Abstracts

Seizure semiology in temporal lobe epilepsy (TLE) has been extensively described. Most common motor behaviors are typical automatisms involving distal body segments, particularly fingers, tongue and lips. Other include unilateral arm dystonic posturing and face and arm clonic movements. Our objective was to describe less common complex motor behaviors during seizures of temporal lobe origin, both in pediatric and adult patients. All patients admitted to the EMU between 1996 and 2003 considered to have TLE based on clinical, EEG and radiological findings were reviewed. Seizures were analyzed by 2 trained epileptologists. Patients with complex motor behaviors as the main seizure manifestation were selected. They had to be either seizure free after a temporal resection (temporal lobectomy/lesionectomy) or have a typical surface EEG temporal pattern together with a temporal lesion on MRI. Of 729 monitored patients (579 adults, 200 children), 441 (60.5%) were considered to have TLE. Of those, only 12 (8 men, 4 women) with uncommon complex behaviors were found. Mean age at evaluation was 34 years (14-58).
Movements which predominantly affected proximal segments of the limbs, producing large and occasionally violent movements (hypermotor seizures) were seen in 7 patients. Three patients had seizures consisting mainly of repetitive body rocking, one patient had pelvic thrusting and one patient had axial tonic seizures with prominent bilateral arm dystonia. Six patients had auras (3 abdominal, 1 olfactory, 2 unclassifiable) preceding the complex movements, and 7 patients had typical oral automatisms following them. EEG showed interictal epileptiform activity over the temporal lobe in all patients (unilateral in 9, bilateral in 3). Surface EEG showed unilateral regional temporal patterns in all patients. MRI showed unilateral MTS in 6 patients, cavernous angioma in the temporal neocortex in 2 patients, mesial temporal benign tumors in 2 patients, focal cortical dysplasia in the superior temporal gyrus in one patient, and focal atrophy of the temporal pole in one patient. Six patients had surgery (one lesionectomy and five temporal lobectomies). All patients are seizure free with at least one year of follow-up. Of the remaining six patients, one has become seizure free on drugs, 2 patients with mesial temporal tumors have declined temporal lobectomy and surgery was not offered to 3 patients because of failed Wada test. Although uncommon, a spectrum of complex motor behaviors may be seen in temporal lobe seizures, including predominantly proximal, large and violent movements typical of frontal lobe seizures. Complex motor behaviors in TLE are often preceded by auras and followed by typical distal automatisms. These patients have an excellent prognosis after temporal lobe resections, and there is no need for invasive studies if there are congruent EEG and MRI data.