your stability of your neck restored.

Hyperbaric oxygen therapy?

An October 2024 study in the journal Life Sciences (11) writes: “Hyperbaric oxygen therapy (HBOT) elevates the pressure of life-sustaining oxygen (pO2), thereby saving lives. However, Hyperbaric oxygen therapy (HBOT) can also cause toxic effects like lung and retinal damage (peripheral oxygen toxicity) and violent myoclonic seizures (central nervous system (CNS) toxicity). The mechanisms behind these effects are not fully understood, hindering the development of effective therapies and preventive strategies.” In this paper the researchers provide evidence that:

  • increased oxygen pressure increases reactive oxygen species (ROS – in simplest terms toxic oxygen metabolism molecules) concentration in tissues, which irreversibly alters cell receptors, causing peripheral oxygen toxicity and contributing to central nervous system oxygen toxicity.

Seizures

  • The researchers add, increased ROS concentration contributes to the rapid onset of Hyperbaric oxygen therapy -derived seizures.

Meet patients whose seizures were helped at Caring Medical:

References
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