Ipsilateral blinking seizures during left fronto-temporal ictal pattern on scalp EEG

Area of Science:

• Pediatric Neurology
• Epileptology
• Neurophysiology

Background:

• Communicating hydrocephalus is often treated with ventriculo-peritoneal shunts.
• Epileptogenic lesions can arise secondary to medical interventions, including shunt placement.
• Understanding seizure semiology is crucial for localizing the epileptogenic zone.

Observation:

• An infant presented with left eye blinking seizures.
• Scalp electroencephalography (EEG) revealed a left fronto-temporal ictal pattern.
• The underlying cause was identified as left frontal encephalomalacia adjacent to a ventriculo-peritoneal shunt tract.

Findings:

• The unilateral blinking seizures were ipsilateral to the EEG ictal pattern and the lesion.
• This suggests that ictal blinking has lateralizing value in localizing seizure onset.
• The findings support the hypothesis that blinking seizures involve activation of ipsilateral trigeminal pathways or the cerebellum.

Implications:

• Ictal blinking can serve as a useful clinical sign for lateralizing seizure origin in infants.
• This case highlights a potential complication of ventriculo-peritoneal shunts, leading to focal epilepsy.
• Further research into the neurophysiological mechanisms of blinking seizures is warranted.