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Seizures with tonic posturing: Semiologic difference between supplementary sensorimotor area (SSMA) origin and
Bunpot Sitthinamsuwan1,2, Naotaka Usui1, Takayasu Tottori1
1National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.
Epilepsia
|December 15, 2015
Summary
This study differentiates seizures originating in the supplementary motor area (SSMA) from those in other cortical areas based on tonic posturing. SSMA seizures are linked to preserved consciousness and asymmetrical posturing, aiding in seizure origin identification.
Area of Science:
- Neurology
- Epileptology
- Neurosurgery
Background:
- Differentiating seizure origin in focal epilepsy with tonic posturing is challenging.
- The supplementary motor area (SSMA) role in seizure semiology requires further elucidation.
- Previous studies have not specifically compared SSMA seizures with extra-SSMA seizures presenting with tonic posturing.
Purpose of the Study:
- To investigate and differentiate seizure semiology between the SSMA and extra-SSMA origins in patients with intractable focal epilepsy and tonic posturing.
- To identify distinct clinical features that may help localize the seizure onset zone.
Main Methods:
- Retrospective analysis of 22 patients with intractable focal epilepsy and tonic limb posturing undergoing resective surgery.
- Classification of patients into SSMA (N=12) and extra-SSMA (N=10) groups based on resection location.
- Detailed review of video-recorded seizures to compare tonic posturing characteristics and accompanying symptoms.
Main Results:
- Preservation of consciousness was significantly higher in the SSMA group (p < 0.001).
- SSMA seizures were associated with unilateral or bilateral asymmetrical tonic limb posturing.
- Extra-SSMA seizures showed a significantly higher incidence of bilateral symmetrical tonic limb posturing (p < 0.05).
Conclusions:
- Tonic posturing semiology, including limb symmetry and consciousness preservation, can help differentiate seizures originating from the SSMA versus other cortical areas.
- These findings offer valuable insights for presurgical localization in epilepsy patients with prominent tonic posturing.
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