title: Biceps electromyography in dialeptic and automotor seizures with and without secondary generalization.
abstract: OBJECTIVE
  Localization of seizure onset during presurgical video-EEG monitoring is indispensable for successful epilepsy surgery. Sometimes analysis of ictal EEG and video fails to identify this zone. Therefore, this study explored the hypothesis that ictal EMG recordings contribute to the lateralization or localization of focal epilepsy.
  
  
  METHODS
  All patients with automotor or dialeptic seizures with or without secondary generalization were prospectively included during presurgical video-EEG monitoring over a 5years study period. We analyzed characteristics of ictal biceps EMG and compared the results to EEG and video findings.
  
  
  RESULTS
  79 patients with 185 seizures were included (51.9% male; 73.5% automotor and 26.5% dialeptic seizures; 24.3% seizures secondarily generalized). Even in dialeptic seizures, muscle tone increased bilaterally within seconds after EEG seizure onset (66.7%) without clinical movements. Bilateral "spindle-shaped" EMG activity during the automotor phase predicted secondary generalization in 88.7%. Increase of muscle activity in the contralateral side of the body in the beginning of the secondarily generalized tonic-clonic phase was detected in 78.1% after automotor seizures whereas this phenomenon was less pronounced after dialeptic seizures (69.2%). 38.5% of dialeptic seizures evolved into generalized tonic-unilateral clonic seizures.
  
  
  CONCLUSIONS
  Ictal EMG recordings provide lateralizing signs especially in secondarily generalized automotor seizures. In addition, the study suggested that secondary generalization in automotor seizures is determined early already during the automotor phase. Dialeptic seizures can evolve only unilaterally into a tonic-clonic seizure while the other side of the body remains tonic.
  
  
  CONCLUSIONS
  Ictal biceps EMG can provide further information regarding lateralization of epileptic seizures.
authors.affiliation: Epilepsy Center, Department of Neurology, Friedrich-Alexander-University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany. Electronic address: mareike.hagge@uk-erlangen.de.
authors.forename: Mareike
authors.initials: M
authors.lastname: Hagge
authors.affiliation: Department of Neurology, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Nunnemann
authors.affiliation: Epilepsy Center Frankfurt Rheine-Main, Department of Neurology, Goethe-University Frankfurt am Main, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany; Philipps-University Marburg, Baldingerstr., 35043 Marburg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bauer
authors.affiliation: Epilepsy Center, Department of Neurology, Friedrich-Alexander-University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Gollwitzer
authors.affiliation: Department of Neurology, Philipps-University Marburg, Baldingerstr., 35043 Marburg, Germany.
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Oertel
authors.affiliation: Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Baldingerstr., 35043 Marburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Knake
authors.affiliation: Epilepsy Center Frankfurt Rheine-Main, Department of Neurology, Goethe-University Frankfurt am Main, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany; Department of Neurology, Philipps-University Marburg, Baldingerstr., 35043 Marburg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Rosenow
authors.affiliation: Epilepsy Center, Department of Neurology, Friedrich-Alexander-University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
authors.forename: Hajo M
authors.initials: HM
authors.lastname: Hamer
mesh_terms: D000293:Adolescent; D000328:Adult; D001132:Arm / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000379:methods; D004576:Electromyography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D018482:Muscle, Skeletal / Q000502:physiology*; D011446:Prospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000503:physiopathology*; D055815:Young Adult
keywords: Biceps EMG; Generalized tonic–unilateral clonic seizure; Seizure; Spindle