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Folia Psychiatrica et Neurologica

Japonica, Vol. 33, No. 3, 1979

A Case of Epilepsia Cursiva whose Running Fits were Precipitated


by Psychogenic Factors
Tetsuo Kumakura, M.D., Masataka Hayashi, M.D.
and Yasuo Shimazono, M.D.*
Department of Neurology, Kofu City Hospital, Kofu and
*Department of Neuropsychiatry, Faculty of Medicine,
Tokyo Medical and Dental University, Tokyo

INTRODUCTION

Epilepsia cursiva, a running fit, is classified as an ambulatory automatism type of


psychomotor seizure characterized by episodic alteration of consciousness associated
with running, during which a patient avoids
objects and suffers a complete amnesia for
the episode. The first detailed case report
including EEG findings was described by
Sisler et al.* in 1953. According to various
case reports,l the EEG in the intermittent
period of seizure shows focal findings in AT
(anterior temporal), or F (frontal) to MT
(middle temporal). It was thought that
psychogenic factors play an important role
in initiating the seizures. However, subsequent studiesl expressed negative opinions
on it.
We would like to present a case which
started with generalized convulsion, then
developed, as age progressed, into various
types of psychomotor seizure, including running fits. In this case, a psychogenic factor
was believed to play a vital role in precipitating the running fits.

CASE REPORT
I.Y. is a 28-year-old male who has a
Received for publication June 25, 1979.

history of head trauma at the age of 10


years, accompanied by prolonged disturbance of consciousness lasting for several
hours. He has no family history of convulsive disorders. The first onset of his generalized convulsions which occurred during
sleep was at the age of 15, and since then,
he has had an attack every 3G60 days. He
made his first visit to our clinic in 1971 (at
the age of 21). At that time, physical and
neurological examinations were normal. The
EEG showed a rare amount of irregular
8-12 C.P.S. alpha waves with a moderate
voltage and a moderate amount of &7 C.P.S.
theta waves, but with a large amount of low
voltage fast waves during the awake state. In
a very light sleep stage, the record demonstrated single 2.5-3 C.P.S. spike and wave
complex, most remarkable in left F and AT
(Fig. 1).
He was put on Diphenylhydantoin and
Phenobarbital therapy, but seizures were not
controlled owing to his irregular visits and
medications. As shown in Fig. 2, in December, 1973 (at the age of 23), he began
to have seizures in which there was a sudden
standing-up, followed by a paroxysmal attack
of gastric distress, change of-skin color and
micropsia. Carbamazepine was then added
to previous medications,
Later, another type of seizure, probably
behavior automatism, started, i.e., the pa-

T. Kumakura

256

et at.

tient suddenly got up early in the morning,


crying out Wake up! or he shook his
family awake; or put away the mattress in
the closet. He had this type of seizure 2-3
times a night. Phenylethylacetylurea was
added, but seizures remained uncontrollable.
In July, 1974 (at the age of 24), he
began to have frequent running fits at night
(3-5 times a night). The pattern of attack
was as follows; he suddenly got up early in
the morning, then opened the door, ran
toward the porch and lay down on the floor
or went out into the garden and began running for about 30 seconds. Thereafter, he
began to have running fits even at daytime,
and on some occasions, we had an opportunity to observe the actual attacks. While
awaiting his turn in the waiting room of our
clinic, he suddenly picked up his mothers
handbag, then stood up, rummaging in the
handbag, and began running through the

CASE I.Y. 28vs. male


DATE

10 12 1

Traffic Violation

CLINICAL COURSE

I974

1976
12 1

I975
12 1

0.

Theft

1I

i
71977,2

I978
6

Psychomotor
Running Fits

u).

-8
.4

P B
DPH
PEC
CBZ
APT
PRM
DZP
A2
1
DPA

48

I
800

I
I
I

ms

Fig. 2:

600
I000
7-12
I

750

Clinical Course

PB: phenobarbital, DPH: diphmylhydantoin. PEC: phenylethylacetylurea, CBZ: carbarnmepine, APT:


acetylphenaceturide, PRM: primidone, DZP: diazepam, AZA: acetazolamide, DPA: dipmgylacetate.
single attack a day, x ,
frequent attacks a day.
Note: X .

*:

*:

257

EpiIepsia Cursiva by Psychogenic Factofs

July 1s. 1974

I.Y. 24yn.

July 15,1974

I.Y. 24 yn.

