Video-EEG analysis of ictal repetitive grasping in "frontal-hyperkinetic" seizures

The aim of this study was to obtain a qualitative and quantitative description of the phenomenon of forced prehension during epileptic seizures (ictal grasping- IG) with hyperkinetic semiology. We analysed retrospectively the presurgical, video-EEG recordings of 35 "frontal hyperkinetic" seizures (FHS) in 14 patients (age range: 9-48 years) evaluating the features of ictal grasping by means of off-line, frame-by-frame video-analysis. Ictal grasping was observed in 97.1% of the frontal hyperkinetic seizures in 100% of the patients, with a mean latency of 3.2 seconds with respect to seizure-onset; a mean number of 7.7 IG per seizure were detected. During the same FHS, both arms could perform IG in an alternating fashion. Grasping was usually preceded by a reaching movement and followed by holding or pulling. The sites of prehension were restricted to relatively few sectors, either on the patient's body (45.5%) or the peri-personal space (54.5%). In some cases, the grasping was elicited by hand touching. We did not find a consistent relationship between side of hand grasping and side of ictal EEG discharge or MRI lesion. In conclusion, ictal grasping is an extremely frequent clinical manifestation during FHS. It was an early, forced and repetitive motor behavior, without a clear lateralizing value. Ictal grasping appeared with consistent semiological features, similar to voluntary prehension, suggesting a probable ictal release of physiological grasping behavior. [Published with video sequences].