Case
A 30-year-old man presented with a single unprovoked convulsion and a 5-year history of recurrent, severe right-sided flank pain of unclear etiology. Workup over the course of his presentation included multiple subspecialist evaluations, including emergency room visits to rule out nephrolithiasis. Other differentials included dystonia, radiculopathy, and musculoskeletal pathology.
Video EEG (Video 1) captured multiple stereotypic events characterized by the onset of vibrating, painful sensation over the right flank that radiated down to the groin, with associated agitation, restlessness, and hypermotor manifestations (truncal flexion/arching toward the right and repeated right leg extension) followed by abrupt return to baseline. EEG (Figure) showed epileptic seizures with delayed electrographic onset over the left centroparietal region.
Figure. Ictal EEG on Average Montage.
Delayed electrographic onset characterized by rhythmic theta over C3/P3/Cz with evolving sharply contoured activity and repetitive low amplitude spikes.
Seizure semiology as sudden onset, vibrating, painful sensation over the right flank radiating to the groin with associated agitation, restlessness, and hypermotor manifestations.Download Supplementary Video 1 (18.2MB, mp4) via http://dx.doi.org/10.1212/207216_Video_1
Unilateral ictal pain is a rare seizure semiology1 which localizes to the contralateral parietal lobe2 and should be considered as a differential for pain that is abrupt, paroxysmal and stereotypic.
Author Contributions
M.K.C. Dorotan: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data. N. Hayes: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data. S. Tobochnik: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data.
Study Funding
No targeted funding reported.
Disclosure
All authors report no disclosures. Go to Neurology.org/N for full disclosures.
References
- 1.Hwang ST, Goodman T, Stevens SJ. Painful seizures: a review of epileptic ictal pain. Curr Pain Headache Rep. 2019;23(11):83. [DOI] [PubMed] [Google Scholar]
- 2.Siegel AM, Williamson PD, Roberts DW, Thadani VM, Darcey TM. Localized pain associated with seizures originating in the parietal lobe. Epilepsia. 1999;40(7):845-855. [DOI] [PubMed] [Google Scholar]
Associated Data
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Supplementary Materials
Seizure semiology as sudden onset, vibrating, painful sensation over the right flank radiating to the groin with associated agitation, restlessness, and hypermotor manifestations.Download Supplementary Video 1 (18.2MB, mp4) via http://dx.doi.org/10.1212/207216_Video_1