Postictal nose wiping in childhood absence epilepsy: A rare phenomenon

Dear Sir,

Seizure-associated nose wiping (NW) has been hypothesized to result from ictal limbic activation, particularly due to the involvement of the amygdala.^[1] The occurrence of NW in cases of primary generalized epilepsy is rare. A 7-year-old typically developing girl presented with multiple brief episodes of unresponsiveness and vacant stare for the past 2 months. On bedside hyperventilation, she became unresponsive and was unable to vocalize her name despite repeated prompting. This unresponsiveness lasted for a few seconds, and toward the end of this episode, she used the dorsum of her right hand to wipe the tip of her nose before finally responding to her name [Video 1]. Electroencephalography revealed bursts of generalized 3-Hz spike-and-slow-wave complexes suggestive of childhood-onset absence epilepsy [Figure 1]. She responded favorably to sodium valproate. Research suggests that the hand used for NW corresponds to the lobe of origin of the seizure and serves as a marker for laterality in focal seizures.^[2] Clinicians must be wary of the possibility of postictal NW in other seizure semiologies, such as absence and generalized seizures, to ensure this phenomenon is not overlooked.

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Figure 1:

Awake electroencephalography record suggestive of primary generalized epilepsy (3Hz spike and slow wave complexes). Red lines: Right side electrodes, blue lines: Left side electrodes, black lines: Central electrodes.

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