Ictal automatisms with preserved responsiveness in a patient with left mesial temporal lobe epilepsy

Purpose: To describe the possible mechanism of ictal automatisms with prese rved responsiveness (APRs) in a patient with left mesial temporal lobe epil epsy, which had not been reported previously. Methods: Ictal EEGs recorded from bilateral foramen ovale electrodes with s calp-sphenoidal electrodes were analyzed in respect to the ictal semiology. Results: The patient had a right hemispheric language dominance in the dext ral. Electroclinical analysis revealed that the onset of oroalimentary auto matisms coincided with the involvement of the left mesial and lateral tempo ral structures by spreading ictal discharges. The ictal discharge spreading was limited to the ipsilateral hemisphere throughout the seizure, which ex plained the intact consciousness and preserved responsiveness of the patien t. Conclusions: This case suggests that APRs take place in seizures originatin g from the nondominant temporal lobe, during which ipsilateral mesial and l ateral temporal structures are diffusely involved without spreading to the contralateral side.