Elsevier

Seizure

Volume 14, Issue 4, June 2005, Pages 269-273
Seizure

Ictal dystonic posturing in mesial versus neocortical temporal lobe seizures

https://doi.org/10.1016/j.seizure.2005.03.001Get rights and content
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Summary

Purpose:

Ictal contralateral dystonic posturing is a frequently observed clinical feature in temporal lobe seizures. It is generally interpreted as the result of spread of the ictal discharge into basal ganglia structure. In previous reports, analysing ictal behavior, a precise definition and description of the upper limb ictal dystonia is often lacking or contradictory. In our study we aimed to determine whether different subtypes of dystonia and their latency from the clinical onset of seizure might be of value for the differentiation between mesial temporal lobe epilepsy (MTLE) and neocortical temporal lobe epilepsy (NTLE).

Methods:

Eighty seizures (51 MTLE and 29 NTLE) and 30 patients (20 MTLE and 10 NTLE) were analyzed with regard to dystonic posturing of the upper limb. Ictal dystonia was subdivided into different subtypes according to distinct clinical features. Their frequency and latency from the clinical onset of seizure were assessed.

Results:

Frequencies of all subtypes were similar in MTLE and NTLE. Concerning the latencies contralateral dystonic posturing characterized by sustained muscle contractions with flexion of the wrist and fist closure, a frequently appearing feature, occurred significantly earlier in NTLE than in MTLE seizures.

Conclusions:

This difference between the two groups may provide a differentiation between an epileptic focus of mesial from neocortical temporal lobe origin.

Keywords

Dystonic posturing
Temporal lobe epilepsy
Ictal seizure spread

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