| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Departments of Neurology (Drs. Chee, Kotagal, Van Ness, and Luders, and D. Murphy) and Biostatistics (L. Gragg), The Cleveland Clinic Foundation, Cleveland, OH, and the Department of Neurology (Dr. Chee), Tan Tock Seng Hospital, Singapore.
We evaluated the accuracy and interobserver variability of selected ictal and postictal behavioral changes. Three observers, blinded to clinical history, EEG, and side of surgical resection, analyzed videotapes of 166 seizures in 38 patients, looking for lateralizing signs. Twenty-seven patients with temporal lobe resections were seizure-free for 
1 year postoperatively, and 11 with extratemporal resections had at least 90% reduction in seizures 1 year postsurgery. The epileptogenic region (ER) was lateralized by analyzing lateralizing signs in 78% of patients; positive predictive value (PPV) was 94% (90% CI = 87% to 100%). Overall kappa was 0.68. Signs were considered present if seen by two or more observers. Forty-five percent had version, ie, forced and sustained head deviation (kappa = 0.76, PPV = 94%); 37% had dystonic posturing of the upper extremity (kappa = 0.47, PPV = 93%); and 34% had unilateral mouth deviation (kappa = 0.83, PPV = 92%). These signs indicated a contralateral ER. Twenty-one percent had unilateral upper extremity automatisms, all ipsilateral to the ER (kappa = 0.65, PPV = 100%); 21% had postictal dysnomia, indicating a dominant-hemisphere ER (kappa = 0.89, PPV = 100%); and 16% had ictal speech, usually indicating a nondominant-hemisphere ER (kappa = 0.75, PPV = 83%). Dystonic posturing, postictal dysnomia, ictal speech, and unilateral upper extremity automatisms may indicate a higher probability of temporal lobe epilepsy. Analysis of lateralizing signs shows good interobserver agreement and provides useful clinical information.
Address correspondence and reprint requests to Dr. Prakash Kotagal, S51, Section of Pediatric Epilepsy and Neuropharmacology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Received October 27, 1992. Accepted for publication in final form May 3, 1993.
This article has been cited by other articles:
|
|
 |
|
  M Zijlmans, P van Eijsden, C H Ferrier, K H Kho, P C van Rijen, and F S S Leijten Illusory shadow person causing paradoxical gaze deviations during temporal lobe seizures J. Neurol. Neurosurg. Psychiatry, June 1, 2009; 80(6): 686 - 688. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. L. Schomer and P. M. Black A 24-Year-Old Woman With Intractable Seizures: Review of Surgery for Epilepsy JAMA, December 3, 2008; 300(21): 2527 - 2538. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Fogarasi, J. Janszky, and I. Tuxhorn Peri-ictal lateralizing signs in children: Blinded multiobserver study of 100 children <=12 years Neurology, January 24, 2006; 66(2): 271 - 274. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G Shukla, M Bhatia, M V Padma Srivastava, M Tripathi, A Srivastava, V P Singh, P Saratchandra, A Gupta, S Gaikwad, C S Bal, et al. Unidirectional whole body turning: a new lateralising sign in complex partial seizures J. Neurol. Neurosurg. Psychiatry, December 1, 2005; 76(12): 1726 - 1729. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Rusu, F. Chassoux, E. Landre, V. Bouilleret, F. Nataf, B. C. Devaux, B. Turak, and F. Semah Dystonic posturing in seizures of mesial temporal origin: Electroclinical and metabolic patterns Neurology, November 22, 2005; 65(10): 1612 - 1619. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Meletti, G. Cantalupo, L. Volpi, G. Rubboli, A. Magaudda, and C. A. Tassinari Rhythmic teeth grinding induced by temporal lobe seizures Neurology, June 22, 2004; 62(12): 2306 - 2309. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Nobili, M. Cossu, R. Mai, L. Tassi, F. Cardinale, L. Castana, A. Citterio, I. Sartori, G. Lo Russo, and S. Francione Sleep-related hyperkinetic seizures of temporal lobe origin Neurology, February 10, 2004; 62(3): 482 - 485. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Kellinghaus and P. Kotagal Lateralizing value of Todd's palsy in patients with epilepsy Neurology, January 27, 2004; 62(2): 289 - 291. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Devinsky A 48-Year-Old Man With Temporal Lobe Epilepsy and Psychiatric Illness JAMA, July 16, 2003; 290(3): 381 - 392. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Lux, M. Kurthen, C. Helmstaedter, W. Hartje, M. Reuber, and C. E. Elger The localizing value of ictal consciousness and its constituent functions: A video-EEG study in patients with focal epilepsy Brain, December 1, 2002; 125(12): 2691 - 2698. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Leutmezer, S. Woginger, E. Antoni, B. Seidl, and C. Baumgartner Asymmetric ending of secondarily generalized seizures A lateralizing sign in TLE Neurology, October 22, 2002; 59(8): 1252 - 1254. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Boesebeck, R. Schulz, T. May, and A. Ebner Lateralizing semiology predicts the seizure outcome after epilepsy surgery in the posterior cortex Brain, October 1, 2002; 125(10): 2320 - 2331. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. C. Shin, S. B. Hong, W. S. Tae, and S. E. Kim Ictal hyperperfusion patterns according to the progression of temporal lobe seizures Neurology, February 12, 2002; 58(3): 373 - 380. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Rosenow and H. Luders Presurgical evaluation of epilepsy Brain, September 1, 2001; 124(9): 1683 - 1700. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Ficker, R. Shukla, and M. D. Privitera Postictal language dysfunction in complex partial seizures: Effect of contralateral ictal spread Neurology, June 12, 2001; 56(11): 1590 - 1592. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. R. Benbadis, W. O. Tatum, and a. F. L. Vale When drugs don't work: An algorithmic approach to medically intractable epilepsy Neurology, December 26, 2000; 55(12): 1780 - 1784. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Dupont, F. Semah, P. Boon, J.-M. Saint-Hilaire, C. Adam, D. Broglin, and M. Baulac Association of Ipsilateral Motor Automatisms and Contralateral Dystonic Posturing: A Clinical Feature Differentiating Medial From Neocortical Temporal Lobe Epilepsy Arch Neurol, August 1, 1999; 56(8): 927 - 932. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C H Ferrier, J Engelsman, G Alarcón, C D Binnie, and C E Polkey Prognostic factors in presurgical assessment of frontal lobe epilepsy J. Neurol. Neurosurg. Psychiatry, March 1, 1999; 66(3): 350 - 356. [Abstract] [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
