Hypermotor seizures in patients with temporal pole lesions

• Published in: Epilepsy research 2008-11, Vol.82 (1), p.93-98
• Main Authors: Wang, Lina, Mathews, Gregory C, Whetsell, William O, Abou-Khalil, Bassel
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anticonvulsants. Antiepileptics. Antiparkinson agents; Automatism - etiology; Automatism - physiopathology; Biological and medical sciences; 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; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Hemangioma, Cavernous, Central Nervous System - complications; Hemangioma, Cavernous, Central Nervous System - physiopathology; Humans; Hypermotor seizures; Magnetic Resonance Imaging; Male; Malformations of Cortical Development - complications; Malformations of Cortical Development - physiopathology; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Neuropharmacology; Pharmacology. Drug treatments; Positron-Emission Tomography; Postoperative Complications - physiopathology; Radiation Injuries - physiopathology; Seizure semiology; Supratentorial Neoplasms - complications; Supratentorial Neoplasms - physiopathology; Temporal Lobe - injuries; Temporal Lobe - pathology; Temporal Lobe - physiopathology; Temporal Lobe - surgery; Temporal lobe epilepsy; Temporal pole lesions; Tomography, Emission-Computed, Single-Photon; Young Adult
• ISSN: 0920-1211; 1872-6844
• DOI: 10.1016/j.eplepsyres.2008.07.005

Summary 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.