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Eur Neurol 2000;43:117119

Epilepsia cursiva
The Forgotten Running Fits

Franz-Josef Holzer, Pierre R. Burkhard, Theodor Landis


Department of Neurology, University Hospital Geneva,
Switzerland

Temporal lobe epilepsy features a wide variety of clinical manifestations. Some of them are considered to be of psychogenic origin.
Motor manifestations like blinking, mastication or gesticulation are
common and easily identified. Even the more complex activity of
walking during a non-convulsive status is well documented. However, running as an ictal manifestation of temporal lobe epilepsy is
uncommon and probably often unrecognised. We report a new case,
which illustrates the typical features of the so-called running fits.
In 1985, this 45-year-old right-handed healthy accountant developed left sensory seizures leading to the diagnosis of a right parietal
tumor confirmed by biopsy as an astrocytoma grade 2.
Over the next years, the patient progressively developed a sensorimotor deficit of the left hemibody, occassionally accompanied by
involuntary forced closure of the right eyelid.
CT scan and MRI showed progression of the tumor size with
extension into the frontotemporal regions (fig. 1), and a second biopsy confirmed transformation into grade 3. Clonazepam was introduced as anticonvulsive medication, and loco-regional radiotherapy
led to a significant reduction of the tumor size, an improvement of
the left hemisyndrome and the seizure frequency.

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astrocytoma of the right temporal lobe (scale in centimetres).

In August 1997, 4 months prior to admission, he complained


about unsteadiness and gait difficulties. Two months later, the first
running episode occurred. While walking his dog he suddenly felt an
irrepressible urge to run which could not be suppressed by will and
which was indeed followed by an involuntary run around the nearby
building. Although partially capable of directing his way, he first
bumped into the main entrance of the building, then against the mailboxes. Still continuing his run he escalated a flight of stairs toward
the second floor where he hit the banisters and finally the entry door
of his apartment where the run stopped abruptly. This episode lasted
about 5 min.
He reported no unusual feelings prior to the run and did not lose
consciousness. There was no emotional change during the run, and
recall of the episode was intact. Despite additional treatment with
phenytoin 100 mg t.i.d, the patient repeatedly suffered similar episodes over the next 2 months, occasionally leading to falls.
At admission, neurological examination showed a left sensorimotor deficit and signs of phenytoin intoxication (116 mol/l, normal
range 4080 mol/l) which improved after correction. EEG showed
persistently rhythmic theta abnormalities over the right centroparietal regions.
Running as an ictal manifestation of epilepsy has been known for
a long time. Penfield and Jasper [1] cite Thomas Erastus [2], a Swiss
physician and philosopher who described in 1581 a girl running for
half an hour with loss of contact and retrograde amnesia but conserved spatial orientation. Bootius [3] proposed in 1619 the terms
epilepsia cursiva. Up to now, some 39 cases of cursive epilepsy have
been described, a good number of which have been thought to be of
psychogenic origin. Moreover, a relation to gelastic epilepsy has been
postulated [4]. However, association of running seizures and laughing in a single patient is extremely rare. In 1973, Chen and Forster [5]
published a study of 5,000 cases of epilepsy. They found 8 cases of

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References
1 Penfield W, Jasper H: Epilepsy and the Functional Anatomy of the Human
Brain. Boston, Little, Brown 1954, pp 11.
2 Erastus T: Comitis Montani Vincentini novi medicorum clusoris, quinque
librorum de morbis nuper editorum viva anatome. Basilea, 1581.
3 Bootius: Observationes medicae de affectis omissis. London, 1619.
4 Kaplan PW, Loiseau P, Fisher RS, Jallon P: Epilepsy A to Z: A Glossary of
Epilepsy Terminology. New York, Demos Vermande, 1995, pp 79.
5 Chen RC, Forster FM: Cursive epilepsy and gelastic epilepsy. Neurology
1973;23:10191029.
6 Bachmann DS, Shultz J, Cooper R: Cursive and gelastic epilepsy: Case
Report. Clin Electroencephalogr 1981;12:3234.
7 Jandolo B, Gessini L, Occhipinti E, Pompili A: Laughing and running fits
as manifestation of early traumatic epilepsy. Eur Neurol 1977;15:177
182.
8 Sethi PK, Rao TS: Gelastic, quiritarian, and cursive epilepsy: A clinicopathological appraisal. J Neurol Neurosurg Psychiatry 1976;39:823828.
9 Walsh GO, Delgado-Escueta AV: Type II complex partial seizures: Poor
results of anterior temporal lobectomy. Neurology 1984;34:113.

