POSTICTAL BEHAVIOR - A CLINICAL AND SUBDURAL ELECTROENCEPHALOGRAPHIC STUDY

Objective: To examine postictal behaviors after temporal lobe complex partial seizures (CPSs) and to correlate these behavioral phenomena wi th side of origin and ictal spread pattern. Design: Review language an d other behavioral phenomena after seizures defined by subdural electr oencephalography. Setting: A surgical epilepsy center. Patients: We st udied postictal behavior following 65 CPSs in 18 patients with left he misphere language dominance using subdural electrode recordings. Inter vention: Subdural electrodes. Main Outcome Measures: Language function , affect, orientation, and postictal automatisms. Results: Following t he CPS ictal discharge, the mean interval for initial nonreflexive res ponse to an environmental stimulus was 43 seconds (left foci, 57 secon ds; right foci, 29 seconds; not significant) and for first correct ver bal response was 219 seconds (left foci, 275 seconds; right foci, 167 seconds; not significant). Impaired comprehension with fluent but unin telligible speech, as well as anemia, occurred after seizures arising from either temporal lobe. All nine seizures followed by global or non fluent aphasia originated on the left side. Paraphasic errors were sig nificantly more common after left temporal CPSs. Prolonged disorientat ion for place and flat affect were significantly more common after rig ht temporal CPS. Postictal automatisms were frequent and included rubb ing of the face, fumbling and picking hand movements, and repetitive o ral movements. Conclusions: Postictal paraphasias, disorientation for place, and flat affect most likely reflect the functions of the area f rom which seizures arise but not the areas involved by spread.