The lateralizing value of upper extremity movements in complex partial seizures of temporal lobe origin: A video-EEG study

We evaluated the lateralizing value of ictal upper extremity movements in t emporal lobe epilepsy (TLE). Videotapes of 259 complex partial seizures fro m 83 patients who became seizure-free after anterior temporal lobectomy wer e retrospectively studied. Pathologic diagnosis included hippocampal sclero sis in 73 patients and "lesional" in 10 patients. Ictal upper extremity mov ements were arbitrarily classified into four categories including dystonic posturing, tonic posturing, hand automatisms, and immobility. Dystonic post uring occurred in 86 seizures (33.2%) from 29 patients (34.9%), which inclu ded 28 hippocampal sclerosis and only one (3.4%) lesional. In all seizures except one (98.8%), dystonic posturing was unilateral and contralateral to the seizure focus (p < 0.001). Tonic posturing was observed in 64 seizures (24.7%), 48 unilateral and 16 bilateral, from 31 patients (37.3%). Tonic po sturing did not lateralize the seizure focus (p = 0.477) or tend to seconda rily generalize (p 0.757). Unilateral or bilateral hand automatisms occurre d in 188 seizures (72.6%) from 71 patients (85.5%). From 113 seizures with unilateral hand automatisms, 105 (92.9%) originated from the ipsilateral te mporal lobe (p < 0.001). Immobility of the upper extremities was found in 6 4 seizures (24.7%) and appeared not to lateralize. Key Words: Complex parti al seizures-Temporal lobe epilepsy-Anterior temporal lobectomy-Dystonic pos turing-Tonic posturing-Hand automatisms. (C) 1998 by Elsevier Science Inc. All rights reserved.