Case reports of ‘ictal lid saccades’ and ‘ictal blinks’
Reviewed by Claire Howard

The authors present two cases of lid movements with discrete physiology and propose the terms ‘ictal lid saccades’ and ‘ictal blink’ to describe the movements seen. These two types of lid movement, blinks and saccades, have discrete kinematic properties and physiology. Unilateral ‘ictal blinking’ is typical of temporal lobe epilepsy whereas ‘ictal lid saccades’ are reported to have precise localising value for frontal or parietal eye field seizures. The first patient described by the authors demonstrated rhythmic bilateral lid saccades that followed passive downward drift of both eyelids. This correlated with rhythmic epileptiform discharges from the right parietal eye field on electroencephalogram (EEG). The second patient presented with unilateral ictal blinking due to ipsilateral temporal lobe seizures. These two examples demonstrate that the kinematics of the yoked, saccadic lid movements that accompany the eye-field seizures are fundamentally different from ictal blinking seen with temporal lobe seizures. Future research is now required, involving a larger cohort of patients, to further support these pilot observations.

Ictal lid movements: blinks and lid saccades.
Pyatka N, Gajera P, Fernandez-Bacavaca G, Lhatoo SD.
NEURO-OPHTHALMOLOGY
2021;45(5):301-8.