Rotatory Seizures

Abstract

Scientific background and OBJECTIVE: Rotatory seizures (RSs) are characterized by a rotation around the body axis during a seizure for at least 180 degrees. Here, we aim to describe a case of RSs and to discuss RSs in the classification of epilepsies and possible mechanisms of RSs.

CASE: In the first admission, she had seizures of 5 to 8 rotation of body with deviation of head and eyes to right. Movement of right hand to the mouth preceded each time. Duration of episodes was in 15 to 25 sc, they repeated up to 15 times a day. She rarely had short episodes of deviation of eyes to the right and twitching of right side of mouth. Ictal EEG showed spike and wave discharges which started from left frontal region and generalized. MRI revealed possible cortical dysplasia on left superior frontal gyrus. Seizures disappeared by combination of valproic acid and levetiracetam. She does not have any seizures since six months and her psychomotor development is normal.

CONCLUSION: When it was described firstly, RSs were suggested to originate from focal cerebral lesions, however, in time they were reported in partial epilepsies without lesion or idiopathic generalized epilepsies. Pathogenesis is not yet explained, however, there are studies indicating frontal lobe, basal ganglions and vestibular cortex. Prognosis of RSs in partial epilepsies without lesion or idiopathic generalized epilepsies may be favorable, whereas, in resistant symptomatic cases surgery may be an alternative approach. We did not plan surgical approach since seizures are disappeared by medical treatment and she is being followed clinically and radiologically.