Nonmanipulative proximal upper extremity automatisms lateralize contralaterally in temporal lobe epilepsy.
OBJECTIVE
Upper extremity automatisms are considered to be an ipsilateral seizure lateralizing sign in temporal lobe epilepsy (TLE). Herein we describe different types of contralateral upper extremity automatisms (CUEAs).


METHODS
One hundred ninety-three video-(electroencephalography) EEG recordings of 59 patients were reviewed. Other than two patients who refused surgery, all patients underwent standardized temporal lobectomy with favorable postoperative outcome. Fifty-seven seizures of 21 patients were selected with CUEAs. We evaluated their electroclinical characteristics and their relation to other lateralizing motor symptoms.


RESULTS
Two types of CUEAs were observed. Nonmanipulative, proximal upper extremity automatisms were seen unilaterally and contralaterally to the operated side. These automatisms were rhythmic; repetitive; and often occurred with a circulatory component resembling waving, flaunting, circling, or stirring movements. They occurred in 29 seizures (15%) of 11 patients (19%), in most seizures in the first half of the seizure, and never postictally, in various time sequences and combined with dystonic/tonic posturing or limb immobility. Manipulative/distal type of CUEAs occurred in 11 seizures (6%) of 7 patients (12%) on the unexpected contralateral side. These CUEAs were seen in all phases of the seizures, including in the postictal state.


CONCLUSIONS
Nonmanipulative unilateral proximal upper extremity automatism is a reliable lateralizing sign to the contralateral hemisphere in TLE. This sign may be pathophysiologically related to dystonic/tonic posturing. Manipulative distal automatisms have less lateralizing value.
National Institute of Neurosurgery, Budapest, Hungary. kelemenanna@hotmail.com
Anna
A
Kelemen
András
A
Fogarasi
Csaba
C
Borbély
Anna
A
Szucs
Dániel
D
Fabó
Rita
R
Jakus
György
G
Rásonyi
Péter
P
Halász
D000293:Adolescent; D000328:Adult; D038481:Anterior Temporal Lobectomy; D001332:Automatism / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology; D002648:Child; D004421:Dystonia / Q000503:physiopathology; D004569:Electroencephalography / Q000706:statistics & numerical data; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D034941:Upper Extremity / Q000503:physiopathology*; D014741:Video Recording