Abstracts

Rationale: Distal automatisms are involuntary complex motor movements that resemble normal body movements and involve the mouth, tongue, and distal areas of upper and lower limbs. We studied the occurrence and the sequence of different distal automatism during automotor seizures. These findings were used to define if the type of distal automatisms relates to a specific epileptogenic zone location or lateralization and to determine the pathophysiology of these automatisms. Methods: We retrospectively reviewed 63 patients with distal automotor seizures. We categorized the automatisms into oro-alimentary automatisms (lip smacking, tongue protruding, lip pursing, swallowing, blowing), manual automatisms (finger/pill rolling, picking/fumbling, hand rolling/flapping, grasping, rubbing) and uncharacterized oral/manual movements. Semiology was classified by two authors (MI & RI) and the epileptogenic zone (EZ) was determined by another author (GF) who were blinded to all the data. Results: Automotor seizures were preceded by aura in 16 patients. The commonest aura noted were: psychic (5 patients) and non-specific aura (5 patients). The individual automatisms occurred in isolation or in a sequence of 2-3 individual components. The most common individual component noted was lip smacking which occurred as first component in 39 patients and as a later component in 6 patients. Upper extremity automatisms remained on the same side (ipsilateral or contralateral to EZ) or remained bilateral or switched side in 17, 5 and 3 patients respectively. In 6 patients the automatisms were bilateral initially and later shifted to ipsilateral side to the EZ in 4 patients. Contralateral dystonia was seen in the 3 patients all with ipsilateral automatisms. There was increased tone of one or both limbs in 17 patients and no appreciable tone changes in 20 patients. Individual components of upper extremity automatisms were contralateral to the EZ in 16 patients, bilaterally in 13 patients and ipsilateral to the EZ in 8 patients. Contralateral dystonia was seen in the 5 patients all with ipsilateral automatisms. Dominant hemisphere EZ was seen in 38 patients and non-dominant hemisphere EZ was seen in 25 patients. In 8 patients with right non dominant epilepsy, there was preserved awareness. 61 of 63 patients with distal ictal automatisms had temporal lobe epilepsy. 42 patients had mesial temporal epilepsy and 19 had lateral temporal epilepsy. Only 2 patients had extra-temporal lobe epilepsy. Postictal automatisms lasting for 10 ?" 110 seconds were seen in 9 patients. In 7 out of 9 patients the ictal and postictal automatism were the same. 2 patients had a new postictal automatism. Conclusions: 97% of the distal automatisms occurred in temporal lobe epilepsies. The commonest automatisms was lip smacking. Ipsilateral automatisms with contralateral dystonia was the most reliable lateralizing sign with correct lateralization of the epileptogenic zone in all cases. The frequent occurrence of identical ictal and postictal automatisms favors the hypothesis that ictal distal automatisms are most likely due to a cortical release phenomenon of subcortical motor centers. Funding: None