Ictal unilateral hyperkinetic proximal lower limb movements: an independent lateralising sign suggesting ipsilateral seizure onset

Our aim was to determine the lateralising value of ictal repetitive unilateral hyperkinetic proximal lower limb movements. Among 16 patients with ictal hyperkinetic features who underwent intracranial EEG between 2008 and 2011 in our centre, three had repetitive unilateral hyperkinetic proximal lower limb movements, sometimes associated with "hemiballic-like" movements of the ipsilateral upper limb. There were no other consistent lateralising signs. In all patients, these movements were ipsilateral to the ictal onset zone and started a few seconds after electroencephalographic seizure onset. In two patients, intracranial EEG showed seizure onset within the parietal lobe and mesial temporal ictal onset was recorded in a third. Two patients underwent resection and became seizure-free. Our results suggest that unilateral ictal repetitive hyperkinetic proximal lower limb movements may be an independent lateralising sign to the ipsilateral hemisphere.