Peri-ictal bed leaving in temporal lobe epilepsy: Incidence and lateralizing value

We analyzed peri-ictal bed leaving (PBL) symptoms in 105 patients with temporal lobe epilepsy (TLE). All patients were classified as Engel I at the 2-year follow-up visit. Histopathological examination revealed hippocampal sclerosis (TLE-HS) in 64 patients and other lesions in 38 patients (TLE-other); 3 patients had no lesions. We reviewed 412 seizures. PBL was defined as lateralized leaving of the bed occurring during the seizure or up to 3 minutes after the end of the seizure. PBL was observed in 28 of 105 patients (26.7%), and in 45 of 412 seizures (10.9%). PBL occurred more frequently in patients with TLE-HS than in patients with TLE-other (32.8% vs 17.1%, P = 0.058). PBL was ipsilateral to the seizure onset in 71.4% of patients and 71.2% of seizures (P = 0.012 and P < 0.001). In patients with TLE-HS, PBL was ipsilateral to seizure onset in 76.2% of patients and 81.2% of seizures (P = 0.008 and P < 0.001). In patients with TLE-other, PBL was ipsilateral to seizure onset in 42.8% of patients and 46.1% of seizures. There were no differences in the incidence and lateralizing value between patients with right-sided and those with left-sided TLE. PBL is a relatively frequent peri-ictal sign in patients with TLE. The side of PBL in patients with TLE-HS lateralizes the seizure onset to the ipsilateral temporal lobe.

Research highlights
► Peri-ictal bed leaving is a new lateralizing sign in temporal lobe epilepsy.
► This relatively frequent peri-ictal sign occurred in 26.7% of patients.
► Peri-ictal bed leaving occurred more often in patients with hippocampal sclerosis.
► It was ipsilateral to the side of seizure onset in 71% of patients and seizures.