Document Detail

Mesial frontal epilepsy and ictal body turning along the horizontal body axis.
MedLine Citation:
PMID:  18195141     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate the clinical utility of mesial frontal semiology. DESIGN: Retrospective case series. SETTING: Tertiary epilepsy referral center. PATIENTS: Part 1 of the study involved 152 patients who underwent frontal lobe surgery. Part 2 involved 253 patients who underwent non-frontal lobe surgery. MAIN OUTCOME MEASURES: Inclusion criteria for both parts of the study were seizure localization by analysis of resection margins (mesial frontal, lateral frontal, orbitofrontal, nonfrontal) or intracranial exploration and an Engel class I outcome. In part 1, 84 patients had their habitual seizures analyzed by video encephalography using a semiology checklist of 47 items during the early phase (electrographic onset to 10 seconds) and late phase (rest of episode). Localization semiology was analyzed by chi(2) test with Bonferroni correction and cluster analysis when occurrence exceeded 10% in at least 1 region. In part 2, 144 patients had their habitual seizures screened with mesial frontal semiology from the first part of study during the early phase only. RESULTS: In part 1 of the study, the statistically significant localizing semiology for the mesial frontal region in the early phase was ictal body turning along the horizontal axis (57% of patients), crawling (57% of patients), restlessness (64.3% of patients), facial expressions of anxiety (42.9% of patients) and fear (35.7% of patients), grimacing produced by bilateral facial contraction (42.9% of patients), barking (32.1% of patients), head shaking (25% of patients), and pelvic raising (25% of patients) (all P< .001). In the late phase, recurrent utterance (21.4% of patients) was the additional statistically significant item (P< .002). In part 2 of the study, ictal body turning along the horizontal axis gave a 55.2% positive predictive value, which improved to 85.7% when clustered with restlessness, facial expressions of anxiety and fear, and barking. CONCLUSIONS: Ictal body turning along the horizontal body axis and semiology with physiological movement are not only prevalent semiology items of mesial frontal lobe epilepsy but they distinguish mesial frontal from lateral frontal and orbitofrontal seizures.
Howan Leung; Kaspar Schindler; Hans Clusmann; Christian G Bien; Annkathrin Pöpel; Johannes Schramm; Patrick Kwan; Lawrence K S Wong; Christian E Elger
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Archives of neurology     Volume:  65     ISSN:  0003-9942     ISO Abbreviation:  Arch. Neurol.     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-15     Completed Date:  2008-02-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372436     Medline TA:  Arch Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  71-7     Citation Subset:  AIM; IM    
Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing St, Shatin, NT, Hong Kong SAR, The People's Republic of China.
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MeSH Terms
Child, Preschool
Cluster Analysis
Epilepsy, Frontal Lobe / physiopathology*,  psychology,  surgery
Facial Expression
Frontal Lobe / physiopathology
Middle Aged
Neurosurgical Procedures
Retrospective Studies
Seizures / physiopathology*,  psychology,  surgery

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