title: Semiology of hypermotor (hyperkinetic) seizures.
abstract: BACKGROUND
  Hypermotor seizures (HMSs) consist of complex movements involving proximal segments of the limbs and trunk that appear violent and inappropriate for the situation.
  
  
  METHODS
  We analyzed hypermotor seizure videos in seizure-free patients (Engel class I) following resective epilepsy surgery. After completion of video analysis, we reviewed EEG and neuroimaging data.
  
  
  RESULTS
  Search of our epilepsy surgery database yielded 116 patients classified as having hypermotor seizures between 1996 and 2013. From this subset, 17/31 (55%) patients had been seizure-free for >6months (mean follow-up: 3.3years). Mean seizure duration was 35s (range: 6-91s), of which the HM phase lasted a mean of 22s (range: 3-53s). In 16 patients (95%), hypermotor activity was seen at or within 10s of clinical seizure onset. Type I semiology occurred in 6 patients, type II semiology in 10 patients, and 1 patient exhibited features of both. Type I and type II semiologies were noted in patients who had frontal lobe as well as extrafrontal resections. Nonversive head and body turning occurred in 10 patients (ranging from 90° to 270°) which was ipsilateral to the side of resection in all patients and seen both in frontal and extrafrontal resections. Six out of eleven patients with abnormal MRI and 4/6 patients with nonlesional MRI underwent invasive EEG evaluation. Eight patients (47%) had frontal lobe resection, 4/17 (23%) patients had temporal lobe resection, and one patient each had parietal lobe, insular, temporoparietooccipital, or motor sparing resection; 1 patient had functional hemispherectomy.
  
  
  CONCLUSIONS
  Hypermotor semiology typically occurs at or within 10s after seizure onset. Ipsilateral head/body turning appears to be of lateralizing value whereas asymmetry of limb movement was not lateralizing. Hypermotor semiology is most often seen in frontal lobe epilepsy but may occur in seizures arising from other locations.
authors.affiliation: Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
authors.forename: Khalid
authors.initials: K
authors.lastname: Alqadi
authors.affiliation: Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Neurology, Creighton University Medical Center, Omaha, NE, USA.
authors.forename: Ram
authors.initials: R
authors.lastname: Sankaraneni
authors.affiliation: Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Epilepsy Center, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Ursula
authors.initials: U
authors.lastname: Thome
authors.affiliation: Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: kotagap@ccf.org.
authors.forename: Prakash
authors.initials: P
authors.lastname: Kotagal
mesh_terms: D000293:Adolescent; D000328:Adult; D004569:Electroencephalography / Q000379:methods; D017034:Epilepsy, Frontal Lobe / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000503:physiopathology; D006801:Humans; D006948:Hyperkinesis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012640:Seizures / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D013702:Temporal Lobe / Q000503:physiopathology; D055815:Young Adult
keywords: Epilepsy surgery; Frontal lobe epilepsy; Intractable epilepsy; Lateralizing signs