Illusory shadow person causing paradoxical gaze deviations during temporal lobe seizures
- 1Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands
- 2Department of Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands
- Dr M Zijlmans, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; g.j.m.zijlmans{at}umcutrecht.nl
- Received 20 May 2008
- Revised 21 July 2008
- Accepted 6 August 2008
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.
Footnotes
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A video is published online only at http://jnnp.bmj.com/content/vol80/issue6
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Competing interests: None.
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Patient consent: Obtained.
