Semiology and its Lateralizing Signs in Mesial Temporal Lobe Epilepsy

ABSTRACT

We analysed video tapes in 31 patients of 97 seizures who were evaluated for epilepsy surgery at AMC Neurology department between 1992 and 1994. All patients had epilepsy surgery such as temporal lobe resection or gamma knife radiosurgery. They were either seizure free or had a greater than 90% reduction in the number of seizures for at least 12 months following surgery. Oromandibular automatism (74.2%), behavioral arrest/staring (63.9%), and upper extremity automatisms (37 1%) were frequent ictal manifestations of mesial temporal lobe epilepsy in our patients, Initial non-versive head turning was observed in 49 events (ipsilateral 77.8%, contralateral 22.2%), while versive head turning was noticed in 25 events (ipsilateral 7.1%, contralateral 92.9%). Contralateral dystonic posture was observed in 47 events (48.5%). Vocalization was observed in 2 among 12 patients (16.7%) with non-dominant sided lesions, and 9 among 19 patients (47.4%) with dominant sided lesions. Dystonic posture was observed contralaterally (100%), hand automatism ipsilaterally (94.4%) and versive head/eye turning wart observed ipsilaterally (92.3%) in our patients. So we concluded that valuable lateralizing sign in mesial temporal lobe origin seizure are contralateral dystonic posture, ipsilateral hand automatism, and versive contralateral head/eye turning. And also turning and rounding sign may have possible lateralizing value.