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Illusory shadow person causing paradoxical gaze deviations during temporal lobe seizures
  1. M Zijlmans1,
  2. P van Eijsden2,
  3. C H Ferrier1,
  4. K H Kho2,
  5. P C van Rijen,
  6. F S S Leijten1
  1. 1
    Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands
  2. 2
    Department of Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands
  1. Dr M Zijlmans, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; g.j.m.zijlmans{at}umcutrecht.nl

Abstract

Generally, activation of the frontal eye field during seizures can cause versive (forced) gaze deviation, while non-versive head deviation is hypothesised to result from ictal neglect after inactivation of the ipsilateral temporo-parietal area. Almost all non-versive head deviations occurring during temporal lobe seizures are directed to the side of seizure onset, so in derogatory cases it is worth while explaining the paradoxical event. We present a patient with a paradoxical direction of gaze deviation during temporal lobe seizures with an unexpected explanation. Electrocortical stimulation of the temporo-parieto-occipital junction elicited an irrepressible urge to look towards an illusory shadow person besides the patient. Paradoxical non-versive gaze deviations in temporal lobe seizures may be due to illusory experiences masked by postictal amnesia.

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