title: Electroclinical analysis of postictal noserubbing.
abstract: BACKGROUND
  Postictal noserubbing (PIN) has been identified as a good, albeit imperfect, lateralizing and localizing sign in human partial epilepsy, possibly related to ictal autonomic activation.
  
  
  METHODS
  PIN was studied prospectively in a group of consecutive patients admitted for video-EEG monitoring, with the laterality of noserubbing correlated with electrographic sites of seizure onset, intra- and interhemispheric spread, and sites of seizure termination.
  
  
  RESULTS
  PIN was significantly more frequent in temporal than extratemporal epilepsy (p<0.001; 23/41 (56%) patients and 41/197 (21%) seizures in temporal lobe epilepsy compared with 4/34 (12%) patients and 12/167 (7%) seizures in extratemporal epilepsy). The hand used to rub the nose was ipsilateral to the side of seizure onset in 83% of both temporal and extratemporal seizures. Seizures with contralateral PIN correlated with spread to the contralateral temporal lobe on scalp EEG (p<0.04). All extratemporal seizures with PIN showed spread to temporal lobe structures. One patient investigated with intracranial electrodes showed PIN only when ictal activity spread to involve the amygdala: seizures confined to the hippocampus were not associated with PIN. PIN was not observed in 63 nonepileptic events in 17 patients. Unexpectedly, one patient with primary generalized epilepsy showed typical PIN after 1/3 recorded absence seizures.
  
  
  CONCLUSIONS
  This study confirms PIN as a good indicator of ipsilateral temporal lobe seizure onset. Instances of false lateralization and localization appear to reflect seizure spread to contralateral or ipsilateral temporal lobe structures, respectively. Involvement of the amygdala appears to be of prime importance for induction of PIN.
authors.affiliation: Division of Neurology, University Health Network, Toronto Western Hospital, University of Toronto, Ontario, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Wennberg
mesh_terms: D000679:Amygdala / Q000503:physiopathology; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000503:physiopathology*; D007839:Functional Laterality; D006624:Hippocampus / Q000503:physiopathology; D006801:Humans; D009043:Motor Activity; D009666:Nose; D011446:Prospective Studies; D013702:Temporal Lobe / Q000503:physiopathology; D014741:Video Recording