Hypermotor temporal lobe epilepsy revisited‐expanding the spectrum

• DOI: 10.1002/epd2.20327
• Publication Date: 2025-02-18T07:21:01Z
• Authors: Pavan Kumar Rudra...; Jayakumari Nandana; George C. Vilanilam; Bejoy Thomas; Chandrasekharan K...; Ashalatha Radhakr...; Ramshekhar N. Menon
• Keywords: Hippocampal sclerosis; Neuroradiology

Abstract Objective Typical semiology with associated 5As (Antecedent, Aura, Arrest, Automatisms, and Amnesia) is the prototypical seizure manifestation of temporal lobe epilepsy (TLE) in adults. However, patients TLE can present phenomenology referred to as “hypermotor TLE” (HMS‐TLE) which mimic extratemporal focal epilepsy. We studied clinico‐electrographic, imaging profile, surgical outcomes drug‐resistant HMS‐TLE patients. Methods analyzed ictal signs electroencephalography data who became free following surgery a minimum follow‐up 1 year compared them typical (1:2 ratio). Hypermotor seizures were identified based on presence stereotyped complex movements at onset including body rocking, pelvic thrusting, bimanual bipedal with/without affective components. Results Out 684 underwent during 2010–2020, 16 (2.34%) met criteria for 32 TLE. Predominant “hypermotor” components included motor agitation, bicycling/kicking movements, gyration followed by violent automatisms, thrusting. Age onset, age video telemetry recording, surgery, duration gender distribution, aura comparable between two groups. History febrile (31.3% vs. 65.6%; p ‐value = .024), hippocampal sclerosis MRI, histopathology (56.3% 90.6%; .006 50% 96.9%; .002, respectively) lower, neocortical abnormalities MRI (87.5% 59.4%, .048), dysplasia histopathological evaluation (25% 0%, .003) higher HMS‐TLE. group had lower number focal‐onset patterns (37.5% 90.6%, .0001). Significance are rare TLE, however it does not preclude non‐invasive selection surgery. Hence, physicians should be aware this subtype early intervention have good outcomes, akin