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Association of Ipsilateral Motor Automatisms and Contralateral Dystonic Posturing
A Clinical Feature Differentiating Medial From Neocortical Temporal Lobe Epilepsy
Sophie Dupont, MD;
Franck Semah, MD;
Paul Boon, MD, PhD;
Jean-Marc Saint-Hilaire, MD;
Claude Adam, MD;
Dominique Broglin, MD;
Michel Baulac, MD
Arch Neurol. 1999;56:927-932.
Background Clinical features that may help to differentiate medial temporal lobe epilepsy (MTLE) from neocortical temporal lobe epilepsy (NTLE) are lacking.
Objective To investigate the localizing and lateralizing value of the association of ipsilateral motor automatisms and contralateral dystonic posturing in patients with medically refractory temporal lobe epilepsy.
Patients and Methods Videotapes of 60 patients with well-defined MTLE, NTLE, 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 posturing. This sign was observed in patients with MTLE and NTLE. It was mostly contralateral to the seizure focus in patients with MTLE and exclusively ipsilateral in patients with NTLE. Unilateral motor automatisms occurred in 26 of the 60 patients with MTLE or NTLE. It was predominantly ipsilateral to the seizure focus in patients with MTLE and exclusively contralateral in patients with NTLE. The association of ipsilateral motor automatisms and contralateral dystonic posturing was found in 14 patients with MTLE but in none of the patients with NTLE. Two patients who had medial and neocortical seizure onset also exhibited this clinical feature. This association was not significantly correlated with the postoperative outcome in patients with MTLE.
Conclusions The association of ipsilateral motor automatisms and contralateral dystonic posturing may help to differentiate MTLE from NTLE with a reliable lateralizing value. This clinical association may reflect a specific pattern in the spread of the ictal discharge.
From the Epilepsy Unit, Clinique Neurologique Paul Castaigne, Hôpital de la Pitié-Salpêtrière, Paris, France (Drs Dupont, Semah, Adam, Broglin, and Baulac); the Epilepsy Monitoring Unit, Gent University Hospital, Gent, Belgium (Dr Boon); and the Department of Neurology, Hôpital Notre-Dame, Montreal, Quebec (Dr Saint-Hilaire). Dr Semah is now with the Service Hospitalier Frédéric Joliot, Commissariat à l'Energie Atomique, Orsay, France.
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