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Abstract
Objective: To evaluate and identify the frequency of hand postures during generalized convulsions in patients with genetic generalized epilepsy (GGE), localization-related epilepsy (LRE), and nonepileptic attacks (NEA).
Methods: We retrospectively analyzed 98 consecutive videos of generalized convulsions in 62 patients who were admitted for diagnostic video-EEG monitoring. Demographics were recorded, and hand postures were subdivided into fanning, fisting, index-finger pointing (IFP), clawing, and flaccid posturing. Hand postures were then compared between patients with GGE, LRE, and NEA for each stage of the convulsion and for the whole event.
Results: In patients with LRE, 96% had IFP, where fanning occurred in 91.3% of GGE (and only at onset), and the flaccid hand posture occurred in 56.0% of NEA. Fisting, fanning, and IFP postures all occurred significantly more frequently during epileptic seizures than during NEA (74.0% vs 32.0%, p = 0.0003; 60.3% vs 20.0%, p = 0.0005; 83.6% vs 12.0%, p < 0.0001). The claw hand posture was present only during NEA, and the flaccid posture occurred significantly more frequently during NEA than during epileptic seizures (56.0% vs 15.1%, p = 0.0001).
Conclusions: Distinct ictal hand or finger posturing is present in patients with GGE, LRE, and NEA. The presence of any fisting, fanning, clawing, IFP, or flaccid hand posturing can help distinguish epileptic seizures from NEA. IFP suggests LRE while fanning with evolution suggests GGE. Overall, hand posturing during seizures provides unique information and aids in the differential diagnosis and classification of epilepsy.
GLOSSARY
- EMU=
- Epilepsy Monitoring Unit;
- GGE=
- genetic generalized epilepsy;
- GTCS=
- generalized tonic-clonic seizures;
- IFP=
- index-finger pointing;
- IP=
- interphalangeal;
- LRE=
- localization-related epilepsy;
- MCP=
- metacarpophalangeal;
- NEA=
- nonepileptic attacks;
- PPV=
- positive predictive value;
- VEM=
- video-EEG monitoring
Footnotes
This manuscript was presented in abstract form at the American Clinical Neurophysiology Society annual meeting on February 13, 2016, as well as the epilepsy plenary session at the American Academy of Neurology annual meeting in Vancouver, Canada, on April 21, 2016.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received February 25, 2016.
- Accepted in final form July 7, 2016.
- © 2016 American Academy of Neurology
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Letters: Rapid online correspondence
- Response to Dr. Mintzer
- Statistical analysis
- Author Response to Dr. Lanska
- Hand postures during convulsions
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