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Pupillary hippus (PH) refers to spontaneous bilateral synchronous rhythmic constriction and dilatation of the pupils [1]. This rare phenomenon is spasmodic, cyclic and bilaterally in phase, and is usually considered benign [2]. However, this clinical sign can rarely be the main manifestation of refractory epilepsy and nonconvulsive status epilepticus (NCSE) in critically ill patients [1,3–4]. Nevertheless, a detailed description of video-electroencephalography (v-EEG) correlate remains elusive.