Abstracts

Rationale: Bruxism refers to the involuntary rhythmic grinding of teeth, typically from sleep. Ictal bruxism is a rare form of oroalimentary automatism. To our knowledge, prior documentation of ictal bruxism is limited to three case reports. We report the case of a patient with ictal bruxism who underwent telemetry EEG monitoring in our unit, whose ictal EEG recordings showed a highly distinctive checkerboard-like pattern. We review the existing literature regarding ictal bruxism and discuss potential underlying physiological mechanisms.

Methods: We report the clinical case of a 32-year-old right handed gentleman with non-lesional drug resistant temporal lobe epilepsy who was admitted to our Epilepsy Monitoring Unit to undergo telemetry EEG monitoring as part of a pre-surgical evaluation. A number of clinical events were recorded, with associated EEG changes, in which teeth grinding was a prominent feature. The bruxism was shown to rhythmically alternate between left-sided and right-sided predominance. A distinctive pattern of muscle artefact produced as a result of teeth grinding is evident in the EEG recording, alternating rhythmically from left to right.

Results: Our case illustrates a clear example of ictal bruxism with a highly characteristic EEG pattern. To date, all documented cases of ictal bruxism have occurred in patients with temporal lobe epilepsy. Bruxism may be useful as a localising but not as a lateralising sign. There are a number of features that may be useful in distinguishing ictal bruxism from other causes of nocturnal teeth grinding. Possible underlying mechanisms include deactivation of inhibitory neocortical areas such as the cingulated or frontonasal regions, or masticatory central pattern generator in the brainstem.

Conclusions: Ictal bruxism is a rare clinical phenomenon which may be useful as a localising, but not lateralising sign in temporal lobe epilepsy.

Funding: Please list any funding that was received in support of this abstract.: Not applicable.