Gyratory seizures revisited: a video-EEG study

Area of Science:

• Neurology
• Epileptology
• Clinical Neuroscience

Background:

• Gyratory seizures (GSs), characterized by body axis rotation (≥180°), are infrequently documented in generalized and focal epilepsies.
• The underlying mechanisms and clinical significance of GSs remain incompletely understood and debated.

Purpose of the Study:

• To comprehensively describe the semiology of gyratory seizures.
• To evaluate the potential of GSs to lateralize and localize the seizure onset zone in patients with epilepsy.

Main Methods:

• Screening of 277 consecutive patients with intractable epilepsy undergoing presurgical evaluation.
• Classification of epilepsy types: temporal lobe epilepsy (TLE), frontal lobe epilepsy (FLE), generalized epilepsies (GE), and extratemporal/multifocal epilepsy.

Main Results:

• Twelve patients experienced 17 seizures with gyratory movements; 8 had FLE and 4 had TLE (p < 0.001).
• In 58% of cases, GSs began with forced head version, followed by rotation contralateral to seizure onset.
• In 42% of cases, GSs lacked preceding head version, with rotation direction indicating the ipsilateral seizure onset zone.

Conclusions:

• GSs demonstrate lateralizing value in focal epilepsy, contingent on seizure evolution.
• GSs initiating with head version lateralize to the contralateral hemisphere; those without head version lateralize ipsilaterally.
• GSs are more prevalent in FLE than TLE; they were not observed in the studied GE patients.