Abstracts

Post-ictal nose-wiping is considered highly lateralizing in temporal lobe epilepsy (using the hand contralateral to the focus). Like many automatisms, its origin is not completely understood. It could represent a [quot]release[quot] phenomenon if it occurred either ictally or post-ictally. There is some reason to believe this behavior to be ictal, rather than post-ictal, as vibrissae rubbing occurs in one stage of kindled seizures in rats. One report of nose-wiping during absence seizures is more consistent with a release phenomenon. We therefore report on intracranial recordings during [quot]nose wiping[quot] on two patients. Two patients with history of nose and face wiping underwent implantation of an 8x8 grid, hippocampal depth and sutemporal stip electrodes to locate epileptogenic zones. The first was on the left, the second on the right. The electroclinicical and neuroanatomical correlates of nose-wiping were collated across all seizures. Patient No. 1 had 5 of 7 seizures with face and/or nose rubbing. This occurred at 61, 59, 34, 74, and 26 sec after D-EEG onset, during ictus. The ictal activity was basal and lateral temporal cortex at the time. All were CPS except one which secondarily generalized. The hands used were ipsilateral on the 1st and ipsilateral to bilateral on the 2nd seizures, bilateral on the other three. Only the last event generalized. Patient No. 2 had ipsilateral nose wiping on 3 of 5 seizures. Those without it secondarily generalized. It began 110, 106, and 149 sec after onset of the seizure, during ictus, but persisted after the D-EEG activity stopped in two. The ictal activity was perisylvian at the time of onset. The fact that seizures with nose-wiping rarely generalized (1 of 8) and the persistence of nosewiping after cessation of ictus suggests that this behavior is a release type phenomenon, but not specifically post-ictal. When nose-wiping was an isolated automatism the focus was ipsilateral but when it occurred in the context of other facial wiping, lateralizing value was lost. The literature will be reviewed and further cases will be sought for evaluation. Video clips will be presented