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Show Letters to the Editor Epileptic Nystagmus and Eye Movements TIl the Editllf: I rt.>,1(! with intl'rl'st till' .1I'tidl' ~lf NelsllJl l't al. (I) repllrtin~ a Ill'lIn.1 te wi thill tr.1\'ell trind.ll' 11l'll1orrh. 1~l' .1nd sl1llrl -li\'l'd d i\'l'r~l'll I oClIl.H 111lJVl'Jl1L'Il!s .1SSllci,lted with .111 EEC burst slIppressillJl pattern; the ,1lIthllrs beliL'\'ed the ,lbl1l1rJl1.11 periodic eVt' ml)\'ements rt'prescllkd a brainskm ll1esen~eph. 1lic reticular rde.1sc phenl1mend rather than an epileptic manifest.1tilln, The\' e~pressed having no knllwled~e lli an\, case with epileptiiorll1 activity obsef\'ed with ocular vergence, Vignaendra an~i Lim (2) in 1977 described a 27-war-old man with iocal epileps~' and secondary g~neralizt'd seizures in whom ocular convergence alone, in Ii~ht or darkness, independent oi evelid mOVt'll1ent and .liter pupillar~' and accommodation retlex paralysis elicited right posteril1r (mostly occipital) electwgraphic seizures oi pl1lvspike and wave discharges; these were iollo\\'ed bv focal rhvthmic beta activit~, beiore becomin~ ge~eralized, " \;elson et al. (1) also acknowledged the prior reports of eyelid opening and of vertical eve movements locked to EEG burst-suppression' patterns in anoxic encephalopathy, As recently reported by Simon and Aminoff (3), the vertical periodic eye movements in question in anoxic coma may be small, difficult to detect under the closed eye'lids, and may constitute the sale clinical manife~tation of status epilepticus (although, and of additional speculative value, difficult to suppress with anticonvulsants), Electrographic seizures invariablv accompanied the eye movements (3), Efforts should be made, therefore, to perform acute EEG monitoring on patients with coma and periodic eye movements, Finally, I wish to add to their list of epilt'ptic nystagmus variants a patient of mine who had monocular horizontal nystagmus during abscncl' seizures evoked by intermittent photic stimulation (4), Daniel E, Jacome, M,D, Department of Medicine Palmetto General Hospital, Hialeah, Department of Neurology University of Miami School of Medicine Mi'lmi, Florida 269 ", I~Kh ROVl'n Pre'", :\lew York REFERENCES I, N"I"m KR, Ilrl'nnl'r RI', Carlow T), Divc'rgc'nl-convergent "V" l11ovl'nll'nh "nd tr.1I1,ic'nt c'yelid opening a""cialed with ,In Uc(; nur,l-'upprc'"ion pattern, I ClI/1 Ncuro-I.l/'h1/, 1111/1,,1 14Xo;0:41-o, , Vign.lendr" V, Lim CI., Lpileptil di,charg," triggered bv C'VC' lonvergenn', N,'un'/"Xtf J47X;2H:5H4-yJ ' ,1, Sil110n RP, Aminoll M), 1\ ,Iinical ,ign prL'dieting l'll'd"'o.:nl° l'phtllogrilphic "itl-ItU" l'pill'ptil"U'" in dn("ic CClmrl \;nl ,."/''Sl/ 14Xh;Jh(Suppl J,2X7 4, !"nmw DE. fitzCc'r"ld R, M"n"cuIM ictal nl',t"gTnU"'\,,/i Neili'll/ 1~H2;J4:oS'l-h The Authors Reply We wish to thank Dr, Jacome for bringing tll llur attentilln his patient who e~hibited ml)nncular ictal nystagmus (1), as well as the case reptlrt of Vignaendra and Lim (2), In the latter, l'\'C ('(1I1\'ergence induced fllcal epileptic discharge..;, ..;tlmetimes accompanied b\' ftlcal clinical ..;eizurc..;, HllWever, it is important tll ntlte that ctln\'ergt'nce \\'.1"; the stimulus in their caSt' tlf refle\' epilep..;\' and not an ictal e\'enl. In the p,ltienb recenti\' described bv Simon and Amil1llfi (3), the e\'e ~1ll\'t:>ments and EEG findings diiier fwm llur' case (.il. as well as from pre\'il1us reptlrts llf e\'elid llpenin~ and vertical eve ml)\'enwnts assllci,llt'd \\'ith an EEG bllrst-sllppressil1n p,ltterl1 (:;- 7'), We certainl\' agrec with Dr. 1,1cllnw Ih,11 111 Cl)m, ltoSL' p,lticnts wilh pl'ri"dic C'\'L' nh)\'l'l11l'nh, EEG Il1tlnitoring m.1\' indic,lll' th,ll till' t'\t' I11l1\L'ments are ictal (H), Kevin R, Nebpn, t\1 I) Richard 1', Brenner. roo 1 [l Thlll11,lS I, C,Hlll\\, roo 1 I) Dl'p.HII11L'nl pi NL'UI', d, ',",\ Uni\'L'rsil\' "' "~'l1lllCk\ \ i.',' LL'xingtllll, "el1lllCk\' I, ).lC"I11"))1':. I'it/l;"I.,id I. \1."" Nt'lIftll 1l)~2;.1l):h~' ""1' , Vig".ll'ndr,l V, Lim II 'I":' l·~'\.' Ctlll\'ergl'nn'" ,\""111"1"',11 I q-. " |
