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Electroclinical analysis of postictal noserubbing
1Division of Neurology, University Health Network, Toronto Western Hospital, University of Toronto, Ontario, Canada.
Summary
Postictal noserubbing (PIN) is a reliable indicator of temporal lobe epilepsy seizure onset, especially when it occurs on the same side as the seizure. PIN
Area of Science:
- Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Postictal noserubbing (PIN) is a recognized, though not perfect, sign for lateralizing and localizing partial seizures in epilepsy.
- Its occurrence may be linked to autonomic nervous system activation during seizures.
Purpose of the Study:
- To prospectively investigate postictal noserubbing (PIN) in patients undergoing video-electroencephalogram (EEG) monitoring.
- To correlate the laterality of PIN with electrographic seizure onset, spread, and termination points.
Main Methods:
- Prospective study of consecutive epilepsy patients during video-EEG monitoring.
- Correlation of PIN laterality with EEG-documented seizure onset, interhemispheric spread, and termination.
- Analysis of PIN occurrence in temporal vs. extratemporal epilepsy and in nonepileptic events.
Main Results:
- PIN was significantly more frequent in temporal lobe epilepsy (56%) than extratemporal epilepsy (12%).
- The hand used for PIN was ipsilateral to seizure onset in 83% of cases.
- PIN correlated with seizure spread to temporal lobe structures, particularly the amygdala, and was absent in nonepileptic events.
Conclusions:
- PIN is confirmed as a strong indicator of ipsilateral temporal lobe seizure onset.
- Deviations in PIN lateralization suggest seizure spread to contralateral or ipsilateral temporal lobe structures.
- Amygdala involvement appears crucial for PIN induction.