Descriptive Psychopathology: The Signs and Symptoms of ...

169 Chapter 7: Disturbances of motor functionTable 7.3. Abnormal movements seen in epilepsyDystonia: With generalized seizures, dystonia occurs as a sudden full body spasm (tonic) thatmay progress to a period of full body myoclonic movement (tonic–clonic or grand mal).In focal seizures, all of the dystonias described below can occur, often at night. These aretermed nocturnal paroxysmal dystonias, and attacks include tonic and choreoathetoidmovements, and oculogyric crisis. 71Atonia: Sudden and brief (a few seconds) loss of all motor tone (drop attacks) is a form ofgeneralized epilepsy. In absence seizures (petit mal), tone is maintained but the patientbecomes unresponsive and stares for 20–30s. Slow blinking may occur.Myoclonus: Myoclonus is a sudden, automatic rhythmic or jerky movement, often repetitive.It is associated with focal and generalized seizures (including absence) as well as otherneurologic conditions and medication toxicities. 72 In children, myoclonic seizures (typicallyin the morning) can be mistaken for “clumsiness”.Catalepsy and posturing: All forms of catatonia occur in epilepsy. Ictal posturing is usually ofshort duration. Post-ictal catalepsy can last for hours. Stereotypy occurs in both these phasesof seizure disorder. Hand and arm postures are typical of some frontal lobe seizures.Speech disorders: Frontal lobe seizures may elicit speech arrest (transient mutism), forcedvocalizations and coprolalia, screaming, grunting and mumbling, muttering, and palilalia.These vocalizations are sudden and transient. Brief classic aphasia syndromes occur.The patient is not fully alert.Automatisms: Automatisms are classic signs of partial complex seizures, but may occur aftergeneralized clonic–tonic seizures as the patient awakens. Automatisms are repetitivebehaviors performed in an automatic fashion such as chewing, lip smacking, pedaling andkicking, grimacing, foot stomping, pelvic thrusting and other coital behaviors, and rubbingand scratching of body parts. The patient is not fully responsive.Complex actions: Aimless walking (or fugue that is typically post-ictal), drinking, urinatingand defecating, undressing, and all forms of so-called conversion disorders and hysterias areassociated with epilepsy. The patient is not fully responsive during these events.expressed during wakefulness. 73 Not recognizing or ignoring the sleep disorder leadsto misdiagnosis, inappropriate treatment, and exacerbation of any co-occurringbehavioral syndrome.The dyssomnias are associated with excessive daytime sleepiness or complaintsof insomnia. The parasomnias are associated with behavioral, movement, andsensory disturbances. Some sleep disorders are identified solely by their motormanifestations. Table 7.4 displays the present classification of sleep disorders withassociated specific abnormal movements.Movements associated with the dyssomnias 74Periodic limb repetitive flexion movements during non-REM sleep affectingmost commonly the legs are involuntary and are seen in persons without disease,