Abstracts

Rationale: Asymmetric tonic posture of upper limbs (figure 4) has been shown to be an accurate lateralizing sign in focal epilepsy of the temporal lobe. However, involvement of lower limbs in lateralization of TLE is rarely reported. Therefore we evaluated the lateralization of figure 4 of the lower limbs in TLE.Methods: We retrospectively reviewed records of 91 consecutive patients with TLE admitted to EMU at JFK hospital. Video EEG data were analyzed for the presence of figure 4 of the lower limbs observed during secondary generalized tonic clonic seizures.Results: There were 38 males (age range 17-71 yrs) and 53 females (age range 18-81 yrs). Thirty-one patients had right temporal lobe focus and sixty had left focus. Thirty-seven out of ninety-one patients were excluded due to lack of secondary generalized tonic clonic seizure. In fourteen patients we failed to record the seizure on camera and fourteen patients had electrographic events only. Therefore 26 patients with a total of 142 secondary generalized seizures were evaluated and 88 were assessable. Fifty-seven of eighty-eight seizures (66.8%) showed figure 4 with asymmetric tonic extension of lower limbs and all were contralateral to the epileptogenic hemisphere. This occurred equally in both sides (8 patients with left TLE and 8 with right TLE) constituting 61.3% of the patients. However, four seizures (4.6%) showed tonic flexion of the lower limbs ( two patients with left and one with right focus) and 27 seizures (28.6%) showed tonic extension of the lower limbs (4 patients has left and 3 patients has right temporal lobe focus).Conclusions: Lower limb asymmetric tonic posturing (figure 4) is frequently present during secondary GTC seizures. It has an excellent lateralizing value in TLE, which is always contralateral to the epileptogenic hemisphere.