BACKGROUND: Anteromesial temporal resection (AMTR) is well established as effective in patients with intractable mesial temporal epilepsy. However, little electroclinical information is available relevant to poor surgical outcome after AMTR. We examined the postoperative electroclinical features based on postoperative MRI and video-EEG monitoring (VEM) in patients with poor surgical outcome. METHODS: We reviewed clinical features and postoperative VEM results in 20 patients with failure in AMTR. According to the postoperative electroclinical features, we classified them into mesial temporal (MT), bitemporal (BT), extramesial temporal (XMT), combined (C), and unclassified groups. The postoperative VEM results were compared among the groups. Surgical outcome was assessed in five patients who underwent reoperation. RESULTS: Patients comprised 6 MT, 2 BT, 6 XMT, 1 C, and 6 unclassified. Aura and automatism were more frequent in MT (50.0%, 83.3%) than in XMT (16.7%, 33.3%). Theta to delta rhythm, during the ictal onset and build-up period, was more frequent in MT (83.3%, 66.7%) than in XMT (33.3%, 33.3%). The ictal onset and build-up pattern of ictal EEG were most frequently localized to the frontotemporal region in MT (66.7%, 100.0%), while there was no predominantly localized region in XMT. The surgical outcome after reoperation was better in MT group than in XMT and C groups. CONCLUSIONS: Postoperative MRI and VEM are useful to assess the postoperative electroclinical features in failed AMTR. Reoperation of the residual mesiotemporal structures after confirming epileptogenic foci may have good surgical outcome.
Automatism ; Delta Rhythm ; Electroencephalography ; Epilepsy ; Humans ; Reoperation ; Seizures

Ictal spitting is an unusual manifestation that originates from the non-dominant hemisphere, but rarely from the dominant hemisphere. In the latter case, it has not been well defined as to whether symptomatogenic area for ictal spitting originates from the dominant hemisphere. We present a patient with ictal spitting. Intracranial EEG demonstrated a left hippocampal onset with propagation to the right hemisphere, and subsequent ictal spitting development. Even in dominant hemispheric seizures, the non-dominant hemisphere is a symptomatogenic area for ictal spitting.
Automatism* ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Humans ; Seizures ; Temporal Lobe*

We investigated the postictal EEG and semiology in temporal lobe epilepsy in order to evaluate their possible clinical utility. Fifty four well lateralized seizures in 10 patients, recorded during presurgical evaluation, were analysed in regard to the frequency, pattern and location of the EEG activity (42 seizures with scalp-sphenoidal electrodes, 27 seizures with intracranial electrodes). Postictal EEG changes were very heterogenous, at best categorized to several patterns: (1) theta+delta slowing (2) attenuation (3) spike activation, among them theta+delta slowing was mosts frequently encountered. The lateralizing value of the earliest pattern was 59.3% using intracranial electrodes but only 23.3% using scalp-sphenoidal electrodes. Postictal semiology also showed a variety of behavioral manifestation such as confusion(81.5%), lip smacking(40.7%), hand automatism (18.5%). Lip smacking was more often seen following the left temporal seizure (16 out of 22, p<.05). Behavioral distinction between ictal and postictal semiology was not possible. Postictal EEG and semiology appears to be consisting of heterogenous mechanisms and wide spectrum. We feel that the clinical utility is limited.
Automatism ; Electrodes ; Electroencephalography* ; Epilepsy, Temporal Lobe* ; Hand ; Humans ; Lip ; Seizures ; Temporal Lobe*

Circling seizure in which the patient walks repetitively in samall circles is relatively uncommon and may either represent a benign form of primary generalized epilepsy or occur secondary to a focal epileptic activity. Especially circling due to focal seizure activity has been regarded as rare. The authors report 6-year old boy who showed many repetitive circling behavior toward the left side, running automatism, vocalization and mental confusion for 6 hours. He had a history of relatively intractable epilepsy for 3 years of adversive seizures(turning to the right side), staring and vocalzation followed by tonic fencing posturing with cyanosis. The electroencephalography demonstrated frequent focal spikes in the left fronto-temporal area.
Automatism ; Child ; Cyanosis ; Electroencephalography ; Epilepsy ; Epilepsy, Generalized ; Humans ; Male ; Running ; Seizures*

