Semiology of hypermotor (hyperkinetic) seizures.
BACKGROUND
Hypermotor seizures (HMSs) consist of complex movements involving proximal segments of the limbs and trunk that appear violent and inappropriate for the situation.


METHODS
We analyzed hypermotor seizure videos in seizure-free patients (Engel class I) following resective epilepsy surgery. After completion of video analysis, we reviewed EEG and neuroimaging data.


RESULTS
Search of our epilepsy surgery database yielded 116 patients classified as having hypermotor seizures between 1996 and 2013. From this subset, 17/31 (55%) patients had been seizure-free for >6months (mean follow-up: 3.3years). Mean seizure duration was 35s (range: 6-91s), of which the HM phase lasted a mean of 22s (range: 3-53s). In 16 patients (95%), hypermotor activity was seen at or within 10s of clinical seizure onset. Type I semiology occurred in 6 patients, type II semiology in 10 patients, and 1 patient exhibited features of both. Type I and type II semiologies were noted in patients who had frontal lobe as well as extrafrontal resections. Nonversive head and body turning occurred in 10 patients (ranging from 90° to 270°) which was ipsilateral to the side of resection in all patients and seen both in frontal and extrafrontal resections. Six out of eleven patients with abnormal MRI and 4/6 patients with nonlesional MRI underwent invasive EEG evaluation. Eight patients (47%) had frontal lobe resection, 4/17 (23%) patients had temporal lobe resection, and one patient each had parietal lobe, insular, temporoparietooccipital, or motor sparing resection; 1 patient had functional hemispherectomy.


CONCLUSION
Hypermotor semiology typically occurs at or within 10s after seizure onset. Ipsilateral head/body turning appears to be of lateralizing value whereas asymmetry of limb movement was not lateralizing. Hypermotor semiology is most often seen in frontal lobe epilepsy but may occur in seizures arising from other locations.
['Alqadi|Khalid|K|', 'Sankaraneni|Ram|R|', 'Thome|Ursula|U|', 'Kotagal|Prakash|P|']
D000293:Adolescent D000328:Adult D004569:Electroencephalography D017034:Epilepsy, Frontal Lobe D005260:Female D005500:Follow-Up Studies D005625:Frontal Lobe D006801:Humans D006948:Hyperkinesis D008279:Magnetic Resonance Imaging D008297:Male D008875:Middle Aged D012189:Retrospective Studies D012640:Seizures D013702:Temporal Lobe D055815:Young Adult
Epilepsy surgery Frontal lobe epilepsy Intractable epilepsy Lateralizing signs