Head Bobbing or Nodding Seizures: A Fascinating but Non-specific Sign
Abstract number :
2.41
Submission category :
18. Case Studies (case reports and small series less than 5 subjects will not be accepted)
Year :
2022
Submission ID :
2204867
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:26 AM
Authors :
Lauren Bojarski, DO – University of Kentucky, Lexington KY; Fawad Bilal, MD, FACNS – Owensboro Health; Susan Hollar, EMBA, R.EEG.T – Kentucky Neuroscience Institute, University of Kentucky Lexington KY; Gulam Khan, MD – Department of Neurology – Kentucky Neuroscience Institute, University of Kentucky Lexington KY; Zabeen Mahuwala, MD – Department of Neurology – Kentucky Neuroscience Institute, University of Kentucky Lexington KY; Farhan Mirza, MD – Department of Neurosurgery – Kentucky Neuroscience Institute, University of Kentucky Lexington KY; Heidi Turpin, R.EEG.T – Kentucky Neuroscience Institute, University of Kentucky Lexington KY; Rachel Ward-Mitchell, RN – Kentucky Neuroscience Institute, University of Kentucky Lexington KY; Meriem Bensalem-Owen, MD, FACNS, FANA – Department of Neurology – Kentucky Neuroscience Institute, University of Kentucky Lexington KY
Rationale: Rhythmic head bobbing or nodding is characterized by anteroposterior head movements and can be seen in a variety of conditions. Diagnosis can be challenging as it can be seen with tremors, tics, seizures, or in the context of an infectious illness such as nodding syndrome. We describe six patients who presented with brief recurrent head bobbing events, including one patient with documented focal ictal head bobbing during phase II intracranial monitoring.
Methods: Since 2013, six patients with head nodding seizures were identified. Five patients underwent video-EEG monitoring in the epilepsy monitoring unit, and one had an ambulatory EEG study.
Results: Case 1 is a 27-year-old female with history of a mixed epilepsy (focal and generalized epilepsy) who was referred for clusters of head nodding episodes associated with variable alteration in awareness. These episodes were determined to be epileptic and generalized in nature. Case 2 is a 14-year-old female with global neurodevelopment delay presenting with a one-year history of staring events in association with head bobbing. Her events were determined to be epileptic generalized seizures. Case 3 is a 41-year-old female with longstanding refractory focal epilepsy as well as co-existent psychogenic non-epileptic seizures (PNES). Her head nodding episodes were determined to be epileptic. They were associated with prominent oral automatisms, and were recorded on both scalp video-EEG monitoring and stereo EEG (sEEG) during her pre-surgical evaluation. A typical head nodding seizure was recorded and originated from the right mesial electrodes on sEEG. Case 4 is a 20-year-old male with history of intractable generalized epilepsy, who presented with head nodding events. His events were determined to be generalized seizures. Case 5 is a 23-year-old female with focal epilepsy who presented with new onset brief head nodding events; these were diagnosed as PNES. Case 6 is an 8-year-old female with triple X syndrome and intractable generalized epilepsy whose seizures were associated with head nodding.
Conclusions: Ictal head nodding can be observed in both children and adults. This sign is non-specific as it can be observed in both epileptic (focal or generalized) and non-epileptic psychogenic seizures. It is important to evaluate patients presenting with this infrequent clinical sign with video-EEG monitoring in order to establish a correct diagnosis and provide appropriate management.
Funding: No funding was received in support of this abstract.
Case Studies (case reports and small series less than 5 subjects will not be accepted)