Touch-screen automatisms in the digital age.

OBJECTIVE: To describe a novel set of gestural automatisms related to the use of digital screens on smartphones and tablets in patients with epilepsy. METHODS: Representative patients were selected from among those admitted to the Epilepsy Monitoring Unit at the Toronto Western Hospital between April 2016 and January 2020, and included if they exhibited automatisms clearly related to or mimicking digital device use. RESULTS: In total 5 patients were included, 4 female. All had temporal lobe epilepsy: 2 had left mesial temporal sclerosis and 3 had normal imaging. Nearly equal numbers of seizures began with right (5/9) and left (4/9) temporal onsets, with most automatisms occurring after seizure propagation to bilateral temporal involvement (6/9). Left-handed automatisms were most common (8/9). The majority of the automatisms (7/9) were perseverative on device usage prior to the seizure. CONCLUSION: Gestural automatisms appear related to the contemporary lived experience, culture, and habitual behaviour of patients with epilepsy. In the modern era, the use of smartphones and tablets are both common and habitual for many, and this case series shows that touch-screen automatisms may be added to the semiological panoply of temporal lobe seizures.

Forensic neuropsychiatric aspects of epilepsy.

Epilepsy may be associated with automatisms that are classed as 'insane 'as they are deemed to have originated within the mind. 'Sane automatism' is said to occur from external factors, such as physical trauma, while 'insane automatism' is said to be innate to the individual experiencing them. To claim automatism within the context of a criminal matter requires a detailed evaluation of the behavior demonstrated and a questioning of the volitional and purposeful nature of this behavior. It is insufficient to rely upon past behavior in association with these seizures to justify the defense of automatism within a specific event. Epilepsy is often considered to be associated with an increase in violence. Proper epidemiological research, both in long-term, large population control studies and hospital-based studies, has suggested that epilepsy, per se, is not associated with an increase in violence when compared to the population at large and controlled for other familial and environmental factors.

Ictal religious speech in non-dominant temporal lobe epilepsy: three cases.

Ictal religious speech and gestures, rare ictal semiological findings, sign the epileptic focus at the non-dominant temporal lobe in the literature. Therefore, we aim to present non-dominant temporal lobe semiological findings, including ictal praying and religious gestures in three cases.

An International Comparison and Review of Self-Induced Intoxication Causing Automatism.

The topic of self-induced intoxication causing automatism is a complex legal question that straddles the border of psychiatry, the law, and social policy. It has been argued that women and children are predominantly positioned as victims of sexual and domestic violence, in which substances often play a part. This consideration sensitizes society to any legal measures that may potentially excuse, mitigate, or absolve perpetrators. The legal systems in Canada, the United States, and the United Kingdom have dealt with these situations as best as they can, sometimes inconsistently and sometimes coming into conflict with the public discourse and subsequent legislation. This article presents a comparison of case law and legislation among these three countries. We review the concept of automatism and self-induced intoxication leading to automatism, and we show how the courts have dealt with this subject.

La señal de la cruz: un automatismo muy poco frecuente en la epilepsia del lóbulo temporal. Descripción de dos casos / The sign of the cross: a very rare automatism in temporal lobe epilepsy. Two case reports

Introducción: En la evaluación de la epilepsia farmacorresistente, el análisis detallado de la semiología es fundamental para establecer una hipótesis diagnóstica de la localización de la zona epileptógena. La señal de la cruz es un automatismo manual complejo muy infrecuente descrito por primera vez en 2008 y poco referido en la bibliografía. Caso clínico: Presentamos dos casos con presencia de la señal de la cruz de nuestra serie de pacientes monitorizados mediante videoelectroencefalograma, uno de ellos estudiado también con electrodos profundos, en los que describimos la localización de la descarga en el momento de realizar la señal de la cruz. Se realiza también una revisión bibliográfica para intentar establecer un valor localizador y/o lateralizador de este signo.(AU)

Introduction: In the evaluation of drug-resistant epilepsy, a detailed analysis of the semiology is essential to establish a diagnostic hypothesis of the location of the epileptogenic zone. Cross-sign (CS) is a very infrequent complex manual automatism described for the first time in 2008 and rarely reported in the literature. Case report: We present two cases from our series of patients monitored by video-EEG, one of whom also studied with deep electrodes, in which we describe the location of the discharge while performing the CS. A bibliographic review is also carried out to try to establish a localizing and/or lateralizing value of this sign. Conclusion: The sign of the cross is a rare ictal automatism that occurs in patients with temporal lobe epilepsy. The hand used to make the sign of the cross is the dominant one, regardless of the origin of the crises.(AU)

[The sign of the cross: a very rare automatism in temporal lobe epilepsy. Two case reports]. / La señal de la cruz: un automatismo muy poco frecuente en la epilepsia del lóbulo temporal. Descripción de dos casos.

