Stereotyped Post-ictal Texting Behavior as a Potential Biomarker in a Case of Drug-resistant Focal Epilepsy
Abstract number :
3.317
Submission category :
4. Clinical Epilepsy / 4B. Clinical Diagnosis
Year :
2024
Submission ID :
144
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Luca Micci, MD – Walter Reed National Military Medical Center
Angelica Lee, DO, MS – Uniformed Services University of the Health Sciences
Rationale: To describe a patient with an atypical post-ictal behavior following focal onset impaired awareness behavioral arrest epileptic seizures.
Methods: Case Report
Results: A 34-year-old active-duty woman was admitted to the epilepsy monitoring unit for characterization of her spells. She had experienced her first unprovoked seizure 8 weeks prior, followed by numerous focal seizures described as behavioral arrest, right-hand automatisms, vocalizations, and lip-smacking. These episodes were followed by 10-20 minutes of disorientation and retrograde amnesia. During her post-ictal confusion, the patient would send a text message to the same three individuals on her phone: “What is your home address?”. This patient would go on to have two focal spells during her hospitalization, during which she exhibited the same stereotyped ictal spell followed by the same post-ictal text message to the same three phone contacts.
The patient was started on Vimpat and Trileptal but continued to have weekly breakthrough focal seizures, as evidenced by the recurring post-ictal texting behavior. When attempting to quantify the number of seizures on her anti-seizure medication, she would refer to her phone and count the number of instances she had sent the same text message as before, of which some were witnessed by family and correlated with her text message instances.
She is now undergoing evaluation for epilepsy surgery at the NIH.
Conclusions: This case highlights a unique post-ictal behavior of repetitively texting the same contacts for the patient's home address. This behavior appears to be a reliable marker of the patient's ongoing focal seizures and may serve as a useful biomarker to track her response to treatment. A literature review demonstrates that texting behavior has never been reported in relation to ictal or post-ictal processes. Although there have been reports of patterns associated with texting, this is the first time such behavior has been documented in the literature. The patient is scheduled for surgical evaluation, and if a focus is identified, it could provide valuable information about the underlying seizure focus. Additionally, it could potentially serve as a biomarker to track seizure activity and response to surgical treatment.
Funding: N/A
Clinical Epilepsy