title: Lateralizing value of unilateral relative ictal immobility in patients with refractory focal seizures--Looking beyond unilateral automatisms.
abstract: OBJECTIVE
  Ictal motor phenomena play a crucial role in the localization of seizure focus in the management of refractory focal epilepsy. While the importance of unilateral automatisms is well established, little attention is paid to the contralateral relatively immobile limb. In cases where automatisms mimic clonic or dystonic movements and in the absence of previously well-established signs, unilateral relative ictal immobility (RII) is potentially useful as a lateralizing sign. This study was carried out to examine the lateralizing value of this sign and to define its characteristics among patients of refractory focal epilepsy.
  
  
  METHODS
  VEEGs of 69 consecutive patients of refractory focal epilepsy who had undergone epilepsy surgery at our center over last four years were reviewed and analyzed for the presence of RII. Unilateral RII was defined as a paucity of movement in one limb lasting for at least 10s while the contralateral limb showed purposive or semi-purposive movements (in the absence of tonic or dystonic posturing or clonic movements in the involved limb). The findings were seen in the light of VEEG, radiological and nuclear imaging data, and with post-surgical outcome.
  
  
  RESULTS
  Unilateral RII as a lateralizing sign was found in 24 of 69 patients (34.78%), consisting of both temporal and extra temporal epilepsy, with 100% concordance with VEEG and MRI data. All patients demonstrating this sign had a good post-surgical outcome.
  
  
  CONCLUSIONS
  RII, when well characterized is a frequent and reliable lateralizing sign in patients of refractory focal epilepsy.
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Priya
authors.initials: P
authors.lastname: Agarwal
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Bhavna
authors.initials: B
authors.lastname: Kaul
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: garimashukla@hotmail.com.
authors.forename: Garima
authors.initials: G
authors.lastname: Shukla
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Achal
authors.initials: A
authors.lastname: Srivastava
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Mamta Bhushan
authors.initials: MB
authors.lastname: Singh
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Goyal
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Madhuri
authors.initials: M
authors.lastname: Behari
authors.affiliation: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Suri
authors.affiliation: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Aditya
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Garg
authors.affiliation: Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Shailesh
authors.initials: S
authors.lastname: Gaikwad
authors.affiliation: Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: C S
authors.initials: CS
authors.lastname: Bal
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000150:complications*; D005260:Female; D046352:Freezing Reaction, Cataleptic / Q000502:physiology*; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016037:Single-Blind Method; D055815:Young Adult
keywords: Automatisms; Epilepsy surgery; Lateralizing value; Refractory focal epilepsy; Relative ictal immobility; Semiology