Hippus pupil12/30/2023 ![]() Closely-spaced electrodes 10-10 were placed in posterior regions. These changes are followed (2–5 seconds latter) by bilateral pupillary hippus. The first EEG change is a high frequency activity (20 Hz) recorded from electrodes TP8, O2, PO4 and T6, followed 4 seconds later by stereotyped 8 seconds run of rhythmic slow activity, maximal in the posterior region with right sided emphasis. Seizure with display of right EEG channels. The main feature in the interictal EEG was right posterior hemisphere bursts of rhythmic sharpened discharge. ![]() With a delay of 2–5 s from the disappearance of the electrical changes, hippus became evident, lasting between 50 and 70 s. Scalp EEG for all seizures showed, a few seconds after onset of aura, a high frequency discharge over the right posterior temporoparietal and occipital regions, followed by a run of high-amplitude paroxysmal slow activity with similar but slightly more extensive distribution ( Fig. 1). There were no other autonomic features such as skin color or heart rate changes. The patient maintained consciousness throughout, and no other eye signs were evident. Hippus affected both pupils synchronously and manifested as a few cycles of slow irregular constriction/dilatation (Video S1). Bilateral pupillary hippus was then evident. The patient had a nonspecific experiential aura lasting several seconds. Illumination in the room was constant throughout the study. Further daytime EEG-videotelemetry with closely spaced electrodes in the posterior regions (10-10 electrode placement) was performed. Neuropsychological assessment showed only mildly inefficient verbal learning and reduced verbal fluency.ĭuring the admission, electroencephalography (EEG)–telemetry with standard 10-20 electrode placement showed no EEG changes during seizures. No other abnormalities of the skin, mucosa, nails, teeth, cornea, or retina were detected. ![]() There were multiple hypopigmented patches over her back and legs. ![]() She has no other relevant personal or familial medical antecedent, except that her father had tiny hypopigmented areas. Despite various antiepileptic medications, seizures continued at an average frequency of seven per day. The seizures last 30–90 s followed by immediate recovery. Witnesses have noticed her pupils constrict and dilate during a seizure. During these episodes, consciousness is preserved, but the patient describes difficulty in concentrating during a conversation. There are no other accompanying visual symptoms such as hallucinations or photopsia. They begin with a nonspecific experiential aura followed by what she describes as fluctuating changes in her perception of brightness and blurred vision. The patient started to have stereotyped seizures at the age of 9. Case ReportĪ 27-year-old right-handed woman was admitted for evaluation of drug-resistant epilepsy. Herein we present this unusual autonomic epileptic semiology. In particular, monophasic unilateral or bilateral changes in pupillary diameter have been reported to be triggered by seizures ( Muller-Jensen & Hagenah, 1978 Gadoth et al., 1981), but long-lasting pupillary diameter oscillation as the key feature of an epileptic seizure has not been described in the modern literature. Vegetative responses are commonly present during and following epileptic seizures.
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