Hypermotor seizures in patients with temporal pole lesions

Epilepsy Res. 2008 Nov;82(1):93-98. doi: 10.1016/j.eplepsyres.2008.07.005. Epub 2008 Aug 29.

Abstract

Hypermotor seizures are considered to be characteristic of frontal lobe epilepsy, with only rare occurrence in temporal lobe epilepsy. After noting hypermotor seizures in several patients with lesions involving the pole of the temporal lobe, we investigated whether temporal pole lesions were associated with hypermotor seizures. We systematically reviewed medical records, MRI images and pathological findings in consecutive patients who underwent epilepsy surgery over the preceding 10 years in our institution and identified eight patients with temporal pole lesions and intractable complex partial seizures. We analyzed all recorded seizures for semiology, classifying seizures as hypermotor or typical "psychomotor." Four patients exhibited hypermotor seizure semiology and four patients manifested typical psychomotor seizure characteristics. In patients with hypermotor seizures, scalp EEG tended to demonstrate lateral anterior temporal ictal onset, with lesser involvement of the sphenoidal electrode, while the patients with psychomotor seizures had initial inferomesial temporal rhythmic theta activity. Two patients with hypermotor seizures had implanted frontal and temporal subdural grids demonstrating orbitofrontal spread before hypermotor behavior. Patients underwent either anterior temporal lobectomy or lesionectomy. All improved considerably, with six patients seizure-free since surgery. We conclude that hypermotor seizures occur frequently in patients with temporal pole lesions. A search for temporal pole pathology is recommended for patients with hypermotor seizures and temporal epileptiform discharges. Modification of the surgical approach to include this region should be considered in patients who exhibit hypermotor seizures.

MeSH terms

  • Adolescent
  • Adult
  • Automatism / etiology
  • Automatism / physiopathology
  • Brain Injuries / complications
  • Brain Injuries / physiopathology
  • Electroencephalography
  • Epilepsy, Partial, Motor / etiology*
  • Epilepsy, Partial, Motor / pathology
  • Epilepsy, Partial, Motor / surgery
  • Epilepsy, Temporal Lobe / etiology
  • Epilepsy, Temporal Lobe / physiopathology*
  • Epilepsy, Temporal Lobe / surgery
  • Female
  • Gliosis / complications
  • Gliosis / physiopathology
  • Hemangioma, Cavernous, Central Nervous System / complications
  • Hemangioma, Cavernous, Central Nervous System / physiopathology
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Malformations of Cortical Development / complications
  • Malformations of Cortical Development / physiopathology
  • Middle Aged
  • Positron-Emission Tomography
  • Postoperative Complications / physiopathology
  • Radiation Injuries / physiopathology
  • Supratentorial Neoplasms / complications
  • Supratentorial Neoplasms / physiopathology
  • Temporal Lobe / injuries
  • Temporal Lobe / pathology
  • Temporal Lobe / physiopathology*
  • Temporal Lobe / surgery
  • Tomography, Emission-Computed, Single-Photon
  • Video Recording
  • Young Adult