Bicycling movements as a manifestation of complex partial seizures of temporal lobe origin

Alternating movements of the limbs during a seizure, especially bicycling movements of the legs, are often taken as strong evidence for the psychogenic origin of seizure activity in an adult population. A recent review of pseudoseizure manifestations concluded that alternating limb movements were "highly characteristic of pseudoseizures." We report two adult patients with complex partial seizures of temporal lobe origin, confirmed by ictal video EEG recording, in whom bicycling movements were the prominent ictal manifestation. Bicycling occurred 5-30 s after ictal onset and lasted 15-30 s. Use of video EEG recording continues to increase our understanding of the wide range of behaviors which may occur in the course of an epileptic seizure, particularly complex partial seizures. Few absolute clinical criteria remain to distinguish epileptic seizures from pseudoseizures. These two cases and one other reported case clearly remove bicycling movements from that category.