Unusual Case of Epilepsy with Akinetic and Tonic Seizures induced by Movement

Abstract

CASE REPORTA case of an extremely rare form of reflex epilepsy is patient H.C., 22 years old, female, born at full term; delivery was normal. Her development has been normal. She has had no severe disease or head injury in her history; and started to menstruate at the age of 15. At age 16 she had two typical grand ma1 seizures with tongue biting. Since the age of 18 years she has been suffering from attacks of a sudden weakening of the extremities occurring always at the initial phase of any kind of rapid locomotor movement, particularly when following rest. Arising rapidly from a chair, starting suddenly to walk or to dance, or even abruptly increasing the pace of movement may induce the attack. With the onset of the seizure the patient has an ill-defined sensation, lasting only a fraction of a second, described as a feeling of stiffness or tension at first in one leg and then extending to one side of the body. This is followed by the weakness of the extremities of the same side. The leg becomes powerless as if it were of "cotton wool" or "sponge"; the upper extremity becomes limp. Sometimes the seizure is more severe, irivolving one upper and both lower extremities and causing a fall which is not abrupt since the weakness develops gradually. The weakness quickly disappears and then the patient is able to stand up and continue her .walk. The duration of the whole attack does not exceed several seconds. If the attack is less severe the patient does not fall, but leans toward the opposite, uninvolved side. The abortive form of the attack consists only of the feeling of "spasm" in one leg. Both sides of the body may be alternately involved, although seizures of the right side are more frequent, and the patient is not able to tell what it depends on.She has never lost consciousness nor hurt herself when falling. She has usually up to a dozen fits daily; initially they were less frequent. They occur more often before the menstrual period and also if the patient fails to take her anticonvulsive drugs.Movement of gradually inc:easing speed is not likely to induce the seizure; emotional stimuli, even very intense ones never provoke them.At the ward, several seizures were observed which were induced by the patient's rising rapidly from a chair on order, and their appearance was in accordance with the description given above. 7 (1 966) 233-237 Epilepsia,