Neurología para Fisioterapeutas. 4ªed Spanish by Cash (Downie)

By Cash (Downie)

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Thus patients suffering from cingulate epilepsy can present with findings that are normally associated with epileptogenic foci in different areas of the brain. Ictal symptoms may include, for instance, somatosensory feelings, absence-like arrest, fear, vocalizations and verbalizations as well as complex (hypermotor) movements. Moreover, electrostimulation of this area in humans can elicit both movements 32 FURTHER READING and feelings of anxiety while in non-human primates it can also elicit vocalizations indicative of alarm or separation anxiety.

Subsequently, right-sided flexion–extension movements occurred. These movements involved the second, third, fourth and fifth digits at the metacarpophalyngeal joints or the entire hand. The movements were usually arrhythmic but were sometimes rhythmic at 1–3 Hz. Movements would intermittently stop for several seconds. The episodes lasted 7–10 minutes and did not occur during sleep. The episodes stopped briefly when the patient’s attention was diverted while performing a left upper extremity task. There was no weakness during or between episodes.

With each spasm, her arms ‘shot up’ and her head dropped forward for 2–5 seconds. She could remain standing during the spasms. Nitrazepam was restarted but was ineffective despite an increase in the dose to clinical toxicity. Valproate was added 2 weeks later. The runs of spasms decreased but did not stop. About the same time she developed brief staring spells several times a day that were associated with speech interruption, odd facial expression, a small grunt and occasional eye deviation to the right with clonic arm movements.

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