Psychomotor seizures of temporal lobe onset: Analysis of symptom clusters and sequences

• Published in: Epilepsy research Vol. 20; no. 1; pp. 49 - 67
• Main Authors: Kotagal, Prakash, Lüders, Hans Otto, Williams, George, Nichols, Thom R., McPherson, Joseph
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier B.V 1995; Elsevier
• Subjects: Biological and medical sciences; Cluster Analysis; Complex partial seizures; Diagnosis, Differential; Electroencephalography; Epilepsy, Complex Partial - diagnosis; Epilepsy, Temporal Lobe - surgery; Follow-Up Studies; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Medical sciences; Nervous system (semeiology, syndromes); Neurology; Seizures - diagnosis; Symptom analysis; Temporal lobe; Treatment Outcome; Temporal lobe; Complex partial seizures; Symptom analysis; Human; Symptomatology; Nervous system diseases; Central nervous system disease; Complex partial epilepsy; Temporal lobe epilepsy; Behavioral sequence; Cerebral disorder
• ISSN: 0920-1211; 1872-6844
• DOI: 10.1016/0920-1211(94)00055-2

We analyzed 91 psychomotor seizures from 31 patients seizure free at least one year after temporal lobectomy (implying temporal lobe onset). Fifty symptoms were looked for in every seizure and their time of onset and ending noted. Statistical analysis was used to define symptom clusters and the order of appearance of symptoms. Of the eighteen most common symptoms examined, all of these symptoms form a tight cluster showing a high degree of correlation. Within this cluster, there was a tendency towards the following subclusters: (a) epigastric aura, ictal vomiting, alimentary and hand automatisms; (b) behavioral arrest, complete loss of consciousness, staring and bilateral facial contraction; (c) unilateral dystonic posturing of an arm, mimetic automatisms, complex gestures, ictal speech and partial loss of consciousness; (d) looking around, agitation, vocalizations and whole body movements. We also found a strong correlation between epigastric sensation and ictal vomiting in psychomotor seizures arising from the right but not the left temporal lobe. The commonest sequence of symptoms was: behavioral arrest followed by alimentary and hand automatisms, looking around and whole body movements, in that order.