Rhythmic teeth grinding induced by temporal lobe seizures

Seizure, 2020

Sleep-related facio-mandibular myoclonus(SRFMM) is a rare and under-recognized stereotyped parasomnia. SRFMM can present with isolated tongue biting, which can be misdiagnosed as epilepsy and sleep bruxism. We aimed to investigate the clinical characteristics and demographics of patients with SRFMM. Methods: We reported a case of SRFMM and presented a literature review on SRFMM. We searched the Medline, Pubmed, and Web of Science database using the following search algorithm: "facio-mandibular myoclonus" or "masticatory myoclonus" or "tongue biting" limited to publications in English. Results: In total, nine studies were included. In addition to our case, a total of 17 patients were analyzed. SRFMM was found to be more prevalent in males, with a mean age of 48.2 years old. Most of the patients experienced tongue biting during non-rapid eye movement sleep. A majority of the patients were misdiagnosed with epilepsy or sleep bruxism. The simultaneous video EEG and surface EMG was beneficial in confirming the diagnosis of SRFMM. In some patients, clonazepam was reported to ameliorate the tongue biting event. Conclusion: This study represents a comprehensive summary of SRFMM, which has unique clinical features. Extra-caution may be needed in these cases as it may puzzle neurologists in terms of management.

Sleep Medicine, 2019

Epilepsy & Behavior, 2012

Tongue biting (TB) may occur both in seizures and in psychogenic non-epileptic events (PNEEs). We undertook a systematic review to determine sensitivity, specificity, and likelihood ratios (LR) of TB. Five studies (222 epilepsy patients and 181 subjects with PNEEs) were included. There was a statistically significant higher prevalence of TB (both without further specifications on site of lesions and lateral TB) in patients with seizures. Pooled accuracy measures of TB (no further specifications) were sensitivity 38%, specificity 75%, pLR 1.479 (95% CI 1.117-1.957), and nLR 0.837 (95% CI 0.736-0.951). Pooled measures of lateral TB were sensitivity 22%, specificity 100%, pLR 21.386 (95% CI 1.325-345.169), and nLR 0.785 (95% CI 0.705-0.875). Only a pooled analysis of data demonstrated a statistically significant pLR for lateral TB. Lateral TB but not 'any' TB has diagnostic significance in distinguishing seizures from PNEEs, supporting the diagnosis of seizures. Tongue biting without further specifications has, therefore, no value in the differential diagnosis between seizures and PNEEs.

Seizure, 2012

Electroencephalography and Clinical Neurophysiology, 1989

International Journal of Epilepsy

Journal of Clinical Neuroscience, 2016

This study aimed to evaluate the clinical, video electroencephalographic and MRI attributes of patients with eating epilepsy (EE). Consecutive patients who were diagnosed with EE and underwent potential pre-surgical work-up from 2003 to 2012 formed the study cohort. Their electro-clinico-radiological and seizure outcome data were obtained from our prospectively maintained medical records. Out of 7094 patients who underwent evaluation for refractory seizures, 47 patients satisfied the criteria for EE. Twenty-three (48.9%) had exclusive EE; the remainder had a combination of predominantly eatinginduced and unprovoked seizures with no differences noted in timing of seizures in relation to meals. Lesional epilepsy was seen in 34% of patients, with posterior cortex (PC; posterior temporo-parietooccipital) predominance. In MRI negative patients, PC interictal epileptiform discharges were present in 34.4% of patients and multifocal in 20.6% of patients compared to the MRI positive group with 12.5% and 6.5%, respectively (p = 0.003). Among 24 patients (51.1%) with co-existent unprovoked seizures, developmental delay and PC ictal onset was more prevalent (p = 0.013 and 0.029) as compared to exclusive EE. The seizure frequency and outcome did not significantly differ between patients with or without MRI abnormality. Two patients underwent anterior temporal lobectomy, with persistence of their eating seizures postoperatively. EE is a complex reflex epilepsy of cryptogenic and symptomatic etiology. As opposed to the traditionally implied temporo-limbic mechanisms behind epileptogenesis, a multilobar network originating from the PC receiving sensory and visual inputs linked to the limbicopercular pathways represents a plausible mechanism. Surgical selection should be diligent and cautious in this group of patients.

Sleep Medicine Reviews, 2007

Epilepsia, 2009

Clinical Neurophysiology, 2018