Abstracts

We report four patients who at different points in their seizure history incorporated complex behaviors into their typical seizure semiology. Two patients had devolped routine volitional behaviors which they would consciously perform in response to their aura. Their behaviors were 1) finding a bathroom to hide until the seizure passed, and 2) praying for help. Over time, the behaviors were incorporated into the stereotyped complex partial seizure and were performed without volitional control or recall. The once volitional responses became a forced ictal behavior. Similarly, two patients experienced complex partial seizures while performing activites of daily living and subsequently incorporated their immediate behavior into future complex partial seizures. Their behaviors included playing basketball and cheering.
Cinical and electrographic analysis of the seizures was performed in all patients as part of a standard epilepsy surgery evaluation using MRI, PET, MEG, and video-telemetry monitoring with scalp and depth electrodes (when indicated.)
All four patients were determined to have seizures which originated in the right hemisphere. The sites of seizure onset included the frontal (1 patient), temporal ( 2 patients), and parietal lobes (1 patient.) However, in all pateints seizures propagated to the right mesial temporal lobe structures.
We propose [quot]ictal incorporated behavior[quot] is a previously undescribed epileptic phenomenon. Clinical features including the complex and goal directed nature of the behaviors distinguish this phenomenon from simple or complex perseverative automatisms. Localization studies in this small series of patients lateralized seizure onset to the right hemisphere with eventual involvement of the temporal lobe. If future patients with ictal incorporated behavior demonstrate a similar lateralization and localization, these finding may suggest a role of the right temporal lobe in associative learning and implicit memory.