Nose Wiping: An Unrecognized Automatism in Absence Seizures

Abstract

Nose wiping is a well-known postictal automatism in complex partial seizures, considered very important for lateralization. We report a 24-year-old woman selected from 32 patients with video-EEG investigations of absence seizures. The patient, with normal examination and imaging findings, had typical absence seizures from the age of 5 years, which were controlled with either ethosuximide or valproate and worsened by carbamazepine. In two of her recorded typical absence seizures associated with generalized 3 Hz symmetric spike-wave discharges, she wiped her nose as an automatism in the ictal and post-ictal period. Our case showed that nose wiping could be associated with generalized seizures, in contrast to other recent reports.

Current View of Autonomic Findings During Epileptic Seizures

“…They are less common in patients with extratemporal onset seizures and we reported that they also accompany absence seizures (32,33). Activation of the central autonomic network, particularly the amygdala, is thought to lead to nasal secretion.…”

The influence of gender on the aggravation of absence seizures by carbamazepine in the low-dose pentylenetetrazol rat model

“…The results of this study do not support the hypothesis that post-pubertal females are more susceptible than males to the aggravating effect of CBZ on absence seizures. This hypothesis was based primarily on the clinical observation that most of the reported post-pubescent patients have been pre-menopausal women 7,[11][12][13][14][15][16] . This observation may instead reflect a selection bias as a result of absence seizures in adulthood being more common in females than males.…”

“…There is clinical evidence that there may be a sex difference in the susceptibility of post-pubescent patients to the aggravation of absence seizure by CBZ, with the vast majority of such reported cases being pre-menopausal women 7,[11][12][13][14][15][16] . Furthermore, absence seizures persisting into adulthood are more common in females, and the frequency of absence epilepsy in adults is positively correlated with progesterone levels 17 .…”