Post-ictal, lateralized hyperkinetic motor behavior

Recognition of a transient, focal neurologic dysfunction after a seizure is important when evaluating patients with idiopathic epilepsy. Todd's palsy, a transient focal weakness after a seizure, is a highly accurate clinical sign indicative of a contralateral, cerebral epileptic focus. In contrast, a transient, lateralized hyperkinetic motor behavior from a contralateral, hemispheric ictal focus has not been emphasized as a localizing clinical sign. The following case demonstrates that transient hyperkinetic behavior occurs as a post-ictal phenomenon and may have a localizing value, as in Todd's palsy.