Teaching Video NeuroImage: Touch-Screen Automatisms With Stereotyped Postictal Texting Behavior

A 34-year-old right-hand dominant woman was admitted to an epilepsy monitoring unit for characterization of new events concerning for seizures. These events consisted of repetitive eye blinking, behavioral arrest, lip smacking and vocalizations, along with trace nonrhythmic left-hand movements with her cell phone consistent with touch-screen automatisms. These seizures were followed by 10-20 minutes retrograde amnesia, during which the patient would send a text message to the same 3 individuals on her phone: "What is your home address?"MRI brain was nonlesional, and vEEG demonstrated increased beta activity in the right mid-temporal region (T4) with evolution to rhythmic delta activity spreading to the right anterior temporal, and then frontal regions, subsequently generalizing to both hemispheres (Video 1). Touch-screen automatisms are a novel set of gestural automatisms related to the use of digital screens on smartphones and tablets.¹ Their proposed mechanism includes a disinhibition of previously learned motor sequences involving the corticostriatal loops, frontal, parietal, and cerebellar networks.