John Libbey Eurotext

Epileptic Disorders

The Educational Journal of the

Rotatory seizures are not as rare as described Volume 2, issue 2, Juin 2000

Hacettepe University Hospitals, Department of Neurology, 06100 Ankara, Turkey
  • Page(s) : 129
  • Published in: 2000

Rotatory seizures, during which patients turn around their axis one or more times are also known as circling seizures, volvular seizures or gyratory seizures. They are not as rare as described by Ramelli et al. [1]. We previously reported 12 cases with circling seizures and emphasised that these types of seizures may occur in different epileptic syndromes and epilepsies: symptomatic partial epilepsy, cryptogenic partial epilepsy and idiopathic generalised epilepsy [2]. Pathologies underlying the symptomatic partial epilepsy cases were also diverse: grade 3 astrocytoma, oligodendroglioma, infarction and trauma. Turning direction did not show lateralizing value in our patients with symptomatic partial epilepsy. It is also known that head turning has no lateralizing value in adversive seizures [3]. Recently we reported the occurrence of circling seizures in a case of Wilson’s disease and proposed a reasonable explanation for development of this type of movements in relation to the cortico-basal ganglionic-thalamo-cortical circuit [4]. Vercueil et al. also suggested that basal ganglia involvement was a necessary part of the mechanism of rotational seizures [5]. Besides our reported 13 cases, we know from the literature that there are at least two additional reports [6-7]. We would like to draw attention to the fact that reviews of the literature on this subject do not include all of the relevant publications. Since 1996, we have observed an additional five cases of circling seizures. Three of them demonstrated other types of seizures in addition to circling seizures: complex-partial, myoclonic and generalised tonic-clonic. According to ILAE classification [8], two of them had idiopathic generalised epilepsy (one patient has juvenile myoclonic epilepsy), two patients had symptomatic partial epilepsy and one had cryptogenic partial epilepsy with a right frontal epileptic focus. One of the symptomatic, partial epilepsy cases had left hippocampal sclerosis and the other had bilateral frontal and left temporal gliotic lesions. Finally we would like to emphasise the interesting features of circling seizures. Firstly, frequent involvement of structures, which constitute the cortico-basal ganglionic-thalamo-cortical circuit, and characteristics of the behaviour suggest an imbalance in this circuit, as a cause of the circling behaviour; secondly, because circling may constitute the only ictal behaviour observed, patients may be misdiagnosed.