Seizure with prominent tonic initial signs followed by psychomotor features: a case report clinically manifesting an unusual ictal evolution

A clinically tonic seizure phase, immediately followed by psychomotor featu res (right hand dystonic posture, left hand and oral automatisms), was reco rded by video and EEG, in a patient who had gliosis of the left temporal lo be and left hippocampal atrophy. Interictal epileptiform discharges were fr equently seen in the left temporal area, and at the time of the tonic seizu re phase, ictal spike discharges were continuously observed at the left pos terior temporal area, which was recognized only by applying a high frequenc y filler (HFF) of 15 Hz to the digitally recorded EEG because EMG artifacts totally obscured the EEG with a HFF of 60 Hz. It is most likely that tonic seizure can occur in an adult patient with temporal lobe epilepsy, and it is speculated that an epileptogenic focus might activate a certain brain ar ea which is regarded as a symptomatogenic zone for tonic seizures. If the t onic seizure phase is immediately followed by psychomotor features as seen in the present patient, the former could be due to focal epilepsy.