Case ReportSymptomatic complex partial status epilepticus manifesting as utilization behavior of a mobile phone
Introduction
The term utilization behavior (UB), which has been specifically characterized by Lhermitte [1] as one of the signs of the environment dependency syndrome, describes the “automatic elicitation of instrumentally correct, yet highly exaggerated and or inappropriate motor responses to environmental cues and objects” [1], [2].
Patients with this behavior do not seem able to resist grasping and manipulating (most of time adequately) objects in the peripersonal or extrapersonal space, even when they are involved in other tasks or are not required to do so. For example, while talking with the doctor about their symptoms, and without a specific request, they suddenly grasp the sphygmomanometer or the stethoscope (placed on the desk before their arrival in the cabinet) to measure blood pressure or listen to cardiac bruits on themselves or the doctor. In a neuropsychological testing session, a patient with UB might automatically pick up a pen and paper on a table and begin drawing something without being told or asked to do so.
UB is an abnormal behavior that is observable in individuals with right or left frontal lobe dysfunction [1], especially of the nondominant hemisphere. Although UB is often related to underlying structural lesions and, therefore, does not show marked fluctuations, to the best of our knowledge, intermittent UB has not been reported as a symptom of prolonged or repeated complex partial seizures arising from the frontal areas.
Section snippets
Case description
A 60-year-old ambidextrous woman was admitted to our emergency department after her first generalized convulsive seizure. Over the previous few weeks, her relatives noted that she made errors in the use of her mobile phone (wrong calls, difficulty with dialing); otherwise, her past medical history was unremarkable. On examination she was alert, able to name objects and follow simple commands, but disoriented in space and time. She also had deficits of attention and working memory (direct and
Comment
In this patient, an explicit stimulus-bound UB seems to represent the main clinical correlate of a complex partial status epilepticus (SE) originating from the right anterior brain areas, represented by repetitive seizures without intercurrent return to baseline clinical conditions [3]. The marked improvement in both electrographic and clinical manifestations in response to the antiepileptic drugs was another element supporting the diagnosis of complex partial SE and ictal UB.
The patient’s
Conflict of interest statement
The authors do not report any conflict of interest.
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Clinical utility of ictal eyes closure in the differential diagnosis between epileptic seizures and psychogenic events
2013, Epilepsy ResearchCitation Excerpt :Despite these limitations, a pooled analysis of data from all available studies dealing with this topic suggests that for those patients with coexistence of both epileptic seizures and PNEEs, the simple question of eye opening or closure might help differentiate between the two events, as further supported by one study which showed that all patients with both types of events tended to have their eyes closed during PNEE and open during epileptic seizures (DeToledo and Ramsay, 1996). A careful history of seizure semiology in an outpatient setting might therefore help to discern between epileptic seizures and PNEEs, although a video-recording of the paroxysmal event (not necessarily by means of a video-EEG recording, but also with a home video or a mobile phone recording; Zeiler and Kaplan, 2009; Carota et al., 2009) still represents the reference standard to properly differentiate the two conditions by ascertaining ictal semiology and EEG correlates. However, studies with a blind assessment of eyes state are perhaps more methodologically appropriate and more worthy of consideration than unblinded ones.
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2011, NeuropsychologiaCitation Excerpt :However, these authors evaluated only incidental UB. Most publications devoted to UB are case studies (e.g., Boccardi, Della Sala, Motto, & Spinnler, 2002; Carota, Novy, & Rosetti, 2009; Fukui, Hasegawa, Sugita, & Tsukagoshi, 1993; Ishiara, Nishino, Maki, Kawamura, & Murayama, 2002). This observation call into question the seminal definition of UB, which seems to be more regarded as an exceptional sign justifying a publication than as a symptom frequently associated with damage to frontal lobe structures.
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