INTRODUCTION: In the evaluation of drug-resistant epilepsy (DRF), a detailed analysis of the semiology is essential to establish a diagnostic hypothesis of the location of the epileptogenic zone. Cross-sign (CS) is a very infrequent complex manual automatism described for the first time in 2008 and rarely reported in the literature. CASE REPORT: We present two cases from our series of patients monitored by videoEEG, one of whom also studied with deep electrodes, in which we describe the location of the discharge while performing the CS. A bibliographic review is also carried out to try to establish a localizing and/or lateralizing value of this sign. CONCLUSION: The sign of the cross is a rare ictal automatism that occurs in patients with temporal lobe epilepsy. The hand used to make the sign of the cross is the dominant one, regardless of the origin of the crises.

TITLE: La señal de la cruz: un automatismo muy poco frecuente en la epilepsia del lóbulo temporal. Descripción de dos casos.Introducción. En la evaluación de la epilepsia farmacorresistente, el análisis detallado de la semiología es fundamental para establecer una hipótesis diagnóstica de la localización de la zona epileptógena. La señal de la cruz es un automatismo manual complejo muy infrecuente descrito por primera vez en 2008 y poco referido en la bibliografía. Caso clínico. Presentamos dos casos con presencia de la señal de la cruz de nuestra serie de pacientes monitorizados mediante videoelectroencefalograma, uno de ellos estudiado también con electrodos profundos, en los que describimos la localización de la descarga en el momento de realizar la señal de la cruz. Se realiza también una revisión bibliográfica para intentar establecer un valor localizador y/o lateralizador de este signo. Conclusión. La señal de la cruz es un raro automatismo ictal que ocurre en pacientes con epilepsia del lóbulo temporal. La mano empleada para la señal de la cruz es la dominante, independientemente del origen de las crisis.

Involvement of the Anterior Nucleus of the Thalamus during Focal Automatisms in Epileptic Seizures: A First Evidence Study.

The Anterior Nucleus of Thalamus (ANT) Deep Brain Stimulation (DBS) has long been touted as the most effective DBS-target for interrupting seizures in focal refractory epilepsy patients. The ANT is primarily involved in cognitive tasks but has extensive reciprocal connections with motor-related regions, suggesting that it is also involved in motor-cognitive tasks. In this work, we aimed to assess the involvement of the ANT during voluntary upper limbs movements. For this purpose, we analyzed Local Field Potentials (LFPs) signals recorded during a movement protocol from one of the first epilepsy patients implanted with a Percept™ PC system, who performed a 5-day period of simultaneous video electroencephalography (vEEG) and Percept PC-LFPs recordings. We estimated time-frequency maps and performed event-related desynchronization (ERD) or synchronization (ERS) analysis and we found that synchronizations found in left hemisphere 7-17 Hz map corresponded to maximum hand rotations. Positive peaks on the ERD/ERS curve occurred at a similar frequency of the hand movements ([Formula: see text] against [Formula: see text]). These results suggested that the ANT may be involved in the execution of automatisms. Moreover, we found that ERD/ERS appeared approximately 2 seconds before the movement onset, as it was found on the EEG of healthy subjects performing the same protocol.

Clinical features of automatisms and correlation with the seizure onset zones: A cluster analysis of 74 surgically-treated cases.

OBJECTIVES: To identify semiologic features of automatisms correlating to different seizure onset zones (SOZ). METHODS: In total, 204 seizures from 74 patients with either oral or manual automatisms were assessed. Patients were divided into four groups depending on the SOZ into frontal, posterior, neocortical temporal, and mesial temporal cortex groups. A k-means analysis was applied on 11 semiologic features on a multi-criteria scale. Then, the resulting clinical patterns were correlated with the SOZs determined by presurgical anatomy-electroclinical data (25 cases with stereo-EEG). RESULTS: Four clinical patterns of automatisms with different accompanying symptoms were identified. The clinical features of clusters 1 and 4 were mostly found in temporal epilepsy whereas clusters 2 and 3 were more frequent in extratemporal epilepsy. Cluster 1 was significantly correlated with mesial temporal lobe epilepsy (p = .017) and was characterised by aura, postictal confusion, short automatisms delay. Cluster 3 included 1/3 patients with frontal lobe epilepsy and was characterised by emotionality. Cluster 4 was related to neocortical temporal lobe epilepsy and characterised by dystonia and short automatism delay (p = .011). CONCLUSION: The distinct semiologic patterns of automatisms may provide information which may allow clinicians to define the SOZs. These findings could improve diagnostic accuracy and surgical outcome.

