Abstracts

Rationale: To review the local experience of patients with AWCSs. Methods: A retrospective review of 540 consecutive video-EEG telemetry admissions. Results: 2 patients with AWCS were identified. Patient #1. A 41 year old female with normal intelligence and examination has had seizures since age 12 years. Seizures are exclusively nocturnal (frequency = 4/month). The seizures awaken her from sleep with jerking movements of the left abdominal wall (below the costal margin and above the iliac crest); after 30-45 seconds clonic abduction movements of the left shoulder begin and persist for 1-2 minutes followed by numbness of the left face, arm, and leg lasting 1-2 minutes. Habitual seizures were captured during video-EEG telemetry with 1 (on reduced antiepileptic drug) progressing to a secondarily generalized tonic-clonic seizure. The interictal EEG was normal, and the ictal EEG was uninterpretable secondary to movement artifact. The MRI was normal. Patient #2. A 34 year old male with right primary sensory cortex seizures since age 25 years of unknown etiology. Investigations included intracranial subdural electrodes (a 20 contact grid over the central region and 6 multicontact strip electrodes covering adjacent parietal-frontal cortex). Following the subdural electrode placement the patient had, in addition to his habitual seizures, multiple ictal events completely dissimilar to anything previously experienced. These seizures consisted of left abdominal wall clonic contractions (frequency approximately 2 Hz) lasting 2-3 minutes. These clinical events were associated with electrographic seizure rhythms maximal at 2 electrodes located over the right superior paracentral lobule. Conclusions: AWCSs are rare. Only 4 patients with isolated AWCSs have been previously reported (plus 6 patients with epilepsia partialis continua). We report the clinical details of 2 patients with AWCSs including the first documented with intracranial EEG monitoring. AWCSs originate in the contralateral high sensorimotor convexity.