Ictal blinking, an under-recognized phenomenon: our experience and literature review

Marco Andrea Nicola Saporito,¹ Giovanna Vitaliti,² Piero Pavone,² Giuseppa Di Stefano,¹ Pasquale Striano,³ Roberto Horacio Caraballo,⁴ Raffaele Falsaperla<sup>2

1</sup>Neonatal Intensive Care Unit, Santo Bambino Hospital, Policlinico-Vittorio Emanuele University Hospital, University of Catania, Catania, Italy; ²Paediatric Operative Unit and Acute and Emergency, Policlinico-Vittorio Emanuele University Hospital, University of Catania, Catania, Italy; ³Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, Institute “G. Gaslini” University of Genova, Genoa, Italy; ⁴Department of Neurology, Hospital de Pediatría “Prof Dr Juan P Garrahan”, Buenos Aires, Argentina

Abstract: Ictal blinking (IB) is a very rare disease manifesting as an epileptic motor event in children and adults. Until now it has not been included in any classification of focal seizures of the International League Against Epilepsy Commission. It could be unilateral or bilateral, isolated or in association with other motor manifestations such as limbs’ clonus and spasms. Its pathogenesis has not been clearly established: paroxysmal discharges from different areas of the brain could cause IB by activation of trigeminal fibers. Herein authors report three infants and a child with IB, observed in three pediatric centers in two different countries. We also performed a review of literature data, suggesting IB as a seizure type to be included in international classifications, and describing the specific electroencephalographic pattern of this condition.

Keywords: ictal blinking, focal motor phenomenon, ictal electroencephalographic pattern, occipital area, infancy