Volvular epilepsy. A distinctive and underreported seizure type

Area of Science:

• Neurology
• Epileptology

Background:

• Volvular seizures, characterized by repetitive circular walking, are an underrecognized seizure type.
• These seizures can manifest as the entirety of an epileptic attack or precede generalized tonic-clonic seizures.

Observation:

• The described phenomenon involves patients walking repetitively in small circles.
• The direction of rotation can be ipsiversive or contraversive relative to the epileptic focus.

Findings:

• Volvular seizures may arise from primary epilepsy or secondary to focal intracranial pathology.
• Involvement of the striatum is a potential underlying mechanism for this seizure type.
• Four illustrative cases of volvular seizures are presented.

Implications:

• Recognizing volvular seizures as a distinct entity is crucial for accurate diagnosis and management.
• Further research into the neurobiological underpinnings, particularly striatal involvement, is warranted.
• Increased awareness may lead to better identification and reporting of this underdiagnosed seizure phenomenon.