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

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

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

PURPOSE:Temporal lobe epilepsy(TLE) is now recognized as a distinct syndrome in adults. The seizure evolution in adult patients is well characterized, manifesting initially with an aura, behavioral arrest, automatism, and secondary generalized tonic-clonic seizures. In contrast, relatively few studies are available for the pediatric age group. In the present study, we investigated children undergoing temporal lobectomy for refractory seizures and correlated the pathologic findings with clinical presentations. METHODS:The records of the pediatric patients admitted at the Seoul National Children's Hospital for epilepsy surgery between January 1995 and December 2005 were reviewed. Then, eighteen patients were included in this study. The clinical records were reviewed in terms of the patient profiles imaging findings, surgical techniques, and pathologic findings. The seizure outcomes were described according to the Engel's classification. RESULTS:The postsurgical outcomes were favorable. Lateral temporal epilepsy was more common in childhood than in adulthood. Dual pathology was commonly found. Arm dystonia or tonic arm elevation have a lateralizing value. Head turning may have a lateralizing value based upon a time sequence. The brain MRI was less predictable for pathologic findings. The ictal EEG cannot always have a localizing value. Delta beginning in the ictal rhythm may suggest lateral lobe epilepsy. Anterior temporal beginning of the ictal location may suggest mesial temporal lobe epilepsy. Ganglioglioma tends to cause rhythmic beta activities at the beginning of the ictal event. CONCLUSION:TLE in childhood shows more complex and atypical clinical manifestations and have more variable etiologies. No single presurgical investigation can be a good predictable value to localization or lateralization.
Adult ; Arm ; Automatism ; Brain ; Child ; Classification ; Dystonia ; Electroencephalography ; Epilepsy ; Epilepsy, Temporal Lobe* ; Ganglioglioma ; Head ; Humans ; Magnetic Resonance Imaging ; Pathology ; Seizures ; Seoul ; 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*

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*

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

Atypical absence is less understood than typical absence. Several conditions that produce atypical absence are known including Lennox-Gastaut syndrome, myoclonic astatic epilpsy and epileptic encephalopathy with continuous spike and waves in slow wave sleep. A 17-year-old girl with mental retardation had developed frequent loss of consciousness and occasional falling attack with traumatic facial injury for 2 years. The interictal EEG showed 2 Hz slow spike-and-wave complex with maximum over right frontotemporal area and the brain MRI was normal. Carbamazepin was prescribed initially but the drug seemed to worsen the seizures. Long term video-EEG monitoring showed very frequent atypical absence seizures consisting of sudden hypotonia of head and oral automatism with or without secondary generalization. Generalized 2 to 2.5 Hz slow spike-and-wave complexes with duration of 10 to 40 seconds were seen during ictal period. About 10% to 20% of the non REM sleep was occupied with generalized slow spike-and-wave complex and/or polyspikes or polyspikes-and-wave complex with duration of within 1 second. Valprorate monotherapy had failed, then lamotrigin was added. In spite of polytherapy, the seizure was intractable. We think this intractable atypical absence might be associated with juvenile onset Lennox-Gastaut syndrome.
Adolescent ; Automatism ; Brain ; Electroencephalography ; Epilepsy, Absence ; Facial Injuries ; Female ; Generalization (Psychology) ; Head ; Humans ; Intellectual Disability ; Magnetic Resonance Imaging ; Muscle Hypotonia ; Seizures ; Sleep, REM ; Unconsciousness

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: The clinical characteristics of seizures in adults with localization-related epilepsy have been clearly described and classified. But few researches and data are available in childhood intractable epilepsy. METHODS: We analyzed 334 videotaped seizures from 41 pediatric patients who underwent epilepsy surgery at Dong San Medical Center between 1993 and 1997. Twenty- one of 41 patients had temporal lobe epilepsy, and the remaining 20 patients had extratemporal lobe epilepsy. We divided the patient sample into two groups : (a) those with total cases, (b) those with good outcome (seizure-free or more than 90% reduction of seizures after surgery). We compared temporal lobe epilepsy (TLE) with extratemporal lobe epilepsy (ETE) by clinical symptoms and initial ictal symptoms. In addition, we analyzed the lateralizing value of ictal dystonia, head turning, head deviation and automatism. RESULTS: The aura and head deviation of TLE and the motor arrest, head deviation and dystonic posture of ETE were observed more frequently in total group (P<0.05). In contrast, the vocalization and secondary generalization of TLE and the motor arrest, dystonic posture and dysarthria of ETE were observed more frequently in good outcome group (P<0.05). In cases of the initial ictal symptoms, the aura and hand automatism of TLE and the motor arrest and dystonic posture of ETE were observed more frequently in both groups (P<0.05). Of the ictal motor phenomena, ipsilateral hand automatism and contralateral dystonic posture were useful in lateralizing the seizure focus (P<0.05). CONCLUSION: The clinical ictal manifestations in children are very helpful to localize or lateralize the epileptic focus, like in adults case. Because of the lack of younger age group in our study, however, we suggest more rigorous studies based on more comprehensive data.
Adult ; Automatism ; Child ; Dysarthria ; Dystonia ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Temporal Lobe ; Generalization (Psychology) ; Hand ; Head ; Humans ; Posture ; Seizures* ; Temporal Lobe*