Case
A 7-year-old right-handed boy with tuberous sclerosis complex and focal epilepsy presented with new episodes of exercise-induced full body tonic posturing, whimpering, and preserved awareness. He underwent video-EEG investigation where he had a representative seizure after vigorous pedaling on a stationary bike associated with bitemporal (left more than right) ictal correlate (Video 1). Brain MRI demonstrated stability of his cortical tubers, none with temporal topography. Exercise-induced seizures are a rare form of reflex epilepsy.1 Available data suggest these seizures typically localize to the temporal region (left more commonly than right) and tend to be refractory to treatment, depending on the etiology.2 The mechanisms of epileptogenesis in TSC are presumed to be related to the neuropathologic features of the disorder, including cortical tubers and other dysgenesis.3
Video 1
Video-EEG Shows 1 Exercise-Induced Electroclinical Seizure [Sensitivity 20 uV/mm, LF 1 Hz, HFF 70 Hz, notch 60 Hz].
While cycling vigorously, the patient leans forward, extends his right arm, flexes his left arm and whimpers until the seizure ends. Electrographically, there was low-voltage fast activity, followed by rhythmic 50–100 uV 4–6 Hz uV sharply contoured activity at T3/T5 more than T4/T6 with evolution in morphology, frequency, and location.Download Supplementary Video 1 via http://dx.doi.org/10.1212/013216_Video_1
Study Funding
The authors report no targeted funding.
Disclosure
F. Nascimento is a member of the Neurology Resident and Fellow Section Editorial Board. J. McLaren and E. Thiele report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Appendix Authors
Footnotes
Go to Neurology.org/N for full disclosures.
↵* These authors contributed equally as first authors.
Teaching slides links.lww.com/WNL/B710
- © 2021 American Academy of Neurology
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