Complex partial seizures of frontal lobe onset statistical analysis of ictal semiology.
OBJECTIVE
To identify the ictal semiology of complex partial seizures originating from the frontal lobe (FLCPS) and mesial temporal lobe (MTLE) in patients who became seizure free after surgery.


METHODS
We analysed 149 seizures from 42 patients, 28 with MTLE (75 seizures) and 14 with FLCPS (74 seizures) seizure free for at least 1 year after surgery. Fifty-eight symptoms and signs were looked for in every seizure and their time of onset and ending noted. Statistical analysis was then used to define the frequency, time of onset and cluster analysis of these symptoms/signs.


RESULTS
Epigastric aura was more frequent in MTLE while an aura of a general body sensation or indescribable feeling occurred only in FLCPS. Alimentary automatisms were more common and occurred earlier in MTLE (P<0.001). Perseverative automatisms, retching and vomiting occurred exclusively in MTLE while bicycling movements occurred only in FLCPS. Abdominal, psychic or olfactory aura followed by behavioural arrest, alimentary automatisms, repetitive distal upper extremity movements, complete loss of consciousness, looking around and whole body movements were typical of MTLE. Repetitive coarse upper extremity movements, complete loss of consciousness, complex motor and hypermotor activity were typical of FLCPS.


CONCLUSIONS
The earliest symptoms and signs as well as their order of appearance allow one to distinguish between complex partial seizures arising from the frontal lobe and mesial temporal lobe.
Kotagal
P
P
Department of Neurology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. kotagap@ccf.org
Arunkumar
G
G
hammel
J
J
Mascha
Ed
E
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D003937:Diagnosis, Differential; D004569:Electroencephalography / Q000706:statistics & numerical data*; D017029:Epilepsy, Complex Partial / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007223:Infant; D008432:Mathematical Computing; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data*; D015588:Observer Variation; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014741:Video Recording / Q000706:statistics & numerical data*