Neurológia pre prax 1/2010

Paroxysmal alien hand syndrome or RINCH in frontal lobe epilepsy? A video case report + review of literature on alien hand phenomenon and RINCH

A patient is presented who, shortly after the removal of a parasagitally localized tumour of the right frontal lobe, developed frequent paroxysmally occurring involuntary movements of the right hand fingers. Noninvasive video EEG monitoring confirmed the epileptic origin of these motor manifestations for simultaneously occurring ictal EEG pattern with a maximum at the right frontocentral electrodes. In some aspects (particularly the localization of the causal lesion), our case has a resemblance to the rarely reported ictal alien hand syndrome; however, the rhythmic character of the movements rather corresponds to the RINCH (rhythmic ictal non-clonic hand) motions that, however, have so far been described in temporal lobe epilepsies only, namely in the limb contralateral to the focus.

Keywords: alien hand syndrome, epilepsy, motor cingulum, RINCH.