Dissociative Head and Eye Movement during Seizure: A Case Report
الموضوعات : Report of Health Care
Soheila Rezakhani
1
(Department of Neurology, Kerman Medical University, Kerman, Iran)
Mahmood Motamedi
2
(Department of Neurology, Tehran Medical University, Tehran, Iran)
الکلمات المفتاحية: Seizure, Disconjugated Head and Eye Movement, Frontal Eye Field,
ملخص المقالة :
Introduction: Deviation of the eyes may occur with seizures involving any cerebral lobe. Most notably, a lesion of the FEF that causes excess neural activity, like a focal seizure, or spreading of ictal discharges to the FEF will drive the eyes contralaterally during the period of the seizure. The head also may turn contralateral to the seizure focus during the ictus. In the post-ictal state, when there may be lingering hypoactivity of the FEF neurons, the eyes may deviate ipsilateral to the side of the lesion because of a relative increase in the input from the unaffected FEF on the opposite side of the brain. Methods: A 14- year old right handed boy with refractory epilepsy was admitted for video EEG monitoring in an attempt to better define his seizures and to evaluate him for possible epilepsy surgery. He had thirteen clinical seizures with different semiology. In one of these, he had disconjugated head and eye movement that is an unusual finding. In this investigation, we noted his brain MRI with and without contrast that reported focal signal abnormality in the right prerolandic region indicative of AV malformation and also abnormal intraaxial infratentorial cystic mass located in the left cerebellar peduncle. Results: In the present case, disconjugated head and eye movement occurred during the seizure, probably; due to brain stem cystic lesion that is mainly located in mesencephalic area that may interrupt the connections between FEF and superior colliculus. Conclusion: The patient studied in the present study experienced Rt. Side (ipsilateral) eye gaze with dis-conjugated left sided (contralateral) head version during his seizure. While long term video-EEG monitoring and imaging studies pointed to epileptogenic zone of right centroparietal region. This is probably due to a cystic lesion located in the mesencephalic region mainly in the left cerebellar peduncle.
1. Sinclair D, Wheatley M, Snyder T. Frontal lobe epilepsy in childhood. Pediatr Neurol. 2004;30 (3): 169- 176.
2. Zhang W, Liu X, Zuo L, Guo Q, Chen Q. Ipsiversive ictal eye deviation in inferioposterior temporal lobe epilepsy—Two SEEG cases report. BMC Neurol. 2017; 17: 38.
3. Lee SU, Suh aH-I, Choi aJY, Huh BK, Kim aHJ, Kimd caJ-S. Epileptic nystagmus: A case report and systematic review. Epilepsy Behav Case Rep. 2014; 2: 156– 160.
4. Kellinghaus C, Skidmore C, Loddenkemper T. Lateralizing value of epileptic nystagmus. Epilepsy Behav. 2008; 13 (4): 700- 702.
5. Robillard A, Saint-Hilaire JM, Mercier M, Bouvier G. The lateralizing and localizing value of adversion in epileptic seizures. Neurology. 1983; 33 (9): 1241- 1242.
6. Jalili C, Salahshoor MR, Pourmotabbed A, Moradi S, Roshankhah S, Shabanizadeh A, et al. The effects of aqueous extract of Boswellia Serrata on hippocampal region CA1 and learning deficit in kindled rats. Res Pharm Sci. 2014; 9 (5): 351- 358.
7. Schulz R, Tomka-Hoffmeister M, Woermann FG, Hoppe M, Schittkowski MP, Ebner A, et al. Epileptic monocular nystagmus and ictal diplopia as cortical and subcortical dysfunction. Epilepsy Behav Case Rep. 2013; 1: 89- 91.
8. Vernet M, Quentin R, Chanes L, Mitsumasu A, Valero-Cabré A. Frontal eye field, where art thou? Anatomy, function, and non-invasive manipulation of frontal regions involved in eye movements and associated cognitive operations. Front Integr Neurosci. 2014; 8: 66.
9. Saeb S, Weber C, Triesch J. Learning the optimal control of coordinated eye and head movements. PLOS Computational Biol. 2011; 7 (11): e1002253.
10.Sparksa DL, Freedman EG, Chen LL, Gandhia NJ. Cortical and subcortical contributions to coordinated eye and head movements. Vision Res. 2001; 41 (25-26): 3295- 3305.
11.Freedman EG, Sparks D. Coordination of the eyes and head: movement kinematics. Exp Brain Res. 2000; 131 (1): 22- 32.
12.Walton M, Bechara B, Gandhi N. Role of the primate superior colliculus in the control of head movements. J Neurophysiol. 2007; 98 (4): 2022- 2037.
13.Katnani HA, Opstal AJV, Gandhi NJ. A test of spatial temporal decoding mechanisms in the superior colliculus. J Neurophysiol. 2012; 107: 2442- 2452.
14.Stahl JS. Adaptive plasticity of head movement propensity. Exp Brain Res. 2001; 139 (2): 201- 208.
15.Sylvestre P, Cullen K. Premotor correlates of integrated feedback control for eye-head gaze shifts. J Neurosci. 2006; 26 (18): 4922- 4929.
16.Chen B, May PJ. Premotor circuits controlling eyelid movements in conjunction with vertical saccades in the cat: I. The rostral interstitial nucleus of the medial longitudinal fasciculus. Comparative Neurology. 2002; 450 (2): 183- 202.