Electroclinical features and long-term therapeutic response in patients with typical absence seizures.

OBJECTIVE: To characterize in detail the electroclinical features of typical absence seizures and elucidate whether EEG or semiology features, alone or in combination, can predict long-term therapeutic outcome. METHODS: We analysed video-EEG recordings from 213 typical absence seizures from 61 patients with idiopathic generalized epilepsy. We extracted semiological features, in addition to hallmark manifestations (motor/behavioural arrest, non-responsiveness), their location, timing and frequency. We evaluated the duration and frequency of generalized spike-wave discharges and the presence of polyspikes. We used a supervised machine-learning approach (random forest) to search for classifier features for long-term therapeutic outcome (>one year). RESULTS: Besides the hallmark manifestations, additional semiological features were identified in 87% of patients (75% of seizures). The most common additional semiological features were automatisms and eye blinking (observed in 45% and 41.5% of seizures, respectively). Automatisms were associated with longer seizure duration, and oral automatisms occurred earlier compared to limb automatisms (4.03 vs. 6.19 seconds; p=0.005). The mean duration of the ictal spike-wave discharges was nine seconds, and the median frequency was 3 Hz. Polyspikes occurred in 46 seizures (21.6%), in 19 patients (31%). Median follow-up was five years, and 73% of the patients were seizure-free at the end of the follow-up. None of the semiological features, alone or in combination, were predictors of therapeutic outcome. The only significant classifier was the presence of polyspikes, predicting a non-seizure-free outcome with an accuracy of 73% (95% CI: 70-77%), positive predictive value of 92% (95% CI: 84-98%) and negative predictive value of 60% (95% CI: 39-81%). SIGNIFICANCE: Semiological features, in addition to behavioural arrest and non-responsiveness, are common in typical absence seizures, but they do not predict long-term therapeutic outcome. The presence of polyspikes has a high positive predictive value for unfavourable therapeutic outcome, and their presence should therefore be included when reporting EEGs in patients with typical absence seizures.

Examining Automatic Stereotyping From a Propositional Perspective: Is Automatic Stereotyping Sensitive to Relational and Validity Information?

Research on automatic stereotyping is dominated by the idea that automatic stereotyping reflects the activation of (group-trait) associations. In two preregistered experiments (total N = 391), we tested predictions derived from an alternative perspective that suggests that automatic stereotyping is the result of the activation of propositional representations that, unlike associations, can encode relational information and have truth values. Experiment 1 found that automatic stereotyping is sensitive to the validity of information about pairs of traits and groups. Experiment 2 showed that automatic stereotyping is sensitive to the specific relations (e.g., whether a particular group is more or less friendly than a reference person) between pairs of traits and groups. Interestingly, both experiments found a weaker influence of validity/relational information on automatic stereotyping than on non-automatic stereotyping. We discuss the implications of these findings for research on automatic stereotyping.

Ventral pallidum regulates the default mode network, controlling transitions between internally and externally guided behavior.

Daily life requires transitions between performance of well-practiced, automatized behaviors reliant upon internalized representations and behaviors requiring external focus. Such transitions involve differential activation of the default mode network (DMN), a group of brain areas associated with inward focus. We asked how optogenetic modulation of the ventral pallidum (VP), a subcortical DMN node, impacts task switching between internally to externally guided lever-pressing behavior in the rat. Excitation of the VP dramatically compromised acquisition of an auditory discrimination task, trapping animals in a DMN state of automatized internally focused behavior and impairing their ability to direct attention to external sensory stimuli. VP inhibition, on the other hand, facilitated task acquisition, expediting escape from the DMN brain state, thereby allowing rats to incorporate the contingency changes associated with the auditory stimuli. We suggest that VP, instant by instant, regulates the DMN and plays a deterministic role in transitions between internally and externally guided behaviors.

Oral and manual automatisms elicited by electrical stimulation of the pars opercularis cortex in a patient with frontal lobe epilepsy.

