Semiology of Opercular Epilepsies

In this systematic review, we aimed to characterize the semiology of 'pure' opercular seizures by identifying cases in which the epileptogenic zone was restricted to the operculum. Seventy patients from 24 articles were included and categorized into four anatomic groups: 11 frontal, 27 central, 14 parietal, and 18 temporal operculum cases. Across these four anatomic regions, we identified the following semiological patterns: Frontal opercular seizures were characterized by a lower frequency of auras, most commonly nonpainful somatosensory sensations affecting the limbs or trunk and never exclusively the face, along with frequent elementary motor signs. Central opercular seizures exhibited the highest frequency of auras, predominantly nonpainful somatosensory sensations often involving the face; the central operculum was the only region associated with negative motor seizures. Parietal opercular seizures showed the greatest diversity of auras, notably painful sensations, and were associated with a higher prevalence of hypermotor behavior. Temporal opercular seizures were characterized by auditory hallucinations and a higher incidence of generalized tonic-clonic seizures.