Abstracts

Ictal and Postictal Swearing with Whistling as Manifestations of Refractory Epilepsy: A Rare Seizure Semiology Misdiagnosed as Motor and Vocal Tics

Abstract number : 2.235
Submission category : 4. Clinical Epilepsy / 4B. Clinical Diagnosis
Year : 2024
Submission ID : 64
Source : www.aesnet.org
Presentation date : 12/8/2024 12:00:00 AM
Published date :

Authors :
Presenting Author: Moustafa Mesha, MD – University at buffalo

Alexus Ludwid, DO – University at Buffalo
Robert Glover, MD – University at Buffalo

Rationale: Epileptic seizures are a known consequence of traumatic brain injury (TBI). Atypical seizure presentations can lead to misdiagnosing and delaying the appropriate management. We present an atypical case of post-traumatic refractory epilepsy manifesting as ictal and postictal swearing with whistling.


Methods: Case presentation: This is a 38-year-old right-handed male with a remote history of TBI who subsequently developed convulsive seizures that were controlled with medications. Many years later, he developed episodes that started with “a funny feeling in the head” followed by repetitive swearing, whistling, and left arm dystonia which were initially diagnosed as tics. Many years later, these events were captured on surface EEG and were associated with fast activity starting at the C4 electrode evolving into rhythmic sharp waves with spread to involve the whole right hemisphere. The vocal manifestation of the seizure started after the spreading of the electrographic seizure activity to the frontal and temporal electrodes. The patient’s typical seizures lasted for 3 minutes, and the patient was amnestic to them. These seizures were initially misdiagnosed as tics and impacted the patient’s life by causing uncomfortable and embarrassing situations in public spaces. Further workup with brain MRI showed multiple areas of encephalomalacia in the right temporal, frontal, and parietal lobes, and a PET scan revealed hypometabolism in the right temporal and frontal regions.


Results: To our knowledge, this is the first case to report both ictal and postictal whistling with swearing due to medically refractory epilepsy resulting from a remote TBI.


Conclusions: The seizure semiology, EEG findings, as well as imaging are suggestive of a widespread seizure network with involvement of both the frontal and the temporal lobes. Previously described cases of ictal swearing and whistling lateralize to the non-dominant hemisphere. Further workup including intracranial monitoring is warranted to better understand the seizure network and guide further management.


Funding: None

Clinical Epilepsy