Genital automatisms in complex partial seizures

Objective: To determine which brain region is responsible for the generatio n of sexual automatisms. Methods: Ninety consecutive patients with medicall y refractory focal epilepsy (74 with temporal lobe and 16 with frontal lobe epilepsy) referred to an epilepsy monitoring unit were studied. The occurr ence of the following sexual automatisms was assessed during prolonged vide o-EEG monitoring: 1) repeatedly grabbing or fondling the genitals and 2) pe lvic or truncal thrusting or similar movements. Results: Five patients repe atedly fondled or grabbed their genitals during or immediately after some o f their seizures. All five had temporal lobe epilepsy, as evidenced from pr olonged video-EEG monitoring, high-resolution MRI, and goad to excellent-ou tcome after epilepsy surgery. Sexual automatisms did not occur with frontal lobe epilepsy. Conclusion: Sexual automatisms cannot be related exclusivel y to frontal lobe seizures. As previously proposed, apparently sexual hyper motoric pelvic or truncal movements are common in frontal lobe seizures, bu t this study suggests that discrete genital automatisms, like fondling and grabbing the genitals, are more common in seizures evolving from the tempor al lobe.