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An 8-year-old boy with suspected psychogenic seizures was admitted for video-EEG monitoring. A stereotypical spell manifested as bilateral swinging extremity movements, and the patient proclaimed, “I’m doing the disco!” (video on the Neurology® Web site at www.neurology.org). Right frontal-central rhythmic, sharp, fast activity (figure, A and B) was observed. MRI revealed seizure-related right frontal primary motor cortex hyperintense signal (figure, C) near the supplementary motor area (SMA). Bilateral motor involvement rarely allows patients to smile and joke, but seizures involving the SMA1 are an exception. Although bilateral tonic contraction in abduction of the upper extremities is reported to be specific for SMA seizures,2 video-EEG monitoring is needed for confirmation.
The authors thank Linda Barrett, Ozzie Rivera, and Douglas Souris in the CNMC EEG laboratory for technical assistance and Kim Miller, 37th Training Wing Public Affairs Media.
Address correspondence and reprint requests to Dr. David T. Hsieh, Division of Child Neurology, San Antonio Military Medical Center, 2200 Bergquist Drive, Ste. 1, Wilford Hall Medical Center, Lackland AFB, TX 78236 firstname.lastname@example.org
Supplemental data at www.neurology.org
The views expressed in this article are those of the authors and do not reflect the official policy or position of the United States Air Force, Department of Defense, or the US Government.
Disclosure: The authors report no disclosures.