Abstracts

Rationale: The sign of the cross or Signum crucis (SC) in Latin is a ritual hand motion made by members of many branches of Christianity. In Brazil, where the most popular religion is Roman Catholicism, the SC is commonly employed in the beginning of a pray and during everyday activities. This sign, liturgical or devotional in its nature, is delineated by the gesture of tracing two lines intersecting at right angles, touching sequentially the forehead, sternum, left and right shoulders, and indicates symbolically the figure of Jesus Christ cross. Relationship between religion and epilepsy has been reported throughout history, clinical observations and research, in particular among patients with temporal lobe epilepsy (TLE). The purpose of this study was to describe clinical characteristics and lateralizing value of ictal SC in patients with TLE. Methods: We reviewed video-EEG data of 500 patients with epilepsy recorded in a tertiary epilepsy center from 2002 to 2008, which had undergone pre-surgical evaluation with ictal video-EEG monitoring and high-resolution MRI due to refractory epilepsy. The following issues were considered: actual and past religious belief, manual dominance, psychiatric evaluation, mental status during the act of the SC (conscious or not) and lateralization of the SC. Results: Four patients were found to have a complex hand automatism characterized by a gesture similar to the SC at least once during their complex partial seizures. All cases had TLE due to unilateral mesial temporal sclerosis refractory to medical treatment, which was right-sided on MRI. They were right handed and performed the act during seizure with the right hand. During childhood, all patients were baptized catholic, but two of them followed another religion in adulthood. No interictal experiences with hyper-religiosity were recognized in all four cases. Three patients were submitted to anterior temporal lobectomy; two became seizure free, and one is in Engel Class III. Conclusions: Ictal behavioral characteristics may provide clues in determining the localization of the epileptogenic zone. The limbic system is often suggested as the critical site of religious experience. Moreover, the religious experience may be predominantly localized to the temporal lobe of the right hemisphere. Therefore, SC automatism may be related to right temporal lobe epilepsy.