Abstracts

Rationale: Automatisms are a common clinical manifestation in focal seizures; varying degrees of automatisms exist, from simple gestures to more complex behaviors. The aim of this study is to describe the semiology and localization of two different types of religious automatisms and to review the existing literature describing religious ictal behavior.   Methods: We identified two patients with religious automatisms who were evaluated at our level 4 comprehensive epilepsy center. We reviewed the following data: age, sex, religion, age at onset of epilepsy, seizure frequency, scalp ictal EEG onset, seizure semiology, and brain MRI results. We then reviewed existing literature describing religious ictal manifestations.  Results: One patient is a 40 year old right handed African American Catholic female with refractory epilepsy since age 26; her seizure semiology consisted of behavioral arrest, sniffing, and repetitively making the sign of the cross with her right hand.  MRI showed right mesial temporal sclerosis. LTVM revealed right temporal seizure onsets and right temporal interictal discharges. The other patient is a 30 year old right handed Iranian Muslim man with refractory epilepsy since age 24. His seizures consisted of an aura of stomach tightness, followed by behavioral arrest, prostration, and hypermotor movements. LTVM revealed right temporal seizure onsets and right temporal interictal discharges. MRI was unremarkable. Conclusions: The mesial temporal structures, as part of the limbic system, mediate emotional experiences; it is thought that these structures are also responsible for the cognitive component of religious experiences. Both of our patients with religious automatisms had non-dominant mesial temporal lobe seizure onsets, similar to cases described previously in the literature. A case series of patients who did the sign of the cross during seizures reported right (non-dominant) mesial temporal onset in four patients(1). Another case series described 12 patients who performed ictal religious Islamic speech and gestures; all patients had seizure onsets in the right (non-dominant) temporal region.(2)  Prostration, a vital part of daily prayers performed by Muslims, has not been previously described as an ictal automatism in the literature; during prostration, Muslims place their bodies in a submissive prone position.  Our patient clearly demonstrated prostration at the onset of his seizures. Both patients in our series performed religious automatisms in the faith to which they belonged, and both patients described themselves as religious. These findings are consistent with the hypothesis that the mesial temporal structures, from which our patients' seizures originated, are linked to religious experiences.References1.              Lin K, Marx C, Caboclo LO, Centeno RS, Sakamoto AC, Yacubian EM. Sign of the Cross (Signum Crucis): observation of an uncommon ictal manifestation of mesial temporal lobe epilepsy. Epilepsy Behav. 2009;14(2):400-3.2.              Vural G, Irsel Tezer F, Saygi S. Ictal movements mimicking Islamic praying rituals: localizing value in a series of 12 patients. Epilepsy Behav. 2015;53:92-7. Funding: N/A