Abstracts

Rationale: To assess the localizing and lateralizing features of Generalized Tonic Clonic seizures in temporal lobe epilepsyMethods: Retrospective chart review of all patients admitted to EMU between 2012 and 2014 with diagnosis of TLE who had GTCs. Extremities automatism and asymmetric tonic flexion extension, head deviation, post-ictal paralysis and dystonic posturing were correlated to epileptogenic focus.Results: There were 109 TLE patients and 46 had GTC. There were 17 RTLE patients age range 16 -60 years (mean 30). Fifteen were females. 11 were right handed, 1 left handed and another ambidextrous but 4 were undetermined. There were 28 LTLE patients with an age range of 17-66 years (mean 36). Fifteen were females. 22 were right handed, 3 left handed and 3 were undetermined. Head deviation occurred most frequently contralateral to the focus (in 72%; 13 R and 20 L). Ipsilateral heard deviation occurred in 32.6% (5 R and 10 L). Dystonic posturing of hand occurred in 26.3% (5 R and 8 L) and 2 involved the foot (one L and R); all were contralateral to the focus. Manual automatism occurred in 23.9% (2 R and 9 L) and pedal automatism in 8.7% (1 R and 3 L). Simultaneous automatism in upper and lower limbs occurred in 8.7% (3 R and 1 L). Figure 4 with tonic extension contralateral to the focus occurred in 47.8% of the arms (4 R and 18 L) and 8.7% in the legs (3 R and 1 L) and 19.6% of both limbs (6 R and 3 L). However tonic extension of both upper limbs occurred in 5 patients and flexion in 2 patients. Todd’s paralysis contralateral to the focus of both upper and lower limbs occurred in 13% (1 R and 5 L) and in the upper arms only in 8.7% (3 L and 1 R). Facial weakness contralateral to the focus occurred in 26.3% (5 R and 8 L).Conclusions: All the clinical semiology’s during GTCs are of localizing and lateralizing value. Furthermore this finding support the concept of seizure network and may aid in placement of stereo electroencephalography to delineate the epileptogenic focus.