Abstracts

Rationale: To evaluate the anatomic localization and surgical outcome in refractory hypermotor seizures.Methods: We identified eight patients with nonlesional epilepsy with refractory hypermotor seizures from our epilepsy surgery database. We analyzed these patients presurgical evaluation including demographics, semiology, MRI, PET scan, interictal/ictal scalp video-EEG, intracranial recording and correlated with surgical outcomes.Results: These eight patients mean monthly seizure frequency was 55.8 with a range of 4-190 per month with most seizures happening in sleep (5 patients). Marked hypermotor agitation was observed in all patients with flailing, screaming/shouting and asymmetric posturing. All patients had normal MRI. Intracranial recording of typical seizures was conducted in all patients. With intracranial recordings, the ictal focus was localized in anterior temporal region in three patients and inferior lateral temporal region in one patient, orbitofrontal cortex in two patients, and cingulate cortex in two patients. The epileptogenic zones were resected from the temporal lobe in 4 patients and from the frontal lobe in 4 patients. Histologic examinations of the resected tissue demonstrated focal cortical dysplasia in 3 patients, gliosis in 3 patients and hippocampal sclerosis in 2 other patients. The mean duration of clinic follow-up after surgery was 39.4 months with a range of 3-146 months. Five patients (62.5%) had been seizure-free at the last follow up, while one patient had rare disabling seizures since surgery.Conclusions: Hypermotor seizures can often originate from the temporal neocortex as well as the cingulate and orbitofrontal cortex. Temporal lobe should be explored in nonlesional epilepsy with hypermotor seizures.