Oral automatism (OA) and manual automatism (MA) are common signs during initiation of temporal seizures. However, the precise symptomatogenic zones for OA and MA remains largely unclear. In this study, we presented a case of intractable frontal lobe epilepsy (FLE) in which the patient received intracranial EEG monitoring with subdural electrodes. During electrical stimulation of a grid contact located over the right pars opercularis cortex, OA and contralateral MA were observed unexpectedly without afterdischarges (ADs) or with brief ADs detected in the adjacent contacts. This case suggested that the pars opercularis cortex might play an important role in generating OA. In addition, our data implied that the symptomatogenic zone for MA might locate contralaterally to symptomatic hand.

Temporal lobe epilepsy: A never-ending story.

INTRODUCTION: Semiology and anatomo-electroclinical correlations remain invaluable for maintaining the level of excellence in temporal lobe epilepsy (TLE) surgery, in parallel to the constantly evolving technical progress. The aim of this study was to address semiological frequent and not so frequent signs, rarities and red flags in a long follow-up surgical series of patients suffering from TLE. METHODS: Patients operated within the boundaries of the TL at our center, with presurgical video-EEG recorded seizures and seizure free after a postoperative follow-up of at least 24 months were included. Ictal semiology was systematically described and new red flags were explored by comparing with a second group of patients with the same inclusion criteria but whose outcome had been unfavorable (Engel II-IV). RESULTS: Sixty-two patients were included, 46 seizure free and 16 with outcome Engel II-IV. Most seizure-free patients had a classical semiological presentation including aura (69.6%, abdominal the most frequent), followed by loss of responsiveness (90.2%) oral automatisms (90.7%), ipsilateral gestural automatisms (53.5%), contralateral upper limb dystonia (37.5%) or immobility (39.1%), and early ipsilateral non-versive head orientation (33.3%). More infrequent presentations were also present in the group of seizure-free patients: ictal language disturbance (13%), maintenance of responsiveness during seizures (9.8%), and contralateral rhythmic non manipulative automatism (6.9%). The presence of an isolated viscerosensory and/or psychic aura was significantly more frequent in the seizure-free group (p = 0.017), as well as oroalimentary automatisms (p = 0.005). Two signs were only present in the group with outcome Engel II-IV, constituting possible red flags (0.06 < p < 0.07): inferior limbs stepping-like automatisms and postictal dysarthria. CONCLUSION: An adequate clinical exam during seizures and a careful analysis of video recordings allow to recognize infrequent but well-characterized ictal signs that are part of the range of semiology in TLE, together with the most frequent and classical ictal presentations. Special attention to the localization hypothesis must be paid in the absence of oroalimentary automatisms or when the signs classified as possible red flags emerge.

Handwriting in Alzheimer's Disease.

BACKGROUND: Agraphia is a typical feature in the clinical course of Alzheimer's disease (AD). OBJECTIVE: Assess the differences between AD and normal aging as regards kinematographic features of handwriting and elucidate writing deficits in AD. METHODS: The study included 23 patients with AD (78.09 years/SD = 7.12; MMSE 21.39/SD = 3.61) and 34 healthy controls (75.56 years/SD = 5.85; MMSE 29.06/SD = 0.78). Both groups performed alphabetical and non-alphabetical writing tasks. The kinematographic assessment included the average number of inversions per stroke (NIV; number of peaks in the velocity profile in a single up or down stroke), percentage of automated segments, frequency (average number of strokes per second), writing pressure, and writing velocity on paper. RESULTS: A total of 14 patients showed overt writing difficulties reflected by omissions or substitutions of letters. AD patients showed less automated movements (as measured by NIV), lower writing velocity, and lower frequency of up-and-down strokes in non-alphabetical as well as in alphabetical writing. In the patient group, Spearman correlation analysis between overt writing performance and NIV was significant. That means patients who had less errors in writing a sentence showed a higher automaticity in handwriting. The correctness of alphabetical writing and some kinematographic measures in writing non-alphabetical material reached excellent diagnostic values in ROC analyses. There was no difference in the application of pressure on the pen between patients and controls. CONCLUSION: Writing disorders are multi-componential in AD and not strictly limited to one processing level. The slow and poorly automated execution of motor programs is not bound to alphabetical material.

The Strategy of Evaluation Automatism for Disability Assessment: A Pragmatic Choice to Simplify the Decision-making Process in the Italian Welfare System.

The first instance assessment of all disability sectors in Italy takes place in most parts of the country in two stages. The first step is the applicant's examination and judgment performed by the Local Health Authority (ASL). The second phase is the verification of the National Social Security Institute (INPS) on the ASL report, which ends with its confirmation or suspension and repetition. Disability examination strategies can fluctuate between the evaluation automatism and the personalised approach. Evaluation automatism implies a necessary and shared prediction of the judgment due to a specific diagnosis. The personalised approach favours a rigorously individualised, unrepeatable assessment, specifically adapted to the case examined. In both perspectives, the criteria for defining disability belong to a medical model that measures the disease-related impairment. The degree of sharing of judgments between ASL and INPS can often imply and express the contribution of the evaluation automatism to the procedure.

