Rhythmic ictal nonclonic hand (RINCH) motions in temporal lobe epilepsy: Invasive EEG findings, incidence, and lateralizing value

Ictal hand signs: Minimal previous attention to these diagnostic indicators

“…Cup sign points to temporal lobe (in study ii) in study c to fronto-temporal, extended hand to contralateral fronto-temporal (in study ii, iii); claw to fronto-temporal (study iii); fist to frontal (in studies ii, iii), index pointer to frontal (in studies ii, iii); thumb-up, pincer and politician's fist to temporal (study i,iii); a the "cup" sign, contralateral fronto-temporal (ii, iii), b the thumb sign, contralateral temporal (i, iii), c the "claw" sign, contralateral, fronto-temporal (iii), d the extended hand sign, contralateral (ii, iii), e the closed fist sign, contralateral, frontal (ii, iii), f the "pincer" sign, contralateral temporal (ii), g the index pointer sign, frontal (ii, iii), h the Politician's fist to temporal (ii) tonic posturing. Full-blown dystonic upper limb posturing ictal signs that affect only the hand or fingers were described subsequently, and snapping, tonic motor activities, and rhythmic ictal non-clonic hand (RINCH) motions extended the spectrum of hand and finger signs [6][7][8][9][10]. With regard to localization, different ictal hand postures (thumb abduction, wrist flexion, fist closure, finger hyperextension) were first classified in the temporal lobe by Holl et al [11].…”