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Proceedings SNO “Percorsi clinici in Neuroscienze”

proximal limb segments, usually with the preserva-
tion of consciousness are considered specific for
frontal lobe epilepsy in close association with fron-
(1)
topolar and orbitofrontal cortical lesions . This type
of seizure is frequently preceded by an aura (fear, ill-
defined feelings, and somatosensory phenomena) and
includes bizarre gestures, repetitive movements, bi-
cycling, pelvic thrusting and shouting, often charged
(1)
with emotional and aggressive features .
Our case highlights as the coexistence of hypermotor
symptoms, emotional alteration and preserved aware-
ness makes difficult the differential diagnosis between
FLS and PNES in an emergency setting where the cli-
nician is often asked to give immediate conclusions.
Clinicians should evaluate again the patient’s medical
history even after several years. In particular, in our
case the semiology of seizures has changed only two
months before the first evaluation in emergency
room.
In selected cases, proposing a surgical setting in a
phase of the disease definite “manageable” by the
Figure 1. T2 -weighted axial image. MRI scan showing a
dysplasia on the dorsolateral prefrontal cortex. therapy is considered advisable.

can exhibit bizarre motor phenomena that may be
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aggressive behaviour may not depend on dysfunction 2. Lee SK, Kim JY, Hong KS, Nam HW, Park SH, Chung
of a single region, but appears to be related to a large- CK. The clinical usefulness of ictal surface EEG in neo-
scale anatomo-functional system, including the dor- cortical epilepsy. Epilepsia 2000; 41 (11): 1450-1455.
so-lateral prefrontal regions. In prefrontal cortex hy- 3. Benbadis S. The differential diagnosis of epilepsy: a crit-
permotor complex movements involving trunk and ical review. Epilepsy Behav 2009; 15 (1): 15-21.

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