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Epilepsia cursive
The Forgotten Running Fits
Franz-Josef Holzer; Pierre R. Burkhard, Theodor Landis
Department of Neurology, University Hospital Geneva, Switzerland
Temporal lobe epilepsy features a wide variety of clinical manifestations. Some of them are considered to be of psychogenic origin. Motor manifestations like blinking, mastication or gesticulation are common and easily identified. Even the more complex activity of walking during a non-convulsive status is well documented. However, running as an ictal manifestation of temporal lobe epilepsy is uncommon and probably often unrecognised. We report a new case, which illustrates the typical features of the so-called running fits.
In 1985, this 45-year-old right-handed healthy accountant developed left sensory seizures leading to the diagnosis of a right parietal tumor confirmed by biopsy as an astrocytoma grade 2.
Over the next years, the patient progressively developed a sensorimotor deficit of the left hemibody, occassionally accompanied by involuntary forced closure of the right eyelid.
CT scan and MRI showed progression of the tumor size with extension into the frontotemporal regions (fig. l), and a second biopsy confirmed transformation into grade 3. Clonazepam was introduced as anticonvulsive medication, and loco-regional radiotherapy led to a significant reduction of the tumor size, an improvement of the left hemisyndrome and the seizure frequency.
In August 1997, 4 months prior to admission, he complained about unsteadiness and gait difficulties. Two months later, the first running episode occurred. While walking his dog he suddenly felt an irrepressible urge to run which could not be suppressed by will and which was indeed followed by an involuntary run around the nearby building. Although partially capable of directing his way, he first bumped into the main entrance of the building, then against the mailboxes. Still continuing his run he escalated a flight of stairs toward the second floor where he hit the banisters and finally the entry door of his apartment where the run stopped abruptly. This episode...