title: Seizures with tonic posturing: Semiologic difference between supplementary sensorimotor area (SSMA) origin and extra-SSMA origin.
abstract: In seizures with tonic posturing, differentiation of seizures originating in SSMA from seizures originating in cortices other than SSMA and spreading to SSMA has not been previously attempted. Twenty-two patients were studied with intractable focal epilepsy with tonic limb posturing as the most prominent semiology, who underwent resective surgery and obtained favorable postoperative seizure outcomes. These 22 patients were divided into an SSMA group (N = 12) and an extra-SSMA group (N = 10), according to the location of resection. Resection area in the extra-SSMA group was located in the dorsolateral frontal or prefrontal area in four patients, the frontal operculum (insula) in two, the parietal cortex in three, and the temporoparietal cortex in one patient. Video-recorded seizures were carefully reviewed. Tonic posturing characteristics and the presence or absence of accompanying symptoms were compared between groups. Incidence of preservation of consciousness was significantly higher in the SSMA group (p < 0.001). Patients in the SSMA group demonstrated a propensity for having unilateral or bilateral asymmetrical tonic limb posturing. In contrast, patients in the extra-SSMA group had a statistically significantly higher incidence of bilateral symmetrical tonic limb posturing (p < 0.05). These findings may be helpful in identifying seizure origin.
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.|Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Bunpot
authors.initials: B
authors.lastname: Sitthinamsuwan
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.
authors.forename: Naotaka
authors.initials: N
authors.lastname: Usui
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.
authors.forename: Takayasu
authors.initials: T
authors.lastname: Tottori
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.
authors.forename: Kiyohito
authors.initials: K
authors.lastname: Terada
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kondo
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Matsuda
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Baba
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.
authors.forename: Yushi
authors.initials: Y
authors.lastname: Inoue
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000150:complications; D002648:Child; D002675:Child, Preschool; D000069279:Drug Resistant Epilepsy / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D020938:Epilepsy, Partial, Motor / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology / Q000601:surgery; D005911:Gliosis / Q000150:complications; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications; D008279:Magnetic Resonance Imaging; D008297:Male; D054220:Malformations of Cortical Development / Q000150:complications; D010296:Parietal Lobe / Q000503:physiopathology* / Q000601:surgery; D017397:Prefrontal Cortex / Q000503:physiopathology* / Q000601:surgery; D066191:Sensorimotor Cortex / Q000503:physiopathology* / Q000601:surgery; D013702:Temporal Lobe / Q000503:physiopathology* / Q000601:surgery; D014741:Video Recording; D055815:Young Adult
keywords: Epilepsy surgery; Supplementary sensorimotor area; Tonic posturing