Rationale: Initial clinical behavioral characteristics of seizures are very important for seizure classification. Due to increasing interest of epilepsy surgery, the semiology becomes a very valuable tool in lateralizing and localizing seizures.
Methods: NA
Results: A 27-year-old right-handed male presented with medication refractory epilepsy. Patient characterized his seizure as unilateral whole body turning both in standing as well as in the supine position, followed by generalized tonic clonic seizure. The patient has amnesia for these events.
Scalp Video electroencephalography (V‐EEG) recorded a total of four seizures. Three of them were characterized by behavior arrest followed by unidirectional whole body turning to the right side at least 90
⸰,
180
⸰, 560
⸰ respectively, then generalized tonic clonic seizures. Each seizure lasted about 90-105 seconds. Another seizure was shorter about 60 seconds and patient only had behavior arrest.
Ictal EEG in all four seizures showed herald sharp waves in the left mid temporal region, followed by left frontal temporal polymorphic delta rhythm. Seven to ten seconds later, this spreads to the central chain and right temporal region, evolving into theta delta rhythm artifacts. Interictal EEG revealed mid temporal sharp waves. Recent brain MRI demonstrated few nonenhancing supratetorial cystic cortical lesions most notable at the left parietal and left frontal region. PET scan showed left posterior cortical hypometabolic area matches MRI. There is discrepancy between EEG and brain MRI/PET findings. Stereotactic EEG (SEEG) was performed, which suggested epileptiform focus in the left lateral anterior temporal region with a network of spread including left lateral temporal, left parietal and left inferior frontal regions.
Conclusions: The case suggests that unidirectional whole body turning following behavior arrest can be a unique presentation of contralateral temporal epilepsy.
Funding: NA