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Open Access Case report

Changes in physiological tremor associated with an epileptic seizure: a case report

Jean-François Daneault1, Benoit Carignan2, Maxime Robert3 and Christian Duval3*

Author Affiliations

1 Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Quebec, Canada

2 Département de Sciences Biologiques, Université du Québec à Montréal, Montréal, Québec, Canada

3 Département de Kinanthropologie, Université du Québec à Montréal, Montréal, Québec, Canada

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Journal of Medical Case Reports 2011, 5:449  doi:10.1186/1752-1947-5-449

Published: 12 September 2011

Abstract

Introduction

Epileptic seizures are associated with motor, sensory, somatosensory or autonomic symptoms that have all been described in varying detail over the years. Of interest in the present report is a case of normal physiological tremor, which to date has never been evaluated prior to and during an epileptic seizure. In fact, there is only anecdotal mention of pre-ictal and ictal changes in clinically noticeable tremor in the literature.

Case presentation

Our patient was a left-handed, 27-year-old Caucasian woman diagnosed seven years previously with partial epileptic seizures, secondarily generalized. Physiological tremor was measured simultaneously on the index finger of both hands of our patient. Electromyography as well as heart rate and respiration were also monitored. A previously performed electroencephalography examination revealed abnormal oscillations focalized to the left primary somatosensory cortex. She was also diagnosed with left frontal neuronal heterotopias. We detected subclinical changes in tremor characteristics, such as amplitude, median power frequency and power dispersion, contralateral to the localization of epileptic activity. Tremor characteristics remained relatively steady ipsilateral to the localization of the epileptic activity.

Conclusions

Changes in physiological tremor characteristics should be considered as another possible pre-ictal or ictal manifestation. We propose that the network associated with physiological tremor might be more sensitive to abnormal oscillations generated within the central nervous system by epileptic activity from certain structures.