Rhythmic ictal nonclonic hand (RINCH) motions: a distinct contralateral sign in temporal lobe epilepsy.
OBJECTIVE
To describe a new ictal sign in temporal lobe seizures-rhythmic ictal nonclonic hand (RINCH) motions and to determine its lateralizing significance and other ictal manifestations associated with it.


METHODS
We identified 15 patients with temporal lobe epilepsy who demonstrated RINCH motions and reviewed video-EEG recordings of all their seizures. We analyzed the epilepsy characteristics and all clinical features of recorded seizures, with particular attention to RINCH motions.


RESULTS
RINCH motions were unilateral, rhythmic, nonclonic, nontremor hand motions. RINCH motions were usually followed by posturing, sometimes with some overlap. They involved the hand contralateral to the temporal lobe of seizure onset in 14 of 15 patients.


CONCLUSIONS
RINCH motions are a distinct ictal sign that could be considered a specific type of automatism. They appear to be a lateralizing contralateral sign and are associated with dystonic posturing in temporal lobe epilepsy.
Lee
George R
GR
Department of Neurology, Vanderbilt University, Nashville, Tennessee 37232, USA.
Arain
Amir
A
Lim
Noel
N
Lagrange
Andre
A
Singh
Pradumna
P
Abou-Khalil
Bassel
B
D000328:Adult; D001332:Automatism / Q000175:diagnosis / Q000503:physiopathology; D001480:Basal Ganglia Diseases / Q000175:diagnosis / Q000503:physiopathology; D002648:Child; D004421:Dystonia / Q000175:diagnosis / Q000503:physiopathology; D004569:Electroencephalography / Q000706:statistics & numerical data; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006225:Hand / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000175:diagnosis* / Q000503:physiopathology*; D016896:Treatment Outcome; D014743:Videotape Recording