Abstract 1 C. Baumgartner ( 1 Department of Neurology, Medical University of Vienna, Austria ) Motor manifestations during epileptic seizures include focal clonic motor seizures, seizures with asymmetrical tonic posturing and seizures with hypermotor automatisms. Focal clonic motor seizures are generated by epileptic activity in the primary motor cortex and consist of unilateral, jerky, usually rhythmic movements, frequently also tonic components like tonic postural signs and tonic face contractions can be observed. Most frequently they start in the face or hand due to their large representation in primary motor cortex and due to a lower seizure threshold of these cortical regions. Asymmetric tonic seizures or supplementary motor area (SMA) seizures are mediated by epileptic activity in the supplementary sensorimotor area or the premotor cortex, but can also be generated by epileptic activity in other frontal lobe regions. Because frequently somatosensory auras like feelings of pulling, pulsing, heaviness, numbness or tingling which can occur ipsi-, contra- or bilaterally occur the term “supplementary sensorimotor seizures” has been introduced. Asymmetric tonic seizures are characterized by bilateral, asymmetric, tonic or dystonic posturing of the extremities and facial grimacing resulting in tonic posturing. Vocalizations frequently occurring during asymmetrical tonic seizures can be a reactive phenomenon, can be caused by a tonic contraction of the diaphragm and laryngeal muscles and finally can be a consequence of an activation of Broca's area or SMA. While hyperkinetic or ‘hypermotor’ automatisms are not associated with a seizure onset in any specific region within the frontal lobes. They are characterized by prominent and complex, coordinated, purposeless or semipurposefull movements (trembling, waving, rotating, stepping, cycling, rocking, hopping etc.) with an agitated or frenetic appearance. Vocalizations often are explosive and pronounced which seems to be unique for frontal lobe seizures with hypermotor automatisms. Seizures with hypermotor automatisms usually are associated with a loss of consciousness and therefore also are referred to as frontal lobe complex partial seizures.
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