title: Association of ipsilateral motor automatisms and contralateral dystonic posturing: a clinical feature differentiating medial from neocortical temporal lobe epilepsy.
abstract: BACKGROUND
  Clinical features that may help to differentiate medial temporal lobe epilepsy (MTLE) from neocortical temporal lobe epilepsy (NTLE) are lacking.
  
  
  OBJECTIVE
  To investigate the localizing and lateralizing value of the association of ipsilateral motor automatisms and contralateral dystonic posturing in patients with medically refractory temporal lobe epilepsy.
  
  
  METHODS
  Videotapes of 60 patients with well-defined MTLE, NTLE, or both were reviewed to assess the presence and the localizing value of unilateral dystonic posturing associated with motor automatisms.
  
  
  RESULTS
  Twenty-eight of the 60 patients exhibited unilateral dystonic posturing. This sign was observed in patients with MTLE and NTLE. It was mostly contralateral to the seizure focus in patients with MTLE and exclusively ipsilateral in patients with NTLE. Unilateral motor automatisms occurred in 26 of the 60 patients with MTLE or NTLE. It was predominantly ipsilateral to the seizure focus in patients with MTLE and exclusively contralateral in patients with NTLE. The association of ipsilateral motor automatisms and contralateral dystonic posturing was found in 14 patients with MTLE but in none of the patients with NTLE. Two patients who had medial and neocortical seizure onset also exhibited this clinical feature. This association was not significantly correlated with the postoperative outcome in patients with MTLE.
  
  
  CONCLUSIONS
  The association of ipsilateral motor automatisms and contralateral dystonic posturing may help to differentiate MTLE from NTLE with a reliable lateralizing value. This clinical association may reflect a specific pattern in the spread of the ictal discharge.
authors.affiliation: Clinique Neurologique Paul Castaigne, Hôpital de la Pitié-Salpêtrière, Paris, France. sophie.dupont@psl.ap-hop-paris.fr
authors.forename: S
authors.initials: S
authors.lastname: Dupont
authors.forename: F
authors.initials: F
authors.lastname: Semah
authors.forename: P
authors.initials: P
authors.lastname: Boon
authors.forename: J M
authors.initials: JM
authors.lastname: Saint-Hilaire
authors.forename: C
authors.initials: C
authors.lastname: Adam
authors.forename: D
authors.initials: D
authors.lastname: Broglin
authors.forename: M
authors.initials: M
authors.lastname: Baulac
mesh_terms: D000328:Adult; D001284:Atrophy / Q000473:pathology / Q000601:surgery; D001332:Automatism / Q000150:complications* / Q000175:diagnosis; D004421:Dystonia / Q000150:complications* / Q000175:diagnosis; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000150:complications* / Q000378:metabolism / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology*; D006624:Hippocampus / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011187:Posture; D011597:Psychomotor Performance / Q000502:physiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013702:Temporal Lobe / Q000378:metabolism; D014741:Video Recording