Ictal Nose Wiping in Frontal-Onset Absence Epilepsy; A case report

Objectives: Childhood absence epilepsy is a pediatric epilepsy syndrome, characterized by paroxysmal episodes of unconsciousness that begin and end abruptly. Oral automatism (swallowing, chewing, lip smacking and licking) and manual automatism (moving, squeezing, moving legs) are often seen in childhood absence seizures. We presented an extremely rare case of ictal nose wiping in absence epilepsy. Methods: Results: A 10-year-old boy was presented with sudden onset staring, unresponsiveness, followed by ictal nose wiping lasting for10-15 seconds. Seizure frequency was 3-4 times per day for the last 15 days. The EEG showed a generalized 2.5 Hz spike-and-wave activity with bilateral frontal onset lasting for 6-15 seconds and 4 times during hyperventilation. The patient used the left hand to wipe his nose for 5-10 seconds during the seizures triggered by hyperventilation on the video-EEG. He was diagnosed with frontal-onset absence epilepsy and was successfully treated with ethosuximide. He is seizure free for a year. Conclusions: Nose wiping is a peri-ictal automatism which is well-known as a lateralizing and localizing semiology in focal seizures, especially temporal lobe epilepsy and less frequently in extratemporal epilepsy. However, it is an extremely rare entity in generalized onset seizures. Our case showed that ictal nose wiping may also be associated with absence seizures in contrast to other recent reports.
Keywords: absence, epilepsy, automatism, nose wiping.