Ictal hemiparesis: differentiation from stroke

This is a clinical analysis of four patients who presented with recurrent episodes of weakness on one side, feeling of heaviness, numbness, and inability to walk. Admission diagnosis was transient ischemic attacks in three patients and hemiplegic migraine in one patient. Attacks persisted for few minutes to few hours and were stereotyped for each patient and never became generalized during the course of the disease. Electroencephalography showed focal slowing and epileptiform discharges over parietal region. All patients responded dramatically to antiepileptic therapy. This is the first case report of ictal hemiparesis from this part of country.