Semiology of hypermotor (hyperkinetic) seizures

Khalid Alqadi; Ram Sankaraneni; Ursula Thome; Prakash Kotagal

doi:10.1016/j.yebeh.2015.11.017

Semiology of hypermotor (hyperkinetic) seizures

Epilepsy Behav. 2016 Jan:54:137-41. doi: 10.1016/j.yebeh.2015.11.017. Epub 2015 Dec 17.

Authors

Khalid Alqadi¹, Ram Sankaraneni², Ursula Thome³, Prakash Kotagal⁴

Affiliations

¹ Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
² Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Neurology, Creighton University Medical Center, Omaha, NE, USA.
³ Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Epilepsy Center, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
⁴ Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: kotagap@ccf.org.

PMID: 26708064
DOI: 10.1016/j.yebeh.2015.11.017

Abstract

Background: Hypermotor seizures (HMSs) consist of complex movements involving proximal segments of the limbs and trunk that appear violent and inappropriate for the situation.

Methods: We analyzed hypermotor seizure videos in seizure-free patients (Engel class I) following resective epilepsy surgery. After completion of video analysis, we reviewed EEG and neuroimaging data.

Results: Search of our epilepsy surgery database yielded 116 patients classified as having hypermotor seizures between 1996 and 2013. From this subset, 17/31 (55%) patients had been seizure-free for >6months (mean follow-up: 3.3years). Mean seizure duration was 35s (range: 6-91s), of which the HM phase lasted a mean of 22s (range: 3-53s). In 16 patients (95%), hypermotor activity was seen at or within 10s of clinical seizure onset. Type I semiology occurred in 6 patients, type II semiology in 10 patients, and 1 patient exhibited features of both. Type I and type II semiologies were noted in patients who had frontal lobe as well as extrafrontal resections. Nonversive head and body turning occurred in 10 patients (ranging from 90° to 270°) which was ipsilateral to the side of resection in all patients and seen both in frontal and extrafrontal resections. Six out of eleven patients with abnormal MRI and 4/6 patients with nonlesional MRI underwent invasive EEG evaluation. Eight patients (47%) had frontal lobe resection, 4/17 (23%) patients had temporal lobe resection, and one patient each had parietal lobe, insular, temporoparietooccipital, or motor sparing resection; 1 patient had functional hemispherectomy.

Conclusion: Hypermotor semiology typically occurs at or within 10s after seizure onset. Ipsilateral head/body turning appears to be of lateralizing value whereas asymmetry of limb movement was not lateralizing. Hypermotor semiology is most often seen in frontal lobe epilepsy but may occur in seizures arising from other locations.

Keywords: Epilepsy surgery; Frontal lobe epilepsy; Intractable epilepsy; Lateralizing signs.

MeSH terms

Adolescent
Adult
Electroencephalography / methods
Epilepsy, Frontal Lobe / complications
Epilepsy, Frontal Lobe / diagnosis*
Epilepsy, Frontal Lobe / physiopathology*
Female
Follow-Up Studies
Frontal Lobe / physiopathology
Humans
Hyperkinesis / diagnosis*
Hyperkinesis / etiology
Hyperkinesis / physiopathology*
Magnetic Resonance Imaging / methods
Male
Middle Aged
Retrospective Studies
Seizures / complications
Seizures / diagnosis*
Seizures / physiopathology*
Temporal Lobe / physiopathology
Young Adult