title: Unilateral Eye Blinking Arising From the Ictal Ipsilateral Occipital Area.
abstract: We report on an 18-month-old boy with unilateral left eye blinking as a single ictal manifestation without facial twitching. The clinical onset of this phenomenon was first recorded (as an occasional event) at age 3 months, and it was overlooked. By age 6 months, the child's blinking increased to almost daily occurrence in clusters: during blinking the infant showed intact awareness and occasional jerks in the upper limbs and right leg. A video-electroencephalography (video-EEG) documented clinical correlation with a focal pattern arising from the left occipital region, and brain magnetic resonance imaging (MRI) revealed severe brain damage, consisting in poroencephalic hollows and increased spaces in the convexities involving a large area of the left cerebral hemisphere. The boy was prescribed sodium valproate (30 mg/kg/d), resulting in drastic reduction of his clinical seizures. Follow-up to his current age documented good general status, with persistent partial right hemilateral seizures. The blinking progressively disappeared, and is no longer recorded. The pathogenic hypotheses of the unilateral ictal blinking include involvement of the ipsilateral cerebral hemisphere and/or the cerebellar pathways. Review of previous reports of unilateral eye blinking, arising from the ictal ipsilateral brain, revealed that different damaged regions may give rise to blinking ictal phenomena, likely via the trigeminal fibres innervating the subdural intracranial structures and the pial vessels in the ipsilateral affected brain. The eye blinking in the present child represents a further example of an ictal phenomenon, which is predictive of the damaged brain region.
authors.affiliation: Unit of Pediatrics and Pediatric Emergency "Costanza Gravina", University Hospital "Vittorio Emanuele, Policlinic", Catania, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Falsaperla
authors.affiliation: Department of Educational Sciences, University of Catania, Catania, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Perciavalle
authors.affiliation: Unit of Pediatrics and Pediatric Emergency "Costanza Gravina", University Hospital "Vittorio Emanuele, Policlinic", Catania, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Pavone
authors.affiliation: Pediatric Clinic, University of Catania, Catania, Italy terrenere178@tin.it.
authors.forename: Andrea Domenico
authors.initials: AD
authors.lastname: Praticò
authors.affiliation: IRCCS Oasi Maria Santissima, Troina, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Elia
authors.affiliation: Department of Educational Sciences, University of Catania, Catania, Italy.
authors.forename: Martino
authors.initials: M
authors.lastname: Ruggieri
authors.affiliation: Department of Neurology, Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina.
authors.forename: Roberto
authors.initials: R
authors.lastname: Caraballo
authors.affiliation: Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, G. Gaslini Institute, Genoa, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Striano
mesh_terms: D001767:Blinking; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004569:Electroencephalography / Q000379:methods*; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D015835:Ocular Motility Disorders / Q000175:diagnosis* / Q000209:etiology
keywords: EEG anomalies; Unilateral blinking; brain damage; childhood; infantile spasms