Lateralizing value of unilateral relative ictal immobility in patients with refractory focal seizures – Looking beyond unilateral automatisms. (December 2015)

• Record Type: Journal Article
• Authors: Agarwal, Priya; Kaul, Bhavna; Shukla, Garima; Srivastava, Achal; Singh, Mamta Bhushan; Goyal, Vinay; Behari, Madhuri; Suri, Ashish; Gupta, Aditya; Garg, Ajay; Gaikwad, Shailesh; Bal, C.S.
• Is Part Of: Seizure. Volume 33(2015)
• Page Start: 66
• Page End: 71
• Publication Date: 2015-12
• Subjects: VEEG video encephalograms -- RII relative ictal immobility; Refractory focal epilepsy -- Lateralizing value -- Semiology -- Relative ictal immobility -- Automatisms -- Epilepsy surgery; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2015.08.009
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: Analysis of seizure semiology on video-EEG, by using the localizing and lateralizing value of several motor signs defines the ictal symptomatogenic zone. Relative ictal immobility is a common ictal sign in focal seizures, found in up to 35% patients. It is also a very reliable sign, always lateralizing the seizure focus to the contralateral hemisphere. Relative ictal immobility of the limb is observed in both, temporal and extra temporal epilepsy. Abstract: Purpose: Ictal motor phenomena play a crucial role in the localization of seizure focus in the management of refractory focal epilepsy. While the importance of unilateral automatisms is well established, little attention is paid to the contralateral relatively immobile limb. In cases where automatisms mimic clonic or dystonic movements and in the absence of previously well-established signs, unilateral relative ictal immobility (RII) is potentially useful as a lateralizing sign. This study was carried out to examine the lateralizing value of this sign and to define its characteristics among patients of refractory focal epilepsy. Methods: VEEGs of 69 consecutive patients of refractory focal epilepsy who had undergone epilepsy surgery at our center over last four years were reviewed and analyzed for the presence of RII. Unilateral RII was defined as a paucity of movement in one limb lasting for at least 10 s while the contralateral limb showed purposive or semi-purposive movements (in the absence of tonic or dystonic posturing or clonic movements in the involved limb). The findings were seen in the light of VEEG, radiological and nuclear imaging data, and with post-surgical outcome. Results: Unilateral RII as a lateralizing sign was found in 24 of 69 patients (34.78%), consisting of both temporal and extra temporal epilepsy, with 100% concordance with VEEG and MRI data. All patients demonstrating this sign had a good post-surgical outcome. Conclusion: RII, when well characterized is a frequent and reliable lateralizing sign in patients of refractory focal epilepsy.