The lateralizing value of upper extremity movements in complex partial seizures of temporal lobe origin: A video-EEG study

We evaluated the lateralizing value of ictal upper extremity movements in temporal lobe epilepsy (TLE). Videotapes of 259 complex partial seizures from 83 patients who became seizure-free after anterior temporal lobectomy were retrospectively studied. Pathologic diagnosis included hippocampal sclerosis in 73 patients and “lesional” in 10 patients. Ictal upper extremity movements were arbitrarily classified into four categories including dystonic posturing, tonic posturing, hand automatisms, and immobility. Dystonic posturing occurred in 86 seizures (33.2%) from 29 patients (34.9%), which included 28 hippocampal sclerosis and only one (3.4%) lesional. In all seizures except one (98.8%), dystonic posturing was unilateral and contralateral to the seizure focus (p < 0.001). Tonic posturing was observed in 64 seizures (24.7%), 48 unilateral and 16 bilateral, from 31 patients (37.3%). Tonic posturing did not lateralize the seizure focus (p = 0.477) or tend to secondarily generalize (p = 0.757). Unilateral or bilateral hand automatisms occurred in 188 seizures (72.6%) from 71 patients (85.5%). From 113 seizures with unilateral hand automatisms, 105 (92.9%) originated from the ipsilateral temporal lobe (p < 0.001). Immobility of the upper extremities was found in 64 seizures (24.7%) and appeared not to lateralize.