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Ictal unilateral eye blinking and contralateral blink inhibition - A video-EEG study and review of the literature.

Kalss G, Leitinger M, Dobesberger J, Granbichler CA, Kuchukhidze G, Trinka E - Epilepsy Behav Case Rep (2013)

Bottom Line: Both patients did not display any clonic activity of the face.Unilateral eye blinking was ipsilateral to the frontotemporal ictal EEG pattern in both patients.The asymmetric blink frequency during BEB in patient one leads to the hypothesis that ictal UEB is caused by contralateral blink inhibition due to activation in frontotemporal cortical areas and mediated by trigeminal fibers.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Ignaz Harrer Straße 79, 5020 Salzburg, Austria.

ABSTRACT

Introduction: There is limited information on ictal unilateral eye blinking (UEB) as a lateralizing sign in focal seizures. We identified two patients with UEB and propose a novel mechanism of UEB based on a review of the literature.

Materials and methods: We report on two patients with intractable focal epilepsy showing UEB among 269 consecutive patients undergoing noninvasive video-EEG monitoring from October 2011 to May 2013.

Results: Unilateral eye blinking was observed in 0.7% (two of 269) of our patients. Patient one had four focal seizures. Semiological signs in all of her seizures were impaired consciousness, bilateral eye blinking (BEB), and UEB on the right. During one seizure, BEB recurred after UEB with a higher blink frequency on the right. Patient two had ten focal seizures. Among them were one electrographic seizure and nine focal seizures with BEB (in 3/10) and UEB on the left (in 1/10 seizures, respectively). Both patients did not display any clonic activity of the face. In seizures with UEB, ictal EEG onset was observed over the ipsilateral frontotemporal region in both of the patients (over F8 in 2/4, Fp2-F8 in 1/4, Sp2-T2 in 1/4, and F7 in 1/1 seizures, respectively). Ictal pattern during UEB showed bilateral ictal activity (in 4/4) and ictal discharges over the ipsilateral frontal region (maximum over F3 in 1/1 seizure). Interictal EEG showed sharp waves over the same regions.

Discussion: Unilateral eye blinking was ipsilateral to the frontotemporal ictal EEG pattern in both patients. The asymmetric blink frequency during BEB in patient one leads to the hypothesis that ictal UEB is caused by contralateral blink inhibition due to activation in frontotemporal cortical areas and mediated by trigeminal fibers.

No MeSH data available.


Related in: MedlinePlus

Changes in ictal EEG pattern after switching from BEB to UEB on the right: First ictal EEG pattern shows rhythmic sharp waves over both frontotemporal areas. After switching from BEB to UEB on the right, EEG shows decrease of sharp waves over both frontal areas and over the left temporal region, whereas sharp waves are predominantly documented over the right temporal region (maxima Sp2-T2). A. Longitudinal bipolar montage. B. Cz reference montage.
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f0005: Changes in ictal EEG pattern after switching from BEB to UEB on the right: First ictal EEG pattern shows rhythmic sharp waves over both frontotemporal areas. After switching from BEB to UEB on the right, EEG shows decrease of sharp waves over both frontal areas and over the left temporal region, whereas sharp waves are predominantly documented over the right temporal region (maxima Sp2-T2). A. Longitudinal bipolar montage. B. Cz reference montage.

Mentions: Patient one is a 38-year-old, right-handed woman with drug-resistant right-sided focal epilepsy. The patient was on carbamazepine 1200 mg/day and topiramate 175 mg/day at the time of investigation. Seizure history included focal seizures with retained consciousness, abdominal aura, and déjà vu, eventually preceding focal seizures with impairment of consciousness and evolving into bilateral, convulsive seizures. After gradual withdrawal of the antiepileptic medication, four seizures with UEB on the right were recorded. Semiological signs in all of the seizures were bilateral eye blinking (BEB) 29 seconds (s) after EEG onset in median (range: 18–37 s, median duration: 9 s, range: 6–11 s), followed by UEB on the right, starting 51 s after EEG onset in median (range: 30–71 s, median duration: 17 s, range: 10–34 s). Unilateral eye blinking did not evolve into any clonic activity of the face. During one seizure, BEB recurred asymmetrically with a higher blink frequency on the right after UEB on the right (which began 59 s after EEG onset, lasting 17 s) (see Video 1). Further lateralizing seizure phenomena were head-turning to the right (in 2/4 seizures), eye deviation to the left (in 3/4), postictal aphasia (in 2/4), postictal impaired figural memory (in 1/4), and postictal nose wiping (in 2/4). Ictal EEG showed the seizure onset over F8 (in 2/4 seizures), Fp2-F8 (in 1/4), or Sp2-T2 (in 1/4) after placement of additional temporomesial electrodes, which quickly spread to the contralateral hemisphere. During UEB, her EEG showed bilateral widespread ictal activity (in 4/4 seizures). During the focal seizure with a second period of (asymmetric) BEB, ictal EEG discharges decreased over both frontal areas and in the left temporal region (maximum ictal discharges over Sp2-T2) after the switch from BEB to UEB on the right (see Fig. 1). Interictal EEG showed sharp waves over F8, F8-T4, F8-Sp2, or T2 and frontal intermittent rhythmic delta activity (FIRDA) with a frequency of 2–3/s.