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Fig. 1. Coronal T1 MRI scan after gadolinium perfusion showing

gelastic, 6 cases of cursive and 2 cases of both gelastic and cursive


epilepsy. These 8 cases of cursive epilepsy represented a frequency of
0.16% of their series.
A detailed survey of the cases published in the last 50 years [517]
shows that the affected patients are predominantly young males with
a mean age of 19 years and a male to female ratio of 2:1.
The majority of published EEGs are interictal recordings. Findings include dysrhythmic activity and spikes-and-waves discharges.
Only a limited number of ictal recordings [59] of running seizures
are available. They show spikes or spikes-and-waves trains most frequently over the temporal lobes. Walsh and Delgado-Escueta [9] performed depth EEGs and found the seizure focus to be located in the
right hippocampus and right amygdala.
Common causes include trauma or tumor. There does not seem
to be a predilection side.
The mechanism of cursive epilepsy is still unclear. The main
hypothesis proposed by most authors is based on the idea that running during a seizure is ... a dynamic physical expression of an internal state of fear [8]. Fear or anxiety in this context is considered as
the result of epileptic discharges in the limbic system. Other authors
conceive the runnings as equivalent to forced thinking or laughter
existing in other forms of epilepsy.
At variance with this hypothesis, our patient was lacking any
emotional changes or altered consciousness while running. We thus
believe that this particular manifestation may well be a complex
motor automatism due to epileptic discharges not confined to be
temporal lobe, but presumably extending bilaterally toward frontal
regions.
Several lines of argument suggest that our patients running episodes have indeed an epileptic origin: the patient suffered from a
large brain tumor with profound EEG abnormalities; episodes
started and ended abruptly and were not influenced by will, and
moreover, the patient was already known for having focal seizures.
With 57 years of age, our patient is the oldest of the reported cases.
In conclusion, running seizures are a rare manifestation of temporal lobe epilepsy, either left or right, affecting most frequently young
male adults with brain tumour or trauma.
The present case might serve as a reminder of this relatively rare
seizure manifestation, which, as in our case, is regularly mistaken for
a psychogenic manifestation and whose pathophysiology is not yet
well understood. We suggested that running may be added to the
existing list of motor automatisms of temporal lobe origin.

10 Sisler GC, Levy LL, Roseman E: Epilepsia cursiva: Syndrome of running


fits. Arch Neurol Psychiatr 1953;69:7379.
11 Strauss H: Paroxysmal compulsive running and the concept of epilepsia
cursiva. Neurology 1960;10:341344.
12 Shale JH, Murray GB: Psychiatric presentation of epilepsia cursiva. Can
Psychiatr Assoc J 1978;23:395398.
13 Woon TH, Vignaendra V: Cursive and gelastic epilepsy: Probable sequelae
of physical abuse. Postgrad Med J 1984;54:821824.
14 Kumakura T, Hayashi M, Shimazono Y: A case of epilepsia cursiva whose
running fits were precipitated by psychogenic factors. Folia Psychiatr Neurol Jpn 1979;33:255258.
15 Lai ML, Chen RC: Gelastic epilepsy and cursive epilepsy. Taiwan I Hsueh
Hui Tsa Chih 1980;79:483490.
16 Guerreiro CA, Silveira DC, Gereirro MM: Cursive and gelastic manifestations of epilepsies. Arq Neuropsiquiatr 1987;45:397402.
17 Nakken KO: Gelastic and cursive epilepsy. Tidsskr Nor Laegeforen 1989;
109:581583.
Dr. Pierre Burkhard, Department of Neurology,
University Hospital, CH1211 Geneva 14 (Switzerland)
Tel. + 41 22 372 33 11, Fax + 41 22 372 83 33
E-Mail Pierre.Burkhard@hcuge.ch

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