title: Significance of lateralization of upper limb automatisms in temporal lobe epilepsy: a quantitative movement analysis.
abstract: OBJECTIVE
  To evaluate the significance of lateralization of ictal upper limb automatisms in patients with temporal lobe epilepsy (TLE).
  
  
  METHODS
  Ictal upper limb automatisms of 28 patients with temporal lobe epilepsy were quantified. Duration of automatisms in relation to total seizure duration, movement speed, extent, length, and predominant frequencies of the movements were analyzed for both upper extremities separately and compared to the lateralization of the epileptogenic temporal lobe.
  
  
  RESULTS
  Predominantly ipsilateral upper limb automatisms were more common (n = 19) than predominantly contralateral automatisms (n = 9). The duration of ictal ipsilateral upper limb automatisms was significantly longer than the duration of contralateral automatisms (ipsilateral automatisms: 29 of 86 s total seizure duration; contralateral automatisms: 19 of 110 s total seizure duration; p = 0.048). Patients with ipsilateral upper limb automatisms had more often exclusively unitemporal interictal epileptiform discharges (IEDs) (84.2%) than patients with contralateral automatisms (11.1%; p < 0.001). The positive predictive value (PPV) of the combination of these parameters is 84.2%. Excellent surgical seizure outcome was better in patients with ipsilateral upper limb automatisms (77.8%) compared to those with contralateral automatisms (20%) (p = 0.09). The quantitative analysis of movement extent, average speed, maximum speed, and repetition rate of ipsilateral and contralateral upper limb automatisms did not show any statistically significant difference in this patient sample.
  
  
  CONCLUSIONS
  The lateralization of upper limb automatisms in TLE has a good lateralizing value if the lateralization of IEDs were also taken into consideration.
authors.affiliation: Epilepsy Center, Department of Neurology, University of Munich, Munich, Germany.
authors.forename: Zulfiya
authors.initials: Z
authors.lastname: Mirzadjanova
authors.forename: Astrid S
authors.initials: AS
authors.lastname: Peters
authors.forename: Jan
authors.initials: J
authors.lastname: Rémi
authors.forename: Candaş
authors.initials: C
authors.lastname: Bilgin
authors.forename: Joao P
authors.initials: JP
authors.lastname: Silva Cunha
authors.forename: Soheyl
authors.initials: S
authors.lastname: Noachtar
mesh_terms: D000328:Adult; D000368:Aged; D001332:Automatism / Q000175:diagnosis / Q000503:physiopathology*; D001921:Brain / Q000503:physiopathology / Q000601:surgery; D004421:Dystonia / Q000175:diagnosis / Q000503:physiopathology; D004569:Electroencephalography / Q000379:methods / Q000706:statistics & numerical data; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006225:Hand / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D036301:Qualitative Research; D013702:Temporal Lobe / Q000503:physiopathology; D015899:Tomography, Emission-Computed, Single-Photon; D034941:Upper Extremity / Q000503:physiopathology*; D014743:Videotape Recording