A 14-year-old boy with habitual painful seizures of the backs of both hands since age 4 is reported from the Department of Pediatric Neurology, Osaka Medical Center, Japan. He had three febrile convulsions from one to three years of age. Painful hand seizures occurred 5-15 times daily, lasting 15 - 60 seconds, and occasionally followed by loss of consciousness and postictal confusion but no secondarily generalized seizures. Seizures were resistant to conventional medications until 13 years of age, when they showed some response to polytherapy with carbamazepine, valproate, and clorazepate. Interictal EEG showed frequent spikes and spike-waves over the right frontopolar area with spread to the left frontal region. Ictal EEG showed right temporal 4-6Hz rhythmic activity after a pain sensation. CT and MRI were normal. SPECT showed right temporal hypoperfusion. These secondary sensory seizures were thought to originate from the S2A area. [1]
COMMENT. The authors cite 4 reports including eight previous patients with secondary sensory seizures published in the last 40 years, the first involving 2 patients of Penfield and Jasper (1954). One study was entitled ‘Sensory seizures mimicking a psychogenic seizure.’ [2]. It is certainly conceivable that the diagnosis is sometimes overlooked and the symptoms misinterpreted as psychogenic.