Association of ipsilateral motor automatisms and contralateral dystonic posturing - A clinical feature differentiating medial from neocortical temporal lobe epilepsy

Background: Clinical features that may help to differentiate medial tempora l lobe epilepsy (MTLE) from neocortical temporal lobe epilepsy (NTLE) are l acking. Objective: To investigate the localizing and lateralizing value of the asso ciation of ipsilateral motor automatisms and contralateral dystonic posturi ng in patients with medically refractory temporal lobe epilepsy. Patients and Methods: Videotapes of 60 patients with well-defined MTLE, NTL E, or both were reviewed to assess the presence and the localizing value of unilateral dystonic posturing associated with motor automatisms. Results: Twenty-eight of the 60 patients exhibited unilateral dystonic post uring. This sign was observed in patients with MTLE and NTLE. It was mostly contralateral to the seizure focus in patients with MTLE and exclusively i psilateral in patients with NTLE. Unilateral motor automatisms occurred in 26 of the 60 patients with MTLE or NTLE. It was predominantly ipsilateral t o the seizure focus in patients with MTLE and exclusively contralateral in patients with NTLE. The association of ipsilateral motor automatisms and co ntralateral dystonic posturing was found in 14 patients with MTLE but in no ne of the patients with NTLE. Two patients who had medial and neocortical s eizure onset also exhibited this clinical feature. This association was not significantly correlated with the postoperative outcome in patients with M TLE. Conclusions: The association of ipsilateral motor automatisms and contralat eral dystonic posturing may help to differentiate MTLE from NTLE with a rel iable lateralizing value. This clinical association may reflect a specific pattern in the spread of the ictal discharge.