title: Hyperkinetic seizures in patients with temporal lobe epilepsy: clinical features and outcome after temporal lobe resection.
abstract: OBJECTIVE
  Temporal lobe epilepsy (TLE) is usually associated with automatisms. Hyperkinetic seizures are supposed to be unusual. Because we witnessed several patients with TLE and ictal hyperkinetic symptoms, we retrospectively assessed the number, clinical findings, and seizure outcome in such patients who had undergone temporal lobe resection.
  
  
  METHODS
  We reviewed medical history, video-electroencephalography (EEG) recording and neuroimaging of adult patients who underwent epilepsy surgery for TLE at the Kork Epilepsy Center over the last 20 years with a minimum postoperative follow-up of 12 months.
  
  
  RESULTS
  Among 294 patients who were resected exclusively in the temporal region, we identified 17 (6%) who presented with hyperkinetic semiology such as violent vocalization, complex movements of the proximal segments of the limbs, rotation of the trunk, pelvic thrusting, or early tonic or dystonic posturing. Most of the patients had a preceding aura. Ictal EEG activity was located in the corresponding temporal region, usually with a wide distribution over temporal electrodes with fast spread to unilateral frontal electrodes and to the contralateral side. Neuroimaging revealed extended lesions in the temporal lobe involving mesial and neocortical structures. Most of the patients underwent classical anterior temporal lobe resection including amygdalo-hippocampectomy. Fourteen patients (82%) became completely seizure-free (Engel class Ia). Histopathology showed mainly focal cortical dysplasia plus hippocampal sclerosis.
  
  
  CONCLUSIONS
  Hyperkinetic seizure semiology may occasionally occur in patients with TLE and is, therefore, no contradiction to the hypothesis of TLE if scalp EEG patterns and neuroimaging findings correspond. The postoperative seizure outcome is favorable in such patients and not different from outcome data in classical TLE.
authors.affiliation: Kork Epilepsy Center, Kehl-Kork, Germany. astaack@epilepsiezentrum.de
authors.forename: Anke M
authors.initials: AM
authors.lastname: Staack
authors.forename: Sofia
authors.initials: S
authors.lastname: Bilic
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Wendling
authors.forename: Julia
authors.initials: J
authors.lastname: Scholly
authors.forename: Uwe
authors.initials: U
authors.lastname: Kraus
authors.forename: Karl
authors.initials: K
authors.lastname: Strobl
authors.forename: Frédéric
authors.initials: F
authors.lastname: Bodin
authors.forename: Josef
authors.initials: J
authors.lastname: Zentner
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Steinhoff
mesh_terms: D000328:Adult; D038481:Anterior Temporal Lobectomy; D001927:Brain Diseases; D018572:Disease-Free Survival; D004569:Electroencephalography; D004827:Epilepsy; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D054220:Malformations of Cortical Development; D065703:Malformations of Cortical Development, Group I; D012640:Seizures / Q000150:complications / Q000601:surgery; D013702:Temporal Lobe / Q000601:surgery; D016896:Treatment Outcome