Temporal versus frontal
Temporal versus frontal lobe seizures with automatisms in children with surgically verified epileptogenic zone.
Grinenko O., Golovteev A., Troitskiy A., Kazaryan A., Ayvazyan S., Melikyan A.
Kazaryan Clinic of Epileptology and Neurology.
Burdenko Neurosurgical Institute.
Moscow Pediatric Center of Craniofacial Surgery and Neurology.
Purpose: To compare semiology of seizures with automatisms originating from the frontal lobe (FLS) and from the temporal lobe (TLS) in children who became seizure-free after surgery.
Methods: We analyzed 25 videotaped TLS from ten patients and 16 videotaped FLS from six patients aged 3.5–16 years (mean 7.9 years). Median follow-up was 18 months (range 5–40 months). Fourteen types of symptoms and signs were evaluated in every seizure. The course of each seizure conditionally was divided in three consecutive stages. The time of symptoms onset was determined in relation to each stage of seizure.
Results: Ipsilateral distal hand automatisms with contralateral arm distonic posture were seen only in the TLS (13 seizures in 5 patients), whereas proximal automatisms were more frequent in the FLS (14 seizures in 5 patients), then in TLS (5 seizures in 2 patients) (P <0.001).
Ipsilateral manipulating distal automatism were more common in the TLS (P <0.007) (15 seizures in 7 patients) as bimanual ones - in the FLS (9 seizures in 3 patients) (P <0.004).
Nonmanipulating rounded rhythmical proximal automatisms in TLS were determined exclusively contralaterally and only during the first third of the seizure (5 seizures in 2 patients).
Oral automatisms in FLS were seen only in the last third of the seizure (6 seizures in 2 patients).
Conclusion: Automatisms in both TL and FL seizures have a different and specific order of appearance and laterality. A distinctive and strongly contralateral rhythmical rounded proximal automatism was identified in TLS.