The cortical vestibular system: insights from electroencephalography

Purpose of review Although electroencephalography (EEG) is central to epilepsy diagnosis, its role in patients presenting with dizziness or balance disorders has historically been negligible. This review provides a timely synthesis of recent methodological and conceptual advances demonstrating how modern EEG analyses can probe cortical contributions to vestibular and balance function. Recent findings While vestibular epilepsy remains rare, EEG is increasingly being applied to investigate cortical dynamics during vestibular stimulation, postural control, and balance perturbations. Contemporary analytic techniques have revealed that alpha-band and beta-band EEG activity reflect key aspects of vestibular perception, adaptation, and postural control. Findings in patients with higher order vestibular dysfunction link symptoms to abnormal oscillatory patterns corresponding to disrupted sensory integration and maladaptive attentional engagement. Advances in mobile EEG approaches now permit reliable signal acquisition during movement and direct vestibular stimulation, allowing quantification of ecologically relevant cortical responses such as the perturbation-evoked potential. Summary EEG provides a powerful, accessible, and scalable tool to characterize cortical contributions to vestibular processing and balance. These developments highlight its emerging value for identifying neurophysiological biomarkers of vestibular dysfunction, improving diagnostic precision, and informing targeted rehabilitation strategies.