Automatic place-value activation in magnitude-irrelevant parity judgement.

Research on multi-digit number processing suggests that, in Arabic numerals, their place-value magnitude is automatically activated, whenever a magnitude-relevant task was employed. However, so far, it is unknown, whether place-value is also activated when the target task is magnitude-irrelevant. The current study examines this question using the parity congruency effect in two-digit numbers: It describes that responding to decade-digit parity congruent numbers (e.g., 35, 46; same parity of decades and units) is faster than to decade-digit parity incongruent numbers (e.g., 25; 36; different parities of decades and units). Here we investigate the (a-) symmetry of the parity congruency effect; i.e. whether it makes a difference whether participants are assessing the parity of the unit digit or the decade digit. We elaborate, how and why such an asymmetry is related to place-value processing, because the parity of the unit digit only interferes with the parity of the decade digit, while the parity of the decade digit interferes with both the parity of the unit digit and the integrated parity of the whole two-digit number. We observed a significantly larger parity congruency effect in the decade parity decision than in the unit parity decision. This suggests that automatic place-value processing also takes place in a typical parity judgment task, in which magnitude is irrelevant. Finally, because of the cross-lingual design of the study, we can show that these results and their implications were language-independent.

Short Versions of the Questionnaires Related to Dysfunctional Cognitions in a Clinical Sample: Dysfunctional Attitude Scale and Automatic Thoughts Questionnaire. / Klinik Bir Örneklemde Islevsel Olmayan Bilislere Iliskin Ölçeklerin Kisa Versiyonlari: Fonksiyonel Olmayan Tutumlar Ölçegi ve Otomatik Düsünceler Ölçegi.

OBJECTIVE: In the literature, Dysfunctional Attitude Scale (DAS) and Automatic Thoughts Questionnaire (ATQ) are two commonly used questionnaires investigating dysfunctional cognitions within the frame of Cognitive Theory. In this study, it was aimed to examine the psychometric properties of the short versions (DAS-17, ATQ-15, ATQ- 8) of these two questionnaires in a clinical sample diagnosed with major depressive disorder. METHOD: The study included 136 adults diagnosed with Major Depressive Disorder on the DSM-IV-TR criteria. The participants were administered the Beck Depression Inventory along with the DAS and ATQ. RESULTS: Four different models were tested in the confirmatory factor analysis for the DAS-17 which was found to provide the best fit for the bifactor model. The analyses indicated that DAS-17 supports a onedimensional structure, pointing to the use of the total score instead of the sub-dimension scores. Results of the confirmatory factor analysis for the ATQ-15 and the ATQ-8 indicate that both scales have a singlefactor structure. Short versions of DAS and ATQ have, respectively, good and excellent internal consistency reliability coefficients. Also, significant relationships were observed between depressive symptoms and dysfunctional attitudes, and automatic thoughts. CONCLUSION: The DAS-17, ATQ-15 and ATQ-8 are valid and reliable scales for use on individuals diagnosed with depression. Nevertheless, it is considered useful to confirm these findings in larger samples.

Ideomotor compatibility enables automatic response selection.

A task is ideomotor (IM)-compatible when there is high conceptual similarity between the stimulus and the associated response (e.g., pressing a left key when an arrow points to the left). For such an easy task, can response selection operate automatically, bypassing the attentional bottleneck that normally constrains dual-task performance? To address this question, we manipulated the IM compatibility of a Task 2 that was performed concurrently with a non-IM-compatible Task 1, using the psychological refractory period procedure. Single-task trials, randomly intermixed with dual-task trials, served as a baseline against which to assess dual-task costs. The results indicated bottleneck bypassing (i.e., simultaneous response selection on both tasks) when Task 2 was IM-compatible, as evidenced by negligible dual-task costs on Task 2 (as well as on Task 1), very high percentages of response reversals, and weak correlations between Task-1 and Task-2 reaction times. These findings were supported by a fine-grained simulation analysis of inter-response intervals. We conclude that the perception of an IM-compatible stimulus directly activates the response code, which can then be selecting automatically, without recruiting central attention, consistent with A. G. Greenwald's (Journal of Experimental Psychology, 94, 52-57, 1972) original theory of IM compatibility.