Abstract
Objective: We aim to describe hand postures during generalized convulsions in patients with genetic generalized epilepsy (GGE), localization-related epilepsy (LRE), and non-epileptic attacks (NEA). Background: Classifying epilepsy is largely based on history, MRI and interictal EEG. However, even video-EEG occasionally fails to provide a definitive diagnosis. Reliable semiologic lateralizing signs have been described, but hand and finger posturing has received little attention. Methods: We retrospectively analyzed 98 consecutive videos of generalized convulsions in 64 patients admitted to our epilepsy monitoring unit (EMU) for diagnostic video-EEG. Demographics were recorded, and hand postures were divided into fanning, fisting, index-finger pointing (IFP), clawing, and flaccid hand. Hand postures were compared between LRE, GGE, and NEA for each stage of the seizure (onset, tonic phase, and clonic phase). A p = <0.05 was significant. Results: The most common posture in LRE was IFP (96.0[percnt]), higher than GGE (56.5[percnt], p = <0.001). and NEA (12.0[percnt], p = <0.001). The most common posture in GGE was fanning (91.3[percnt]) which only occurred during the seizure onset and was more common than LRE onset (42.0[percnt], p = <0.001). All GGE fanning evolved into either fisting (69.6[percnt]) or IFP (30.4[percnt]) during the tonic phase. The most common hand posture in NEA was the flaccid hand posture (56.0[percnt]), higher than GGE (4.3[percnt], p = <0.001) and LRE (20.0[percnt], p = 0.003). The clawing posture occurred exclusively in NEA (12.0[percnt]). Conclusions: Distinct ictal hand and finger posturing is present in GGE, LRE, and NEA. We found a high prevalence of IFP in patients with LRE and some postures are highly suggestive of NEA. Hand postures also commonly change over the course of a seizure. Hand posturing during seizures provides unique information and aids in the differential diagnosis and classification of epilepsy.
Disclosure: Dr. Siegel has nothing to disclose. Dr. Tatum has received royalty payments from Demos Publishers.
Thursday, April 21 2016, 3:30 pm-5:30 pm
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