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Updated: Nov 21, 2025
Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Semiological differences of focal onset bilateral motor (convulsive) seizure between mesial temporal lobe epilepsy
Pritsana Punyawai1, Naotaka Usui2, Akihiko Kondo2
1National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka, Japan; Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand.
Objective:
We investigated the semiology of focal onset bilateral motor (convulsive) seizure (FBMS) in patients with intractable focal epilepsy who underwent epilepsy surgery to understand its value in localizing the origin of the seizure.
Methods:
The study included 20 patients who underwent resective surgery after intracranial video-EEG monitoring (iEEG) with a favorable seizure outcome (Engel class I), and had at least one FBMS during iEEG. The diagnosis was mesial temporal lobe epilepsy (MTLE) for 7 patients and neocortical epilepsy (NE) for 13 patients (lateral temporal lobe, 3; posterior cortex, 6; frontal lobe, 3; perirolandic, 1). Videotaped FBMSs were carefully analyzed.
Results:
A generalized tonic phase appeared in all 7 patients with MTLE, but was absent in 6 of the 13 patients with NE (P = .044). Tonic cry was more frequently observed in MTLE than in NE (P = .012). Facial tonicity preceding limb tonicity was more frequently seen in patients with MTLE (P = .001).
Conclusion:
Notably, patients with MTLE and those with NE showed semiological differences during bilateralization. FBMS includes not only focal to bilateral tonic-clonic seizure but also focal to bilateral clonic seizure.
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