A case of frontal lobe seizures with 'dancing-like' semiology

Abstract

Background and purpose: 'Dancing-like' semiology is extremely rare and described in few case reports. It is characterized by rhythmic, oscillatory movements of the pelvis and/or limbs during which the subject appears to be dancing. It has been associated with both the frontal and temporal epileptic zone; however, the possible network involved in these fascinating seizures is unclear.

Methods: The case of a 45-year-old woman suffering from drug-resistant focal epilepsy with multi-day seizures of bizarre semiology is described. A structural and perfusion magnetic resonance imaging study (interictal and peri-ictal) and video-electroencephalograms were carried out, and several home videos were employed. A vagal stimulator was implanted.

Results: Home videos documented the 'dancing' semiology of seizures better than video- electroencephalogram recordings. The imaging study revealed a focal frontal polymicrogyria with a peri-ictal cerebral blood flow increase at the perisylvian lesion foci. The combination of add-on cenobamate and vagal nerve stimulation resulted in complete seizure freedom.

Conclusion: The unusual and complex dancing-like semiology observed during our patient's seizures adds to the repertoire of fascinating complex motor manifestations of frontal lobe epilepsy.

Keywords: complex motor behaviour; dancing semiology; dancing‐like seizures; frontal lobe seizures; frontal polymicrogyria.

FIGURE 1

Axial (a) and parasagittal (b) MRI T1‐weighted multi‐planar reconstruction gradient‐echo (MPRGE) well depict the thick and irregularly bumpy course of right perysilvian polymicrogyria (red arrows). Interictal (c) and peri‐ictal (d) pseudo‐continuous arterial spin labelling/T1 MPRGE fusion MRI image. Note the segmental, intralesional increase in cerebral blood flow, due to hyperperfusion (red arrow, green cortex in (d)). Interictal EEGs show interictal epileptiform anomalies with no clearly localized sharp waves, which appear to be prevalent in right centro‐temporal‐frontal regions (e), sometimes presenting as bilateral synchronous high amplitude slow spike and wave bursts over both hemispheres (f).