Clinical symptom analysis of hypermotor seizures originated from the insular-opercular epilepsy

Abstract

Objective To investigate the value of the characteristics of hypermotor seizures in the localization of epileptogenic zone by studying the clinical symptom characteristics originated from the insular-opercular epilepsy. Methods From June 2006 to March 2014, the clinical data of 5 patients with intractable epilepsy of hypermotor seizures including history, imaging, scalp electroencephalogram, and intracranial electrode electroencephalography admitted to the Department of Neurosurgery, Tsinghua University Yuquan Hospital were studied retrospectively. Results In 5 patients, there was 1 with hypermotor seizures type Ⅰ, 2 with hypermotor type Ⅱ, and 2 with mixed type. Three patients accompanied with bilateral asymmetric rigidity. They were located in the contralateral epileptic foci. Five patients had an aura before seizures, 2 of them had a somatosensory aura on the contralateral side, 1 had palpitations, and 2 had a non-specific aura. The seizures of 2 patients originated from the left hemisphere and 3 from the right hemisphere. Four patients had brain area discharge in the intermittent period. They were located on the ipsilateral epileptic zones. No epileptiform discharges were observed in 1 case. Two patients had generalized ictal onset on the ictal electroencephalogram, the other 3 had unilateral hemisphere or unilateral ictal onset. Conclusions Seizures initiated from insular-opercular cortex can show any type in hypermotor seizures. The asymmetric rigidity of specific aura before onset and in hypermotor seizures has the lateralization value. The special facial expression in seizers is more common in hypermotor seizures originated from the insular-opercular cortex. Key words: Epilepsy; Hypermotor seizures; Insular-opercular; Electroencephalography