| Epileptogenic zone |
Semiology |
| Temporal |
Medial Temporal lobe |
• Déjà vu, fear, viscero-sensory auras with nausea, rising epigastric sensation
• Staring and limited motor movement with oral or manual automatism
• Autonomic features
• Dystonic posturing contralateral to seizure focus with ipsilateral automatism
• Ictal speech, vomiting may suggest a non-dominant lateralization
• Postictal aphasia suggests dominant lateralization
|
| Neocortical temporal lobe |
• Aura of auditory phenomena, déjà vu, complex visual distortions, vertigo
• Motionless staring and unresponsiveness
• Contralateral clonic movements
|
| Frontal |
Mesial frontal |
• Ictal fear
• Ictal laughter without mirth
• Onset in sleep
• Fencing posture
• M2e posture (contralateral shoulder abduction, elbow flexion, head deviation toward affected arm)
• Figure-of-4 posture
• Hyperkinetic seizures including body rocking, kicking or boxing
|
| Dorsolateral frontal |
• Spreading clonic activity
• Versive seizures
• Lateral eye deviation
• Aphasia
• Nocturnal hypermotor activity
• Laughing, shouting, bicycle peddling, thrashing of extremities
|
| Orbitofrontal |
• Hypermotor automatisms
• Thrashing movements
• Sudden motion arrest, unresponsiveness, staring
|
| Insular |
• Laryngeal discomfort
• Sensation of throat constriction followed by contralateral paresthesias
|
| Parietal |
|
• Auras of contralateral tingling, numbness, pain, thermal sensation
• Motor activity depending on spread to sensorimotor temporolimbic, supplemetary motor or premotor cortex
|
| Occipital |
|
• Contralateral simple visual distortions, blindness
• Ocular pain
• Tonic deviation, nystagmus, eyelid fluttering
|
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