title: Epilepsy causing pupillary hippus: an unusual semiology.
abstract: Altered pupillary behavior is commonly present during and following epileptic seizures, but symptomatic pupillary hippus as the main feature of a seizure has not been reported in the modern literature. We present the case of a woman with epileptic seizures consisting of sustained fluctuation of perception of brightness. Bilateral pupillary hippus is the main semiologic feature.This autonomic phenomenon is selective for the pupils and does not involve other autonomic-mediated responses. An ictal video illustrates this phenomenon. The epileptogenic region, determined by ictal scalp and intracranial electroencephalography (EEG), is localized in the right posterior parietooccipital areas. Pupillary reflexes can be overridden by cortical input; here authors review the literature and discus the physiologic mechanisms underlying this autonomic phenomenon. Fluctuation in perceptual brightness during epileptic seizures may have a basis in ictal pupillary hippus.
authors.affiliation: Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, United Kingdom.
authors.forename: Maria
authors.initials: M
authors.lastname: Centeno
authors.forename: Maria
authors.initials: M
authors.lastname: Feldmann
authors.forename: Neil A
authors.initials: NA
authors.lastname: Harrison
authors.forename: Fergus J
authors.initials: FJ
authors.lastname: Rugg-Gunn
authors.forename: Umair
authors.initials: U
authors.lastname: Chaudhary
authors.forename: Carles
authors.initials: C
authors.lastname: Falcon
authors.forename: Louis
authors.initials: L
authors.lastname: Lemieux
authors.forename: Maria
authors.initials: M
authors.lastname: Thom
authors.forename: Shelagh J M
authors.initials: SJ
authors.lastname: Smith
authors.forename: Sanjay M
authors.initials: SM
authors.lastname: Sisodiya
mesh_terms: D000328:Adult; D002540:Cerebral Cortex / Q000503:physiopathology / Q000601:surgery; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D011681:Pupil Disorders / Q000209:etiology*