Ictal Automatisms with Preserved Responsiveness in a Patient with Left Mesial Temporal Lobe Epilepsy

Abstract

Purpose: To describe the possible mechanism of ictal automatisms with preserved responsiveness (APRs) in a patient with left mesial temporal lobe epilepsy, which had not been reported previously.

Methods: Ictal EEGs recorded from bilateral foramen ovale electrodes with scalp–sphenoidal electrodes were analyzed in respect to the ictal semiology.

Results: The patient had a right hemispheric language dominance in the dextral. Electroclinical analysis revealed that the onset of oroalimentary automatisms coincided with the involvement of the left mesial and lateral temporal structures by spreading ictal discharges. The ictal discharge spreading was limited to the ipsilateral hemisphere throughout the seizure, which explained the intact consciousness and preserved responsiveness of the patient.

Conclusions: This case suggests that APRs take place in seizures originating from the nondominant temporal lobe, during which ipsilateral mesial and lateral temporal structures are diffusely involved without spreading to the contralateral side.