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Logo of neurologyNeurologyAmerican Academy of Neurology
Neurology. 2009 March 24; 72(12): e56.
PMCID: PMC2677473

Teaching Video NeuroImages: Preserved awareness in a frontal seizure with bilateral motor involvement

A psychogenic mimic
Section Editor: Section Editor Mitchell S.V. Elkind, MD, MS

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 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.

figure znl0120964130001
Figure EEGs with still frame from video and MRI


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.

Supplementary Material


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 lim.fa.dnalkcal@heish.divad

Supplemental data at

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.


1. Fried I, Katz A, McCarthy G, et al. Functional organization of human supplementary motor cortex studied by electrical stimulation. J Neurosci 1991;11:3656–3666. [PubMed]
2. Kanner AM, Morris HH, Luders H, et al. Supplementary motor seizures mimicking pseudoseizures: some clinical differences. Neurology 1990;40:1404–1407. [PubMed]

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