Genital automatisms: a video-EEG study in patients with medically refractory seizures.
OBJECTIVE
Genital automatisms (GAs) are rare clinical phenomena during or after epileptic seizures. They are defined as repeated fondling, grabbing, or scratching of the genitals. The anatomic correlates of GAs have been discussed controversially. The aim of this investigation was to assess the localizing and lateralizing value of GAs.


METHODS
The authors studied 207 consecutive patients with intractable seizures referred to a University Hospital for presurgical evaluation between 1998 and 2002: 135 had temporal lobe epilepsy (TLE); 23, frontal lobe epilepsy (FLE); 29, generalized epilepsies (GEs); and 20 had extratemporal or multifocal epilepsy.


RESULTS
Twenty-three (11%) of 207 patients showed GAs in 42 (3%) of 1,299 seizures. GAs occurred significantly more often in men (17 of 93, 18%) than in women (six of 114, 5%; p = 0.0037). Twenty-one (16%) of 135 patients with TLE performed GAs, one (4%) of 23 with FLE and one (3%) of 29 with GE. GAs were associated with unilateral hand automatisms in 16 (70%) of 23 and with periictal urinary urge in five (22%) of 23. All patients had amnesia for the performance of GAs.


CONCLUSIONS
GAs appear in the ictal or postictal period with impaired consciousness. Men exhibit GAs significantly more often than do women. GAs do not localize or lateralize per se, but may localize seizure onset in the presence of periictal urinary urge or unilateral hand automatisms. They show a tendency to occur more often in TLE.
Dobesberger
Judith
J
Universitätskliniken für Neurologie, Innsbruck, Austria.
Walser
Gerald
G
Unterberger
Iris
I
Embacher
Norbert
N
Luef
Gerhard
G
Bauer
Gerhard
G
Benke
Thomas
T
Bartha
Lisa
L
Ulmer
Hanno
H
Ortler
Martin
M
Trinka
Eugen
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000647:Amnesia / Q000175:diagnosis / Q000523:psychology; D001317:Austria / Q000453:epidemiology; D001332:Automatism / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D001931:Brain Mapping; D015897:Comorbidity; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D005835:Genitalia / Q000502:physiology*; D006225:Hand / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D012720:Severity of Illness Index; D012737:Sex Factors; D019529:Sexuality / Q000502:physiology; D014741:Video Recording