Reflex seizures induced by micturition are rare, and there have been few reports on ictal electroencephalogram (EEG) findings. Here, we report a 7-year-old boy with secondarily generalized partial seizures induced by micturition. The seizures occurred every time he urinated. A few seconds after micturition begun, he toppled down with hand automatism followed by a secondarily generalized tonic posture and loss of consciousness. Ictal video-EEG recording during urination was performed. An ictal EEG demonstrated a polyspike wave discharge onset from the left frontotemporal region, with rapid spread to the right frontotemporal region. He was treated with the antiepileptic drug valproate sodium, which improved seizure control. He remained seizure-free until the last followup for a period of 2 years.
Automatism ; Child ; Electroencephalography ; Follow-Up Studies ; Hand ; Humans ; Posture ; Reflex ; Seizures ; Unconsciousness ; Urination ; Valproic Acid

To find out whether the commonly observed ictal behaviors in temporal lobe epilepsy (TLE) contribute to the lateralization of epileptogenic focus, 116 seizures in 19 unilateral TLE patients were reviewed and analyzed carefully by two epileptologists. Unilateral motor manifestations such as dystonia, tonic posturing, clonic jerking, head version, head turning, eye deviation, unilateral eye blinking and unilateral automatism were observed in ipsilateral or contralateral side of EEG seizure focus. Ictal language was classified as normal speech, speech arrest, dysphasia and nonidentifiable speech. They were evaluated for their significance in determining dominant (DHS) or nondominant hemisphere onset (NHS) based on the results of Wada test. Other categories of automatisms were analyzed to investigate whether they indicate right or left TLE. Dystonia(in 34 seizures), tonic posture(17), clonic jerking(24) and head version (14) were observed only in contralateral side of EEG seizure focus in 89 seizures. The direction of head turning was ipsilateral to seizure focus in 15 seizures (46.9%) and contralateral to seizure focus in 17 seizures (53.1%), Eye deviation direction inclined to suggest contralateral hemisphere seizure origin without statistical significance [contralateral in 13 seizures (65%) and ipsilateral in 7 seizures (35%)]. Unilateral eye blinking and unilateral automatism were seen in 35 seizures and occurred exclusively in ipsilateral side to ictal EEG onset (12,85.7% ;23,88.5%) compared with contralateral side(2,14.3% ;3,11.5%). Ictal normal speech was observed in 9 seizures of 2 patients who had NHS, wheares dysphasia occurred in 4 DHS of 3 patients. Deglutition, sexual automatism and sniffing were observed in both right and left TLE, and not valuable in seizure lateralization. These results show unilateral dystonia, tonic posture, clonic jerking and head version suggest strongly contralateral hemisphere seizure origin. Unilateral eye blinking and unilateral automatism indicate ipsilateral hemisphere seizure focus. Among ictal speech manifestations, ictal normal speech and dysphasia suggested NHS and DHS respectively.
Aphasia ; Automatism ; Blinking ; Deglutition ; Dystonia ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Head ; Humans ; Posture ; Seizures ; Temporal Lobe*

When the spinal cord is suddenly severed, all the fundamental functions of the spinal cord below the level of injury including the spinal cord reflexes are immediately depressed, which is referred to as spinal shock. The resolution of spinal shock occurs over a period of days to months, and spinal shock slowly transitions to spasticity. The definition of spinal shock and the pattern of reflex recovery or evolution remains as an issue of debate and controversy. The identification of clinical signs that determine the duration of spinal shock is controversial. The underlying mechanisms of spinal shock are also not clearly defined. Various authors have defined the termination of spinal shock as the appearance of the bulbocavernosus reflex, the recovery of deep tendon reflexes, or the return of reflexic detrusor activity. However, many questions remain to be answered, such as: When should we define spinal shock as the end? What types of reflexes appear first among polysynaptic cutaneous reflexes, monosynaptic deep tendon reflexes, and pathological reflexes? Should it include changes in autonomic reflexes such as a detrusor reflex?
Automatism ; Muscle Spasticity ; Reflex* ; Reflex, Stretch ; Shock* ; Spinal Cord ; Spinal Cord Injuries

