Hand-biting and hand-waving paroxysms in epilepsy

Abstract

A 20-year-old ambidextrous female student with a 15-year history of refractory seizures was admitted to the epilepsy department for a second opinion on her diagnosis and treatment. She developed frequent motor paroxysms at the age of 4-5 years, which appeared resistant to antiepileptic therapy and which have continued to the present day. Over the last 8 years she also had five generalised tonic-clonic seizures. There is a family history of epilepsy on the maternal side. The first type of episode is characterised by left-hand flickering, associated with head turning and loss of awareness. During the second type of attack the patient demonstrates vigorous hand biting which starts without warning. The patient appears disorientated subsequently. EEG telemetry was performed and confirmed the diagnosis of both epilepsy and non-epileptic attacks. Literature reports of the relevant cases are discussed. Copyright 2012 BMJ Publishing Group. All rights reserved.