Evaluation of lateralization and localization value of hand postures in Pediatric Epilepsy

Identifying epileptogenic zone is essential for selecting patients for epilepsy surgery and understanding seizure pathophysiology. This study aimed to evaluate the role of ictal hand postures in localization and lateralization value in children.

We conducted a retrospective evaluation of 628 individuals utilizing long-term video EEG recordings of Gazi University Video EEG Monitoring Unit (VEMU) between 2013 and 2022. Distinct hand postures were identified in fifty-six patients. The localization and lateralization value of the hand postures identified in these patients were assessed.

A total of 91 seizures from 56 patients were analyzed, and hand postures were categorized as fist, thumb upside fist (TUF), fanning, holding, index-finger pointing (IFP), and pincer grasp. Fist posture was most frequently observed in frontal lobe seizures, while TUF was dominant in temporal lobe seizures. Fanning was primarily associated with generalized seizures. Lateralization analysis revealed that ipsilateral postures were more common in frontal lobe seizures, whereas contralateral postures were prevalent in temporal lobe seizures (p < 0.05).

In conclusion, ictal hand postures may serve as a straightforward and accessible tool for identifying seizure onset zones in children, especially in resource-limited settings. Semiological classification plays a crucial role in the interpretation of video EEG. Accurate identification of semiological manifestations can facilitate timely referral of patients with suspected drug-resistant focal epilepsy for presurgical evaluation.