BACKGROUND: Semiology of epileptic seizure is very important for diagnosis and treatment. However, little is known about the reliability of the observers' description. This study aims to determine the description reliability of seizures in the aspects of classification and lateralization. METHODS: We recorded 72 patients with habitual seizures during video-EEG monitorings. We, then, compared the ictal behaviors described by frequency observers and those recorded on the videotape to compare the accuracy of the observers' descriptions. Finally, we reviewed which aspects of the informants affected the reliability of the data. RESULTS: The classification of seizures based only on the observer-description was somewhat discordant from the videotape (correct classification: 82%) especially in dividing simple partial from complex partial seizures. Description of many ictal behaviors in presumed complex partial seizure such as oroalimentary automatism, motionless staring, tonic/clonic posture and version was accurate except for the hand automatism. A specified direction by the observer has a very high true positive rate. The accuracy of the description was related to the educational status of the observer. CONCLUSIONS: Semiology description by well-educated observers is may be reliable, but every physician should keep its limitation in mind and judge accordingly.
Automatism ; Classification ; Diagnosis ; Educational Status ; Epilepsy ; Hand ; Humans ; Medical History Taking ; Posture ; Reproducibility of Results ; Seizures ; Videotape Recording

Authors experienced a case of insulinoma which was initially misdiagnosed as idopathic temporal lobe epilepsy with automatism. This patients did not show other hypoglycemic symptoms except seizure. It has been reported that some of the patients with insulinoma are unaware of hypoglycemia and are at increased risk for seizures and coma. These patients would have normal glucose uptake in the brain and consequently no sympathoadrenal activation would begin, resulting in an awareness of hypoglycemia. It this case, abnomal EEG pattern consistent with a complex partial seizure remained after successful operation. Recent reports indicate that hypoglycemia is capable of killing neurons in the brain. An endogenous neurotoxin is produced and is released by the brain into tissue and cere-brospinal fluid. Endogenous excitotoxins produced during hypoglycemia may explain the tendency toward seizure activity often seen clinically. We suggest that persistent abnormalities of EEG in this case may be related to focal neuronal damage in hypoglycemia.
Automatism ; Brain ; Coma ; Electroencephalography* ; Epilepsy, Temporal Lobe* ; Glucose ; Homicide ; Humans ; Hypoglycemia ; Insulinoma* ; Neurons ; Neurotoxins ; Seizures ; Temporal Lobe*

BACKGROUND AND PURPOSE: This study aimed to determine whether there are clinicoelectrical differences between anterior lateral temporal lobe epilepsy (ALTLE) and posterior lateral temporal lobe epilepsy (PLTLE), taking medial temporal lobe epilepsy (MTLE) as a reference. METHODS: We analyzed the historical information, ictal semiologies, and ictal EEGs of temporal lobe epilepsy patients with a documented favorable surgical outcome (Engel class I or II) at follow-up after more than one year. LTLE was defined when a discrete lesion on MRI or an ictal onset zone in invasive study was located outside the collateral sulcus. LTLE was further divided into ALTLE and PLTLE by reference to the line across the cerebral peduncle. Total 107 seizures of 13 ALTLE, 8 PLTLE and 21 MTLE patients were reviewed. RESULTS: Initial hypomotor symptom was frequently observed in PLTLE (P<0.001). Oroalimentary automatism (OAA) was not observed initially in PLTLE. Generalized tonic-clonic seizures occurred significantly earlier in PLTLE than in ALTLE or MTLE (P< 0.001). Ictal scalp EEG was not helpful in differentiating between ALTLE and PLTLE. CONCLUSIONS: Frequent hypomotor onset, the absence of initial oroalimentary automatism, and early generalization are characteristic findings of PLTLE, although they are insufficient to differentiate it from ALTLE or MTLE.
Automatism ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Generalization (Psychology) ; Humans ; Magnetic Resonance Imaging ; Scalp ; Seizures ; Tegmentum Mesencephali ; Temporal Lobe*