Nonmanipulative proximal upper extremity automatisms lateralize contralaterally in temporal lobe epilepsy

A. Kelemen, A. Fogarasi, Csaba Borbély, A. Szűcs, Dániel Fabó, R. Jakus, G. Rásonyi, P. Halász

Research output: Article

7 Citations (Scopus)

Abstract

Purpose: Upper extremity automatisms are considered to be an ipsilateral seizure lateralizing sign in temporal lobe epilepsy (TLE). Herein we describe different types of contralateral upper extremity automatisms (CUEAs). Methods: One hundred ninety-three video-(electroencephalography) EEGrecordings of 59 patients were reviewed. Other than two patients who refused surgery, all patients underwent standardized temporal lobectomy with favorable postoperative outcome. Fifty-seven seizures of 21 patients were selected with CUEAs. We evaluated their electroclinical characteristics and their relation to other lateralizing motor symptoms. Results: Two types of CUEAs were observed. Nonmanipulative, proximal upper extremity automatisms were seen unilaterally and contralaterally to the operated side. These automatisms were rhythmic; repetitive; and often occurred with a circulatory component resembling waving, flaunting, circling, or stirring movements. They occurred in 29 seizures (15%) of 11 patients (19%), in most seizures in the first half of the seizure, and never postictally, in various time sequences and combined with dystonic/tonic posturing or limb immobility. Manipulative/distal type of CUEAs occurred in 11 seizures (6%) of 7 patients (12%) on the unexpected contralateral side. These CUEAs were seen in all phases of the seizures, including in the postictal state. Discussion: Nonmanipulative unilateral proximal upper extremity automatism is a reliable lateralizing sign to the contralateral hemisphere in TLE. This sign may be pathophysiologically related to dystonic/tonic posturing. Manipulative distal automatisms have less lateralizing value.

Original languageEnglish
Pages (from-to)214-220
Number of pages7
JournalEpilepsia
Volume51
Issue number2
DOIs
Publication statusPublished - 2010

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Automatism
Temporal Lobe Epilepsy
Upper Extremity
Seizures
Electroencephalography
Extremities

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

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title = "Nonmanipulative proximal upper extremity automatisms lateralize contralaterally in temporal lobe epilepsy",
abstract = "Purpose: Upper extremity automatisms are considered to be an ipsilateral seizure lateralizing sign in temporal lobe epilepsy (TLE). Herein we describe different types of contralateral upper extremity automatisms (CUEAs). Methods: One hundred ninety-three video-(electroencephalography) EEGrecordings of 59 patients were reviewed. Other than two patients who refused surgery, all patients underwent standardized temporal lobectomy with favorable postoperative outcome. Fifty-seven seizures of 21 patients were selected with CUEAs. We evaluated their electroclinical characteristics and their relation to other lateralizing motor symptoms. Results: Two types of CUEAs were observed. Nonmanipulative, proximal upper extremity automatisms were seen unilaterally and contralaterally to the operated side. These automatisms were rhythmic; repetitive; and often occurred with a circulatory component resembling waving, flaunting, circling, or stirring movements. They occurred in 29 seizures (15{\%}) of 11 patients (19{\%}), in most seizures in the first half of the seizure, and never postictally, in various time sequences and combined with dystonic/tonic posturing or limb immobility. Manipulative/distal type of CUEAs occurred in 11 seizures (6{\%}) of 7 patients (12{\%}) on the unexpected contralateral side. These CUEAs were seen in all phases of the seizures, including in the postictal state. Discussion: Nonmanipulative unilateral proximal upper extremity automatism is a reliable lateralizing sign to the contralateral hemisphere in TLE. This sign may be pathophysiologically related to dystonic/tonic posturing. Manipulative distal automatisms have less lateralizing value.",
keywords = "Contralateral, Dystonia, Temporal lobe epilepsy, Upper extremity automatisms",
author = "A. Kelemen and A. Fogarasi and Csaba Borb{\'e}ly and A. Szűcs and D{\'a}niel Fab{\'o} and R. Jakus and G. R{\'a}sonyi and P. Hal{\'a}sz",
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T1 - Nonmanipulative proximal upper extremity automatisms lateralize contralaterally in temporal lobe epilepsy

AU - Kelemen, A.

AU - Fogarasi, A.

AU - Borbély, Csaba

AU - Szűcs, A.

AU - Fabó, Dániel

AU - Jakus, R.

AU - Rásonyi, G.

AU - Halász, P.

PY - 2010

Y1 - 2010

N2 - Purpose: Upper extremity automatisms are considered to be an ipsilateral seizure lateralizing sign in temporal lobe epilepsy (TLE). Herein we describe different types of contralateral upper extremity automatisms (CUEAs). Methods: One hundred ninety-three video-(electroencephalography) EEGrecordings of 59 patients were reviewed. Other than two patients who refused surgery, all patients underwent standardized temporal lobectomy with favorable postoperative outcome. Fifty-seven seizures of 21 patients were selected with CUEAs. We evaluated their electroclinical characteristics and their relation to other lateralizing motor symptoms. Results: Two types of CUEAs were observed. Nonmanipulative, proximal upper extremity automatisms were seen unilaterally and contralaterally to the operated side. These automatisms were rhythmic; repetitive; and often occurred with a circulatory component resembling waving, flaunting, circling, or stirring movements. They occurred in 29 seizures (15%) of 11 patients (19%), in most seizures in the first half of the seizure, and never postictally, in various time sequences and combined with dystonic/tonic posturing or limb immobility. Manipulative/distal type of CUEAs occurred in 11 seizures (6%) of 7 patients (12%) on the unexpected contralateral side. These CUEAs were seen in all phases of the seizures, including in the postictal state. Discussion: Nonmanipulative unilateral proximal upper extremity automatism is a reliable lateralizing sign to the contralateral hemisphere in TLE. This sign may be pathophysiologically related to dystonic/tonic posturing. Manipulative distal automatisms have less lateralizing value.

AB - Purpose: Upper extremity automatisms are considered to be an ipsilateral seizure lateralizing sign in temporal lobe epilepsy (TLE). Herein we describe different types of contralateral upper extremity automatisms (CUEAs). Methods: One hundred ninety-three video-(electroencephalography) EEGrecordings of 59 patients were reviewed. Other than two patients who refused surgery, all patients underwent standardized temporal lobectomy with favorable postoperative outcome. Fifty-seven seizures of 21 patients were selected with CUEAs. We evaluated their electroclinical characteristics and their relation to other lateralizing motor symptoms. Results: Two types of CUEAs were observed. Nonmanipulative, proximal upper extremity automatisms were seen unilaterally and contralaterally to the operated side. These automatisms were rhythmic; repetitive; and often occurred with a circulatory component resembling waving, flaunting, circling, or stirring movements. They occurred in 29 seizures (15%) of 11 patients (19%), in most seizures in the first half of the seizure, and never postictally, in various time sequences and combined with dystonic/tonic posturing or limb immobility. Manipulative/distal type of CUEAs occurred in 11 seizures (6%) of 7 patients (12%) on the unexpected contralateral side. These CUEAs were seen in all phases of the seizures, including in the postictal state. Discussion: Nonmanipulative unilateral proximal upper extremity automatism is a reliable lateralizing sign to the contralateral hemisphere in TLE. This sign may be pathophysiologically related to dystonic/tonic posturing. Manipulative distal automatisms have less lateralizing value.

KW - Contralateral

KW - Dystonia

KW - Temporal lobe epilepsy

KW - Upper extremity automatisms

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JO - Epilepsia

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