title: Temporal lobe origin is common in patients who have undergone epilepsy surgery for hypermotor seizures.
abstract: Hypermotor seizures are most often reported from the frontal lobe but may also have temporal, parietal, or insular origin. We noted a higher proportion of patients with temporal lobe epilepsy in our surgical cohort who had hypermotor seizures. We evaluated the anatomic localization and surgical outcome in patient with refractory hypermotor seizures who had epilepsy surgery in our center.
  
  
  
  We identified twenty three patients with refractory hypermotor seizures from our epilepsy surgery database. We analyzed demographics, presurgical evaluation including semiology, MRI, PET scan, interictal/ictal scalp video-EEG, intracranial recording, and surgical outcomes. We evaluated preoperative variables as predictors of outcome.
  
  
  
  Most patients (65%) had normal brain MRI. Intracranial EEG was required in 20 patients (86.9%). Based on the presurgical evaluation, the resection was anterior temporal in fourteen patients, orbitofrontal in four patients, cingulate in four patients, and temporoparietal in one patient. The median duration of follow-up after surgery was 76.4months. Fourteen patients (60%) had been seizure free at the last follow up while 3 patients had rare disabling seizures.
  
  
  
  Hypermotor seizures often originated from the temporal lobe in this series of patients who had epilepsy surgery. This large proportion of temporal lobe epilepsy may be the result of a selection bias, due to easier localization and expected better outcome in temporal lobe epilepsy. With extensive presurgical evaluation, including intracranial EEG when needed, seizure freedom can be expected in the majority of patients.
authors.affiliation: Neurology, Vanderbilt University Medical Center, Nashville, TN, United States. Electronic address: amir.arain@vanderbilt.edu.
authors.forename: Amir M
authors.initials: AM
authors.lastname: Arain
authors.affiliation: Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.
authors.forename: Nabil J
authors.initials: NJ
authors.lastname: Azar
authors.affiliation: Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.
authors.forename: Andre H
authors.initials: AH
authors.lastname: Lagrange
authors.affiliation: Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: McLean
authors.affiliation: Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.
authors.forename: Pradumna
authors.initials: P
authors.lastname: Singh
authors.affiliation: Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.
authors.forename: Hasan
authors.initials: H
authors.lastname: Sonmezturk
authors.affiliation: Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, United States.
authors.forename: Peter
authors.initials: P
authors.lastname: Konrad
authors.affiliation: Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, United States.
authors.forename: Joseph
authors.initials: J
authors.lastname: Neimat
authors.affiliation: Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.
authors.forename: Bassel
authors.initials: B
authors.lastname: Abou-Khalil
mesh_terms: D000328:Adult; D004569:Electroencephalography; D004827:Epilepsy / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D049268:Positron-Emission Tomography; D012640:Seizures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complex partial seizures; Epilepsy; Epilepsy surgery; Frontal lobe epilepsy; Hypermotor seizures; Seizures; Temporal lobectomy