A teenager who would intermittently rotate around himself for 1 minute
1. 15-year-old Raju was referred for evaluation of unusual behavior. For past one year, he would start rotating around his own body axis in full circles. This would go on for one minute and would stop on own.
1. 15-year-old Raju was referred for evaluation of unusual behavior. For past one year, he would start rotating around his own body axis in full circles. This would go on for one minute and would stop on own.
2. He would remain fully conscious during these episodes, but was unable to control them. He was seen by a neurologist elsewhere. Brain scan and EEG were normal. He was empirically treated for possible #epilepsy, with no benefit.
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3. He was then thought to be suffering from conversion disorder (hysteria) and referred to psychiatrist. Psychiatrist ruled out any psychopathology and requested our opinion. While in the OPD, I witnessed an episode.
4. All of a sudden, Raju stood up from his chair and started rotating in leftward direction around his body axis. This lasted for one minute, during which he also involuntarily passed urine. He was fully conscious though. The diagnosis was obvious now.
5. We were dealing with rotatory seizures (also called circling or gyratory seizures). The origin of these epilepsies are often in frontal lobe of brain.
Long-term video EEG confirmed the localization of epileptiform activity to right frontal lobe.
Long-term video EEG confirmed the localization of epileptiform activity to right frontal lobe.
6. He was started on another anti-seizure drug at appropriate dose. Parents were counselled about the disease and treatment. At one-month and six-month reviews, Raju remained symptom free and had no further episodes of rotatory movements.
7. Rotatory seizures due to right frontal calcified lesion (possible tapeworm infection) was reported by one of our seniors Dr T P Joseph in 1993.
doi.org
doi.org
8. Neurologists from AIIMS, New Delhi reported unidirectional whole body turning in 13 patients due to temporal lobe origin complex partial seizure in 2005.
dx.doi.org
dx.doi.org
9. There are other reports of transient, episodic rotatory movements of body due to tumor or infarcts (blood clots) in frontal lobe or cerebral venous sinus thrombosis-related clots in temporal lobe.
10. Take home message
*Episodes of body rotation and turning in circles could be a sign of epilepsy.
*Routine scalp EEG may be normal. Long-term video EEG may be helpful in confirming diagnosis.
*Medical therapy works in most. In some cases, surgery may be needed.
*Episodes of body rotation and turning in circles could be a sign of epilepsy.
*Routine scalp EEG may be normal. Long-term video EEG may be helpful in confirming diagnosis.
*Medical therapy works in most. In some cases, surgery may be needed.
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