Neuro diagnoses city teen with rare disorder

HYDERABAD: A city-based doctor reported a rare instance of a neurological disorder, wherein a 15-year-old boy spins on a 180-degree axis during a seizure, loses bladder control, but remains fully conscious during the episode without not being to do anything about it.

The disorder is known as ‘gyratory seizures’ or ‘volvular seizures’, wherein the body spins around at an axis of 180 degrees to 360 degrees while having a seizure, Dr Sudhir Kumar posted on his Twitter handle about the case study.

The Hyderabad teen was thought to be suffering from conversion disorder (hysteria) and was also referred to a psychiatrist in the past, but the psychiatrist ruled out any psychopathology and referred him to a neurologist.

But doctors were equally perplexed by his abnormal behaviour, until Dr Kumar identified the same.

“He would remain fully conscious during these episodes but was unable to control them. He was seen by a neurologist elsewhere. Brain scan and electroencephalogram (EEG) were normal. He was empirically treated for possible epilepsy, with no benefit,” Dr Kumar said.

Describing one of the boy’s episodes, Dr Kumar said: “All of a sudden, he stood up from his chair and started rotating in leftward direction around his body axis. This lasted for one minute, during which he also involuntarily passed urine. He was fully conscious though.”

Dr Kumar said that the origin of these epilepsies often lies in the frontal lobe of the brain. “A long-term EEG confirmed the localisation of epileptiform activity to the right frontal lobe,” he said.

Some of the causes of rotatory seizures were right frontal calcified lesion and possible tapeworm infection, due to tumours of infarcts (blood clots) in the frontal lobe or cerebral venous sinus thrombosis-related clots in the temporal lobe.

“A routine scalp EEG may be normal. Long-term EEG may be helpful in confirming diagnosis. Medical therapy works in most and in some cases, surgery may be needed,” Dr Kumar tweeted.