Temporal Lobe Epilepsy Semiology

Table 2

Semiological Features (TLE) - Lateralizing or Localizing Value.

Feature	Location
Automatism
Unilateral limb automatism	Ipsilateral focus
Oral automatism	(m)Temporal lobe
Unilateral eye blinks	Ipsilateral to focus
Postictal cough	Temporal lobe
Postictal nose wiping	Ipsilateral temporal lobe
Ictal spitting or drinking	Temporal lobe focus (R)
Gelastic seizures	(m)Temporal, hypothalamic, frontal (cingulate)
Dacrystic seizures	(m)Temporal, hypothalamic
Unilateral limb automatisms	Ipsilateral focus
Whistling	Temporal lobe
Autonomic
Ictal emeticus	Temporal lobe focus (R)
Ictal urinary urge	Temporal lobe focus (R)
Piloerection	Temporal lobe focus (L)
Motor
Early nonforced head turn	Ipsilateral focus
Late version	Contralateral focus
Eye deviation	Contralateral focus
Focal clonic jerking	Contralateral perirolandic focus
Asymmetrical clonic ending	Ipsilateral focus
Fencing (M2E)	Contralateral (supplementary motor)
Figure  4	Contralateral to the extended limb (temporal)
Tonic limb posturing	Contralateral focus
Dystonic limb posturing	Contralateral focus
Unilateral ictal paresis	Contralateral focus
Postictal Todd’s paresis	Contralateral focus
Speech
Ictal speech arrest	Temporal lobe (usually dominant hemisphere)
Ictal speech preservation	Temporal lobe (usually nondominant)
Postictal aphasia	Temporal lobe (dominant hemisphere)