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Sections of Epilepsy and Clinical Neurophysiology, Cleveland Clinic Foundation, Cleveland, OH (Drs. Kotagal, Lüders, Morris, Dinner, Wyllie, and Godoy)
Pediatric Neurology, Cleveland Clinic Foundation, Cleveland, OH (Dr. Rothner).
We observed unilateral dystonic posturing of an arm or leg in 41 complex partial seizures (CPS) from 18 patients. In all cases this was contralateral to the ictal discharge. Unilateral automatisms occurred in 39 of 41 seizures on the side opposite the dystonic limb. Version occurred in 11 of the 41 CPS to the same side as the dystonic posturing and always followed the posturing. Subdural recordings of seven seizures showed ictal onset from the mesial basal temporal lobe. At the onset of dystonic posturing, maximum ictal activity was in the basal temporal lobe with minimal involvement of the cerebral convexity. Unilateral dystonic posturing occurs frequently in CPS of temporal lobe onset and is a lateralizing sign with a high degree of specificity. It probably reflects spread of the ictal discharge to basal ganglia structures.
Address correspondence and reprint requests to Dr. Kotagal, Section of Epilepsy and Clinical Neurophysiology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195–5221.
Received April 29, 1988. Accepted for publication in final form August 8, 1988.
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