Epileptic gaze deviation and nystagmus

Abstract

We studied a patient with stereotyped focal seizures characterized by leftward conjugate eye- and head-turning followed by nystagmus. Eye deviation was associated with the appearance of seizure activity, recorded over the right temporo-occipital scalp, that did not spread frontally. The initial eye deviation consisted of a staircase of small saccades. The subsequent nystagmus showed rightward decreasing-velocity exponential slow phases and normal leftward quick phases. Saccadic eye movements due to seizures may occur via projections from posterior cortical areas as well as from the frontal eye fields.

Parietal and Occipital Lobe Epilepsy: A Review

“…These seizures, first described by Fere (1890), have been recognized as a unique seizure form only relatively re-cently (Gastaut and Roger, 1954). Early French and Italian literature contains several case descriptions (Messing, 1927;Jayle, 1941;Gastaut and Roger, 1954;Terzian, 1955;Infuso and Migliore, 1959;Kreindler et al, 1959;Giove, 1960;Trevisan and Belasso, 196l), as does more recent German and English literature (von Rad, 1970;White, 1971; Goldberg and Adelman, 1980;Beun et al, 1984;Oller et al, 1985;Thurston et al, 1985;Barry, 1986;Kanazawa et al, 1989; Kaplan and Lesser, 1989;Tusa et al, 1990;Furman et al, 1990). The incidence of oculoclonic seizures has probably been underestimated (Takeda et al, 1969(Takeda et al, , 1970Huott et al, 1974;Ludwig and Ajmone Marsan, 1975), and some investigators have emphasized a high prevalence of this symptom, as well as eyelid flutter, in occipital epilepsy (Gastaut, 1960;Bancaud, 1969;Takeda et al, 1969Takeda et al, , 1970.…”

“…In oculoclonic seizures, the interictal scalp recordings have shown discharges in the posterior brain region on either side, involving one or more of the following: parietal (White, 1971; Goldberg and Adelman, 1980;Beun et al, 1984), parieto-occipital (Trevisan and Belasso, 1961;Beun et al, 1984; 01ler et al, 1985), occipital (Barry, 1986;Kanazawa et al, 1989), posterior temporooccipital (Gastaut and Collomb, 1954;Castaut, 1960;Beun et al, 1984;Thurston et al, 1985) or temporal only (Infuso and Migliore, 1959;Barry, 1986) with occasional spread to frontal regions. Neuroimaging and neuropsychology in parietal and occipital epilepsy Magnetic resonance imaging (MRI) has been shown to be superior to x-ray computed tomography (CT) in detecting lesions underlying partial epilepsy (Tychsen and Hoyt, 1985;Lesser et al, 1986;Theodore et al, 1986;Barkovich et al, 1988;Wee et al, 1990).…”

Epileptic Nystagmus

“…Recent DC recordings of the electroocular potentials associated with this phenomenon have yielded conflicting results. In a comatose patient (Thurston et al, 1985), the slow phase of EN was shown to have exponentially decreasing velocity, suggesting a gaze-holding defect (a "leaky brainstem neural integrator"). Such gaze-paretic nystagmus would be evident only in an eccentric position of gaze (Dell'Osso et al, 1990) and therefore could not explain EN in patients without eye deviation or in patients in whom the eye deviation was opposite in direction to the fast phase of EN such as those described by Talaraich et al.…”

“…With conventional electrode placement, the EEG paroxysms involved the occipital, posterotemporal, and parietal areas of the scalp. This finding is in agreement with observations made in the majority (26 of 33) of reported cases of EN in which ictal EEGs were recorded (Gastaut and Roger, 1954;Terzian, 1955;Infuso and Migliore, 1959;Gastaut, 1960;Giove, 1960;Talairach et al, 1961;Caneschi et al, 1963;Ricci and Vizioli, 1966;Arend et al, 1968;Rad, 1970;White, 1971;Huott et al, 1974;Enokido et al, 1977;Hidaka et al, 1978;Goldberg and Adelman, 1980;Beun et al, 1984;Barry et al, 1985;Ramani, 1985;Thurston et al, 1985;Aldrich et al, 1989;Kanazawa et al, 1989;Furman et al, 1990;Tusa et al, 1990). Supplementary scalp electrodes further localized the seizures to electrodes situated between 02 and T6 in our first patient and between 02, T6 and P4 in a patient studied by Tusa et al (1990).…”

“…Key Words: Eye manifestations-Nystagmus-Focal epilepsy-Stimulus-sensitive epilepsy-Epileptic nystagmus-Ictal nystagmus-Oculoclonic seizures. al., 1977; Hidaka et al, 1978;Goldberg and Adelman, 1980;Pritchard and Tucker, 1982;Smith and Docherty, 1982;Beun et al, 1984; Barry et al, 1985;Ramani, 1985; Thurston et al, 1985;Barry, 1986;Lavin, 1986;Aldrich et al, 1989;Kanazawa et al, 1989; Kaplan and Lesser, 1989;Furman et al, 1990;Tusa et al, 1990). In reviewing the literature on EN since the inception of EEG, we excluded from consideration cases with incomplete clinical or EEG data (Gastaut and Roger, 1954;Bickford and Klass, 1965; Oikawa et al, 1977), nystagmus of uncertain epileptic nature (Paolozzi et al, 1970) or EEG epileptic activity other than clearly individualized partial seizures.…”