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NEUROLOGY 2009;72:e56
© 2009 American Academy of Neurology
Resident and Fellow Section

Teaching Video NeuroImages: Preserved awareness in a frontal seizure with bilateral motor involvement

A psychogenic mimic

Formula

David T. Hsieh, MD and Phillip L. Pearl, MD

From the Department of Neurology, Children’s National Medical Center, Washington, DC.

Address correspondence and reprint requests to Dr. David T. Hsieh, Division of Child Neurology, San Antonio Military Medical Center, 2200 Bergquist Drive, Ste. 1, Wilford Hall Medical Center, Lackland AFB, TX 78236 david.hsieh{at}lackland.af.mil

An 8-year-old boy with suspected psychogenic seizures was admitted for video-EEG monitoring. A stereotypical spell manifested as bilateral swinging extremity movements, and the patient proclaimed, "I’m doing the disco!" (video on the Neurology® Web site at www.neurology.org). Right frontal-central rhythmic, sharp, fast activity (figure, A and B) was observed. MRI revealed seizure-related right frontal primary motor cortex hyperintense signal (figure, C) near the supplementary motor area (SMA). Bilateral motor involvement rarely allows patients to smile and joke, but seizures involving the SMA1 are an exception. Although bilateral tonic contraction in abduction of the upper extremities is reported to be specific for SMA seizures,2 video-EEG monitoring is needed for confirmation.


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  		Figure EEGs with still frame from video and MRI

(A) At the onset, tonic contractions of the upper extremities in abduction is seen clinically, and EEG revealed subtle sharp fast activity from the right frontal-central region, but movement artifact predominates. (B) Later ictal EEG while the patient is proclaiming that he is "doing the disco" revealed a more pronounced electrographic correlate of rhythmic, sharp, fast activity from the right frontal-central region. (C) Fluid-attenuated inversion recovery sequence axial MRI revealed abnormal hyperintense signal of the right frontal primary motor cortex, interpreted as seizure related, and noted on subsequent repeat MRI to have resolved.

 


   ACKNOWLEDGMENT
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 ACKNOWLEDGMENT
REFERENCES
 
The authors thank Linda Barrett, Ozzie Rivera, and Douglas Souris in the CNMC EEG laboratory for technical assistance and Kim Miller, 37th Training Wing Public Affairs Media.

Supplemental data at www.neurology.org

The views expressed in this article are those of the authors and do not reflect the official policy or position of the United States Air Force, Department of Defense, or the US Government.

Disclosure: The authors report no disclosures.


   REFERENCES
Top.
 ACKNOWLEDGMENT
 REFERENCES
 

  1. Fried I, Katz A, McCarthy G, et al. Functional organization of human supplementary motor cortex studied by electrical stimulation. J Neurosci 1991;11:3656–3666.[Abstract]
  2. Kanner AM, Morris HH, Luders H, et al. Supplementary motor seizures mimicking pseudoseizures: some clinical differences. Neurology 1990;40:1404–1407.[Abstract/Free Full Text]




This Article
Right arrow Figures Only
Right arrow Full Text (PDF)
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Right arrow Similar articles in PubMed
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Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hsieh, D. T.
Right arrow Articles by Pearl, P. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hsieh, D. T.
Right arrow Articles by Pearl, P. L.
Related Collections
Right arrow All Pediatric
Right arrow Video/ EEG use in epilepsy
Right arrow Partial seizures
Right arrow Nonepileptic seizures

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