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Prefrontal seizures manifesting as motor stereotypies

Authors

  • Aileen McGonigal MD,

    Corresponding author
    1. Institut de Neurosciences des Systèmes, INSERM UMR 1106, Marseille, France
    2. Aix Marseille Université, Faculté de Médecine, Marseille, France
    3. Service de Neurophysiologie Clinique, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
    • Correspondence to: Dr. Aileen McGonigal, UMR 1106 INSERM, Institut de Neurosciences des Systèmes, Aix Marseille Université, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France; aileen.mcgonigal@univ-amu.fr

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  • Patrick Chauvel MD, PhD

    1. Institut de Neurosciences des Systèmes, INSERM UMR 1106, Marseille, France
    2. Aix Marseille Université, Faculté de Médecine, Marseille, France
    3. Service de Neurophysiologie Clinique, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
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  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • Full financial disclosures and author roles may be found in the online version of this article.

ABSTRACT

Background

The definition of stereotypies traditionally does not include “epileptic automatisms.” However repetitive, sometimes rhythmic behaviors can occur during frontal lobe seizures in a reproducible pattern for a given patient. Thus, the concept of a frontostriatal “motor loop” could be relevant to repetitive ictal behaviors.

Methods

We describe 17 patients with frontal lobe epilepsy who presented with motor and/or verbal stereotypies and who were explored using depth electrodes (stereoelectroencephalography [SEEG]) in the context of epilepsy presurgical evaluation.

Results

Motor patterns were typically reproducible between seizures for a given patient. Distal motor stereotypies were associated with anterior prefrontal localization, and proximal stereotypies were associated with posterior prefrontal localization.

Conclusions

“Stereotypy” is a useful term to describe ictal repetitive behaviors produced by prefrontal seizure discharge. The expression of distal and proximal stereotypies follows a rostrocaudal gradient within the frontal lobes. Exploration of the cortical compartment of frontostriatal networks in epileptic patients offers a unique opportunity to study the mechanisms of stereotypies in vivo. © 2013 International Parkinson and Movement Disorder Society

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