IMPORTANT SEMIOLOGIC FEATURES AND THEIR LATERALIZATING AND/OR LOCALIZING VALUE

SEMIOLOGIC FEATURES Automatism LATERALIZATION AND/OR LOCALIZATION

Oral automatism
Unilateral limb automatism Unilateral eye blinks

Temporal lobe, typically hippocampal

Ipsilateral to seizure origin Ipsilateral to seizure origin

Bipedal automatisms
Ictal spitting or drinking Ictal laughter (Gelastic)

Frontal lobe seizures

Right temporal seizures Hypothalamic, mesial temporal or frontal cingulate origin Ipsilateral temporal lobe seizures Temporal lobe seizures

Postictal nose wiping Postictal cough

IMPORTANT SEMIOLOGIC FEATURES AND THEIR LATERALIZATING AND/OR LOCALIZING VALUE

SEMIOLOGIC FEATURES
Language abnormalities Ictal speech arrest Temporal lobe seizures, usually dominant hemisphere

LATERALIZATION AND/OR LOCALIZATION

Ictal speech preservation

Temporal lobe seizures, usually non-dominant hemisphere

Dominant hemisphere involvement

Postictal dysphasia Autonomic features Ictus emeticus Ictal urinary urge Piloerection (goose bumps)

Right temporal seizures Right temporal seizures Left temporal seizures

SEMIOLOGIC FEATURES
Motor abnormalities Early nonforced head turn Late forced head turn Eye deviation Focal clonic jerking Asymmetric clonic ending Dystonic limb posturing Tonic limb posturing Fencing posture Figure of 4 sign Unilateral ictal paresis Postictal Todds paresis

LATERALIZATION AND/OR LOCALIZATION

Ipsilateral to seizure origin Contralateral to seizure origin Contralateral to seizure origin Contralateral to seizure origin, peri-rolandic Ipsilateral to seizure origin Contralateral to seizure origin Contralateral to seizure origin Contralateral frontal lobe (supplementary motor) seizures Contralateral to the extended limb, usually temporal lobe Contralateral to seizure origin Contralateral to seizure origin

FEATURES
Seizure frequency

FLE
Frequent, often daily Less frequent

TLE
Less common Slower
Slower Common More common and longer Rare Late, less frequent, less prominent

Sleep activation Seizure onset

Progression Initial motionless staring Automatisms Bipedal automatisms Complex postures

Characteristic Abrupt, explosive

Rapid Less common Less common Characteristic Early, frequent, prominent

Hyperkinetic motor signs

Somatosensory symptoms Speech Seizure duration Seondary generalization

Common
Common Loud vocalization Brief Common

Rare
rare Verbalization speech in non dominant seizure Longer Less common

Postictal confusion Postictal dysphasia

Less prominent/short Rare

More prominent and longer Common in dominant TLE