Abstracts

RATIONALE: Semiological data is fundamental for the diagnosis and determination of the origin of epileptic seizures. Post-ictal nose wiping (PINW) and distonic posturing (DP) are important in lateralization of the temporal lobe seizures. The first would be more frequent in mesial temporal lobe epilepsy although there are controversies as to the hemispheric origin of this sign and its occurrence in secondary generalized seizures. METHODS: The presence of PINW and DP were analised in 129 seizures (104 complex partial and 25 CP with secondary generalization) registered in video-EEG in 29 patients during pre-surgical evaluation for epilepsy (average 4.4 seizures/patient). All patients presented lesional involvement of the mesial temporal lobe structures (17 on left and 12 on right) on MRI; in which 22 patients this was confirmed pathologically. RESULTS: PINW was present in 36 of 129 seizures (27%) registered in 12 (41%) of the patients (8 with left TL epilepsy and 4 right). Complex automatisms were present in 30 seizures while simple automatisms, almost proposal were seen in 6. In all, with the exception of 2 seizures while simple with the exception of 2 seizures with simple automatisms, it was done with the hand ipsilateral to the epileptogenic lobe. PINW was observed in 22 of the 104 CPS and in 4 of the 25 with secondary generalization; in 3 of which these were of complex type. DP occurred in 16/129 seizures (12.4%) and in 10/29 patients, always being contralateral to the epileptogenic lobe. In 6 of these seizures there was also PINW. CONCLUSIONS: In this series of patients with mesial temporal epileptsy, PINW and DP constituted important signs for seizure lateralization, specially when complex. This was present in about one third of the cases having been less frequent than that referred to the literature (50%) and also occurred twice as much in left as in right temporal. This percentage differs from the literature data suggesting its importance for the right lateralization.