Lf

RF
b
b
L

M
T

U
m

h TmR

LC
HC

- C R

LP
l

- P R
-

RP

LO

0 1

RO

- o n
J

dhkd W h r S (#tlnB

Fig. 3: Resting record of EEG before


the occurrence of the clinical seizures.
Seizure discharges were frequently occurring
every 10 seconds, prominent in both F and
less remarkable in right AT and MT.

hall. Then, his mother ordered him to be


seen by his doctor while he had an attack.
At her words, he turned around, opened the
door of the examination room violently, and
came into the room. After 40 meters' running, he looked up at his attending physician
and stopped. At that time, he had a very
rapid respiration, looked pale, tense, perplexed and stared around. In a few seconds,
he recovered consciousness and began to
answer the doctor's questions. However, he
had no recollections of his mother's handbag
and running.
In January, 1975 (at the age of 251, we
observed his running fits again while we
were doing a memory test. He suddenly got
out of the room and ran into the examination room which is several meters distant.
Then he got on the bed without taking off
his shoes, lay down on it, stamped the bed

Up)

Fig. 4: EEG recording just before the


occurrence of clinical seizures. Seizure discharge was suppressed.

a couple of times, then moved his hands


aimlessly and stared. Although he had no
recollection of the automatism, he recalled
the memory test accurately. This fact suggests that pre-ictal memory was intact.
In July, 1974 when he had frequent attacks, we were able to observe his running
fits during an EEG recording. He suddenly
got up with the electric plates still on, turned
pale, then tried to get down from the bed
although he was restrained by the technician.
At this time, the EEG showed an irregular,
slow pattern, i.e., slower than his usual, previous records with a large amount of spike
and wave complex in both F, RAT and
RMT (Fig. 3). Shortly before the beginning
of this clinical seizure, the EEG record
showed a suppression of seizure discharges
without any change in the background activities, followed by artefacts caused by
body movement (Fig. 4).

T. Kumakura et

258

This patient had a complicated social


life which is believed to be related to his
disease. Basically, he had an egocentric personality, was thoughtless, and indulged in
attention-getting. In 1974, he was arrested
and charged with violation of traffic rules,
e.g., repeated overspeeding and driving without a license, and was sentenced to a sixmonth imprisonment. Shortly before the
final decision was handed down, he began
to have frequent behavior automatism, and
similar running fits as described above,
which brought him to a mental hospital.
Soon after admission, psychomotor seizures
diminished and running fits disappeared
completely.
In February, 1976 he attempted suicide
by taking an overdose of drugs after being
apprehended by the police for driving without a license. Frequent attacks of running
fits occurred soon after he recovered from
the drug-overdose. Our observation on the
events described above led us to conclude
that emotional influences such as fear and
anxiety played important roles in precipitating his running fits.
In July, 1977, after serving his jail term,
he had crying fits and autonomic seizures.
These seizures were controlled successfully
by a combination of Carbamazepine, Acetylpheneturide, Primidone, Diazepam, and
Acetazolamide. With his seizures under control, he was able to adapt to a well-adjusted
social life and has been engaged in an independent enterprise of his own for a year.
The EEG recorded lately shows 8-12 c.P.s.,
irregular alpha waves, about 30pv, prominent in occipital, parietal and central, with
6-7 c.P.s., theta waves, 50 pv, marked in F
and T. In the drowsy state, the EEG disclosed seizure discharges in F and AT.
DISCUSSION
Psychomotor seizures observed in this pa-

at.

tient, at times abortive, with only epigastric,


autonomic and visual auras, sometimes developed into behavior automatism but never
showed an oral type. Running fits in this
case seemed to be preceded by an emotional
aura such as fear and anxiety.
Unfortunately, we were unable to obtain
an EEG record during the attack, but the
EEG during the interseizure period showing
focal abnormal waves in F and T led us to
conclude that this running fit is a type of
behavior automatism. Sisler et al. emphasized psychogenic factors such as personality deviation and conflicts with other members of the family. They ascribed running
as an expression of running towards or
away from a significant person or situation. In our case, we also found out that
emotional factors (particularly during the
court trial and before court sentence) played
an important role in precipitating the seizures.
SUMMARY
We presented a case of epilcpsia cursiva
starting with generalized convulsion, then
developing as the patient grew older, into
frequent attacks of psychomotor seizures including running fits, in which psychogenic
causes may have played a vital role in
precipitating the seizures.
REFERENCES
1 Chen, R. C. and Forsters, F. M.: Cursive

epilepsy and gelastic epilepsy, Neurology,


238 1010-1029, 1973.
2 Inanaga, K. and Ishikura, R.: 2 cases of
epilepsia cursiva, Kyushu Neuropsychiat,
6: 48-51, 1957 (in Japanese).
3 Kobayashi, K., Shomori, T. and Kosaka,
M.: A case of running fit, Clin Psychiat,
178 613-616, 1975, (in Japanese).
4 Sisler, G. C., Levy, L. L. and Roseman, E.:
Epilepsia cursiva, syndrome of running
fits,Arch Neurol Psychiat, 69: 73-79, 1953.