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Ictal pouting: kabuki visage or chapeau de gendarme?
  1. Itaru Hayakawa,
  2. Masaya Kubota
  1. Division of Neurology, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
  1. Correspondence to Dr Itaru Hayakawa, National Center for Child Health and Development, Okura, Setagaya-ku 157-0074, Tokyo; itaruhayakawa{at}

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A previously healthy 16-year-old boy presented to the emergency department with a peculiar, paroxysmal, stereotypical facial gesture (figure 1). One year earlier, he had first developed a sudden, involuntary ‘coarsening’ of his facial expression lasting several seconds. During this, he retained consciousness and was aware of the facial posture. He had no accompanying aura, fearfulness, anguish or autonomic disturbances. Over the following first 9 months, he had same facial grimace only twice, each time while at school during the daytime. However, in the 3 months before presentation, the paroxysms increased in frequency and became daily in the last month. His neurological examination was normal. Interictal electroencephalography was normal, but 3-day video electroencephalography captured multiple seizures with a possible right frontotemporal origin, each lasting less than 1 min (figure …

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  • Contributors IH took care of the patient, designed the study and drafted the initial manuscript. MK supervised the care and intensively revised the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval National Center for Child Health and Development.

  • Provenance and peer review Not commissioned; externally peer reviewed by Rob Powell, Swansea, UK.

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