Short communicationIctal unilateral blinking is an unreliable lateralizing sign in tuberous sclerosis complex
Introduction
Ictal unilateral blinking is an uncommon but reportedly reliable sign, indicating an ipsilateral focus (Benbadis et al., 1996). Having observed unilateral blinking often during seizures in children with tuberous sclerosis complex (TSC), we sought to determine its utility in TSC.
Section snippets
Methods
We reviewed the clinical, EEG, MRI and surgical data in children with TSC and drug-resistant epilepsy evaluated at our center between 1997 and 2013. Videos of patients whose video-EEG monitoring (VEM) reported ‘blinking’, ‘eyelid/eye blinks’ or ‘eyelid twitching’ were reviewed, blind to localization of their EEG, tubers and surgery. Only patients with clear ictal unilateral blinking were included. Other focal motor semiology, ictal scalp EEG and post-operative seizure outcome were used to infer
Results
Ictal blinking was reported in 20/92 TSC patients who underwent VEM. Eleven (12%) had clear unilateral ictal blinking, of whom 10 underwent tuberectomy and are the basis of this report.
The 10 patients (6 males) were aged 1.9–18 years (mean 10) during VEM. All had multiple bilateral tubers. Findings from VEM and surgery are summarized in Table 1.
Discussion
The frequency of ictal unilateral blinking in our TSC series was 12%, greater than the 1.5% reported in patients with focal epilepsy due to vascular malformations, neoplasms and heterotopias (Benbadis et al., 1996). Unilateral blinking seizures are reported to be mainly of temporal or frontal origin (Kalss et al., 2013, Pestana and Gupta, 2007, Henkel et al., 1999, Benbadis et al., 1996, Wada, 1980), as seemed to be the case in our series.
Wada originally reported unilateral blinking to be
Acknowledgement
None.
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Ictal blinking in focal seizures: Insights from SEEG recordings
2020, SeizureCitation Excerpt :The prevalence of bilateral ictal blinking in our population of SEEG-investigated patients was approximately 7% with an over-representation in occipital SOZ (prevalence of 57.1%) which is in accordance with existing literature on occipital epilepsy (prevalence ranging from 15 to 62.5%) [7,23–27]. The prevalence of unilateral ictal blinking in our cohort was approximately 1.3 %, that is consistent with previous studies (0.7-1,5%) [5,6,9], except in a series focusing on patients with tuberous sclerosis complex (12 %) [10]. Noteworthy, because we have excluded patients without optimal visualisation of both eyes, it is possible that we have a little underestimated the prevalence of ictal eye blinking in our cohort.
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