Illusory shadow person causing paradoxical gaze deviations during temporal lobe seizures

J Neurol Neurosurg Psychiatry. 2009 Jun;80(6):686-8. doi: 10.1136/jnnp.2008.154310.

Abstract

Generally, activation of the frontal eye field during seizures can cause versive (forced) gaze deviation, while non-versive head deviation is hypothesised to result from ictal neglect after inactivation of the ipsilateral temporo-parietal area. Almost all non-versive head deviations occurring during temporal lobe seizures are directed to the side of seizure onset, so in derogatory cases it is worth while explaining the paradoxical event. We present a patient with a paradoxical direction of gaze deviation during temporal lobe seizures with an unexpected explanation. Electrocortical stimulation of the temporo-parieto-occipital junction elicited an irrepressible urge to look towards an illusory shadow person besides the patient. Paradoxical non-versive gaze deviations in temporal lobe seizures may be due to illusory experiences masked by postictal amnesia.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Brain Mapping
  • Dominance, Cerebral / physiology*
  • Electric Stimulation
  • Electrodes, Implanted
  • Electroencephalography
  • Epilepsy, Temporal Lobe / physiopathology*
  • Epilepsy, Temporal Lobe / surgery
  • Eye Movements / physiology*
  • Female
  • Fixation, Ocular / physiology
  • Frontal Lobe / physiopathology
  • Hallucinations / physiopathology
  • Humans
  • Monitoring, Ambulatory
  • Occipital Lobe / physiopathology
  • Optical Illusions / physiology*
  • Orientation / physiology*
  • Parietal Lobe / physiopathology
  • Signal Processing, Computer-Assisted
  • Temporal Lobe / physiopathology