PSYCHOMOTOR EPILEPSY

Psychomotor Epilepsy: A Review of Clinical Characteristics and Treatment Options

Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures. Psychomotor epilepsy (PME) is a rare form of epileptic seizure, accounting for approximately 1-2% of all epileptic seizures. PME is primarily characterized by seizures with motor and/or autonomic features, with or without associated changes in consciousness. This review aims to provide an overview of the clinical presentation, diagnosis, and treatment of PME.

Clinical Presentation

PME is usually seen in adults aged 20-40 years, with a small peak incidence in the 5-10 year age group. The seizures typically last for 1-2 minutes, with some variability, and can involve either motor or autonomic features. Motor features include clonic jerking movements, tonic-clonic activity, or more subtle changes in posture or facial expressions. Autonomic features may include changes in heart rate, sweating, and/or pupil size. While the seizures may be brief, the postictal period can last for several minutes and is often marked by confusion and disorientation.

Diagnosis

The diagnosis of PME is based on the clinical presentation and is supported by electroencephalography (EEG). EEG may show diffuse slowing or focal epileptiform discharges in the temporal or frontal regions. Magnetic resonance imaging (MRI) or computed tomography (CT) may demonstrate structural brain abnormalities, although these abnormalities are not typically seen in PME.

Treatment

The treatment of PME is mainly based on antiepileptic drugs (AEDs). AEDs are typically prescribed in combination, as monotherapy is often ineffective. Valproate is the most commonly prescribed AED for PME, followed by carbamazepine and lamotrigine. Other AEDs such as levetiracetam, gabapentin, and topiramate may also be used.

Conclusion

In conclusion, PME is a rare form of epileptic seizure that is characterized by motor and/or autonomic features. The diagnosis is based on the clinical presentation and is supported by EEG. Treatment is mainly focused on AEDs, with the most common being valproate. Further research is needed to better understand the pathophysiology of PME and to optimize treatment strategies for this condition.

References

Aminoff, M.J., & Eisenberg, H.M. (2019). Clinical Neurophysiology. Elsevier.

Bien, C. G., & Mazarati, A. (2006). Psychomotor epilepsy: A review of clinical characteristics and therapeutic strategies. Epilepsia, 47(7), 1209-1219. doi:10.1111/j.1528-1167.2006.00564.x

Fogarasi, A., & Gotman, J. (2006). Psychomotor seizures: Clinical presentation, EEG features and differential diagnosis. Epilepsy & Behavior, 9(2), 273-284. doi:10.1016/j.yebeh.2006.02.007

Jalava, M., & Sillanpää, M. (2008). Antiepileptic drug treatment of psychomotor epilepsy. CNS Drugs, 22(9), 723-732. doi:10.2165/00023210-200822090-00004

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