Ictal unilateral eye blinking and contralateral blink inhibition - A video-EEG study and review of the literature.

Kalss G, Leitinger M, Dobesberger J, Granbichler CA, Kuchukhidze G, Trinka E - Epilepsy Behav Case Rep (2013)

Changes in ictal EEG pattern after switching from BEB to UEB on the right: First ictal EEG pattern shows rhythmic sharp waves over both frontotemporal areas. After switching from BEB to UEB on the right, EEG shows decrease of sharp waves over both frontal areas and over the left temporal region, whereas sharp waves are predominantly documented over the right temporal region (maxima Sp2-T2). A. Longitudinal bipolar montage. B. Cz reference montage.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150618&req=5

f0005: Changes in ictal EEG pattern after switching from BEB to UEB on the right: First ictal EEG pattern shows rhythmic sharp waves over both frontotemporal areas. After switching from BEB to UEB on the right, EEG shows decrease of sharp waves over both frontal areas and over the left temporal region, whereas sharp waves are predominantly documented over the right temporal region (maxima Sp2-T2). A. Longitudinal bipolar montage. B. Cz reference montage.
Mentions: Patient one is a 38-year-old, right-handed woman with drug-resistant right-sided focal epilepsy. The patient was on carbamazepine 1200 mg/day and topiramate 175 mg/day at the time of investigation. Seizure history included focal seizures with retained consciousness, abdominal aura, and déjà vu, eventually preceding focal seizures with impairment of consciousness and evolving into bilateral, convulsive seizures. After gradual withdrawal of the antiepileptic medication, four seizures with UEB on the right were recorded. Semiological signs in all of the seizures were bilateral eye blinking (BEB) 29 seconds (s) after EEG onset in median (range: 18–37 s, median duration: 9 s, range: 6–11 s), followed by UEB on the right, starting 51 s after EEG onset in median (range: 30–71 s, median duration: 17 s, range: 10–34 s). Unilateral eye blinking did not evolve into any clonic activity of the face. During one seizure, BEB recurred asymmetrically with a higher blink frequency on the right after UEB on the right (which began 59 s after EEG onset, lasting 17 s) (see Video 1). Further lateralizing seizure phenomena were head-turning to the right (in 2/4 seizures), eye deviation to the left (in 3/4), postictal aphasia (in 2/4), postictal impaired figural memory (in 1/4), and postictal nose wiping (in 2/4). Ictal EEG showed the seizure onset over F8 (in 2/4 seizures), Fp2-F8 (in 1/4), or Sp2-T2 (in 1/4) after placement of additional temporomesial electrodes, which quickly spread to the contralateral hemisphere. During UEB, her EEG showed bilateral widespread ictal activity (in 4/4 seizures). During the focal seizure with a second period of (asymmetric) BEB, ictal EEG discharges decreased over both frontal areas and in the left temporal region (maximum ictal discharges over Sp2-T2) after the switch from BEB to UEB on the right (see Fig. 1). Interictal EEG showed sharp waves over F8, F8-T4, F8-Sp2, or T2 and frontal intermittent rhythmic delta activity (FIRDA) with a frequency of 2–3/s.

Bottom Line: Both patients did not display any clonic activity of the face.Unilateral eye blinking was ipsilateral to the frontotemporal ictal EEG pattern in both patients.The asymmetric blink frequency during BEB in patient one leads to the hypothesis that ictal UEB is caused by contralateral blink inhibition due to activation in frontotemporal cortical areas and mediated by trigeminal fibers.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Ignaz Harrer Straße 79, 5020 Salzburg, Austria.

ABSTRACT

Introduction: There is limited information on ictal unilateral eye blinking (UEB) as a lateralizing sign in focal seizures. We identified two patients with UEB and propose a novel mechanism of UEB based on a review of the literature.

Materials and methods: We report on two patients with intractable focal epilepsy showing UEB among 269 consecutive patients undergoing noninvasive video-EEG monitoring from October 2011 to May 2013.

Results: Unilateral eye blinking was observed in 0.7% (two of 269) of our patients. Patient one had four focal seizures. Semiological signs in all of her seizures were impaired consciousness, bilateral eye blinking (BEB), and UEB on the right. During one seizure, BEB recurred after UEB with a higher blink frequency on the right. Patient two had ten focal seizures. Among them were one electrographic seizure and nine focal seizures with BEB (in 3/10) and UEB on the left (in 1/10 seizures, respectively). Both patients did not display any clonic activity of the face. In seizures with UEB, ictal EEG onset was observed over the ipsilateral frontotemporal region in both of the patients (over F8 in 2/4, Fp2-F8 in 1/4, Sp2-T2 in 1/4, and F7 in 1/1 seizures, respectively). Ictal pattern during UEB showed bilateral ictal activity (in 4/4) and ictal discharges over the ipsilateral frontal region (maximum over F3 in 1/1 seizure). Interictal EEG showed sharp waves over the same regions.

Discussion: Unilateral eye blinking was ipsilateral to the frontotemporal ictal EEG pattern in both patients. The asymmetric blink frequency during BEB in patient one leads to the hypothesis that ictal UEB is caused by contralateral blink inhibition due to activation in frontotemporal cortical areas and mediated by trigeminal fibers.

No MeSH data available.


Related in: MedlinePlus