title: Hemifacial motor and crying seizures of temporal lobe onset: case report and review of electro-clinical localisation.
abstract: OBJECTIVE
  To report a case of temporal lobe epilepsy with clinical presentation of paroxysmal episodes of "tightness" over the right hemiface, and ictal crying, and review electroclinical localisation of this phenomenon.
  
  
  METHODS
  Clinical semiology, neurophysiological localising tests, and epilepsy surgery outcome are reported in a subject presenting with paroxysmal right hemifacial movements and ictal crying. Pertinent past reports of somato-motor signs and ictal crying in temporal lobe epilepsy are reviewed and the findings correlated with proposed human facial cortical representation.
  
  
  RESULTS
  Simple partial seizures caused by temporal lobe epilepsy presented with right sided tonic facial movements and ictal crying. Intracranial EEG monitoring documented a left medial temporal onset of seizures that remained asymptomatic until they propagated to the left cingulate region. Anterior temporal lobectomy with resection of the amygdala and anterior hippocampus resulted in cessation of seizures.
  
  
  CONCLUSIONS
  This is a rare example of epileptic seizures of medial temporal onset presenting with isolated somato-motor manifestations and ictal crying. Anatomical-electrical-clinical correlations with cortical regions controlling facial movements were highly suggestive that this case represents secondary activation of "emotional" motor cortex M3 and M4 (rostral and caudal cingulate motor cortex), giving rise to focal hemifacial movements and ictal crying.
authors.affiliation: Department of Neurology, Saint Louis University School of Medicine, Epilepsy Offices, St Louis, MO 63104, USA. hoganr2@slu.edu
authors.forename: R E
authors.initials: RE
authors.lastname: Hogan
authors.forename: V K
authors.initials: VK
authors.lastname: Rao
mesh_terms: D000328:Adult; D000679:Amygdala / Q000503:physiopathology; D003448:Crying; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000150:complications* / Q000503:physiopathology* / Q000601:surgery; D004830:Epilepsy, Tonic-Clonic / Q000150:complications* / Q000503:physiopathology; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D007839:Functional Laterality; D019569:Hemifacial Spasm / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D049268:Positron-Emission Tomography; D011612:Psychosurgery; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D013702:Temporal Lobe / Q000033:anatomy & histology / Q000378:metabolism / Q000601:surgery
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18