Hao Shenglin, Feng Ziyi, Zhao Haifeng, Liu Wei, Zhan Shikun, Sun Bomin, Zhou Qiang, Cao Chunyan
Department of Neurosurgery, Affiliated Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
Department of Laboratory Medicine, Gongli Hospital, Shanghai, China.
Front Hum Neurosci. 2025 Aug 25;19:1593597. doi: 10.3389/fnhum.2025.1593597. eCollection 2025.
Slapping automatism is a type of automatism observed during epileptic seizures, but its underlying electrophysiological mechanisms remain poorly understood. Stereo-electroencephalography (SEEG) provides a unique opportunity to investigate the associated cortical areas with epileptiform discharges during the slapping automatism.
We report five cases of drug-resistant epilepsy in which SEEG recordings captured slapping automatism. In four patients, slapping movements coincided with ictal electrical evolution in the prefrontal lobe, specifically involving the orbitofrontal cortex (OFC), lateral prefrontal cortex (PFC), and anterior cingulate (ACC). Among them, two cases were temporal lobe epilepsy (TLE), while the other two were frontal lobe epilepsy (FLE). Additionally, we describe one patient with TLE and obsessive-compulsive disorder (OCD), whose SEEG recordings revealed frequent interictal epileptiform discharges in both the medial temporal and prefrontal regions. The seizures originated in the temporal lobe and rapidly evolved into generalized seizures. Although slapping automatism was not observed during seizures, the patient exhibited repetitive patting on the bed during the interictal period. Based on SEEG-defined epileptic networks, all patients underwent surgical interventions, including lesion resection and/or disconnection procedures. At follow-up, all three patients achieved Engel class I outcomes and two patients Engel class II.
SEEG recordings in this study confirm a strong association between orbitofrontal lobe epileptic activity and slapping automatism. Notably, we report a case of TLE with comorbid OCD, characterized by frequent epileptiform discharges in the orbitofrontal lobe, providing direct electrophysiological evidence of prefrontal abnormalities in OCD. Together, these findings highlight a shared pathological network of orbitofrontal-striatal-pallidal-thalamic between frontal and temporal epilepsy with slapping automatism and OCD.
掌掴自动症是癫痫发作时观察到的一种自动症类型，但其潜在的电生理机制仍知之甚少。立体定向脑电图（SEEG）为研究掌掴自动症期间伴有癫痫样放电的相关皮质区域提供了独特的机会。
我们报告了5例耐药性癫痫病例，其SEEG记录捕捉到了掌掴自动症。在4例患者中，掌掴动作与额叶的发作期电活动演变同时出现，具体涉及眶额皮质（OFC）、外侧前额叶皮质（PFC）和前扣带回（ACC）。其中，2例为颞叶癫痫（TLE），另外2例为额叶癫痫（FLE）。此外，我们描述了1例患有TLE和强迫症（OCD）的患者，其SEEG记录显示内侧颞叶和前额叶区域频繁出现发作间期癫痫样放电。癫痫发作起源于颞叶并迅速演变为全身性发作。虽然发作期间未观察到掌掴自动症，但该患者在发作间期在床上表现出重复性拍打动作。基于SEEG定义的癫痫网络，所有患者均接受了手术干预，包括病变切除和/或离断手术。随访时，3例患者达到Engel I级预后，2例患者达到Engel II级。
本研究中的SEEG记录证实眶额叶癫痫活动与掌掴自动症之间存在密切关联。值得注意的是，我们报告了1例合并OCD的TLE病例，其特征为眶额叶频繁出现癫痫样放电，为OCD前额叶异常提供了直接的电生理证据。总之，这些发现突出了额叶和颞叶癫痫伴掌掴自动症及OCD之间眶额-纹状体-苍白球-丘脑的共同病理网络。
