CASE REPORT article
Front. Hum. Neurosci.
Sec. Brain Imaging and Stimulation
Volume 19 - 2025 | doi: 10.3389/fnhum.2025.1593597
This article is part of the Research TopicPrevention of and early intervention for behavioral health disorders in people with epilepsyView all 7 articles
Slapping Automatism in Epileptic Seizures: A Case Series
Provisionally accepted
- 1Other
- 2Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital Department of Neurology, Shanghai, China
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AbstractBackground: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.Case Report: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.Conclusion: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.
Keywords: slapping automatism, frontal lobe epilepsy, Temporal Lobe Epilepsy, Obsessive-Compulsive Disorder, Stereo-electroencephalography (SEEG)
Received: 01 Apr 2025; Accepted: 01 Aug 2025.
Copyright: © 2025 Hao, Feng, Zhao, Liu, Zhan, Sun and Cao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Chunyan Cao, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital Department of Neurology, Shanghai, China
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