Spontaneous periictal leaving behavior: a potential lateralizing sign in mesial temporal lobe epilepsy.
OBJECTIVE
Seizure-related spontaneous leaving behavior (LB) is an uncommonly reported phenomenon. The aim of this study was to determine its frequency, clinical significance, and especially its lateralizing value.


METHODS
We analyzed retrospectively the spontaneous periictal LB occurring in complex partial seizures (CPS) of 138 patients with medically refractory mesial temporal lobe epilepsy (MTLE) with excellent postoperative seizure outcome and pathologic finding of hippocampal sclerosis. The relation of LB occurring in different phases of CPS to the side of resection was investigated.


RESULTS
The overall frequency of periictal LB was 8.3% of 517 CPS and 25.2% of 123 patients. Among the 12 patients with ictal LB, 9 patients had epileptogenic focus ipsilateral to language dominant side, whereas the remaining 3 had seizure onset in the nondominant side. Conversely, 8 of 11 patients with postictal LB had foci in the nondominant side, and only three patients' seizures originated in the dominant side. Therefore, it was more likely for patients with left MTLE to show ictal LB and for those with right foci to display postictal LB (p = 0.03).


CONCLUSIONS
LB may represent a potential lateralizing sign. When LB occurs ictally, it may indicate seizure onset in the dominant temporal lobe, and LB occurring postictally indicates nondominant side seizure onset in patients with MTLE.
Jin
Liri
L
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Inoue
Yushi
Y
D000293:Adolescent; D000328:Adult; D001332:Automatism / Q000000981:diagnostic imaging / Q000209:etiology*; D001526:Behavioral Symptoms / Q000209:etiology*; D001931:Brain Mapping; D004569:Electroencephalography / Q000379:methods; D004828:Epilepsies, Partial / Q000150:complications* / Q000473:pathology; D004833:Epilepsy, Temporal Lobe / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014741:Video Recording / Q000379:methods; D055815:Young Adult