Upper limb automatisms differ quantitatively in temporal and frontal lobe epilepsies

We quantitatively evaluated the localizing and lateralizing characteristics of ictal upper limb automatisms (ULAs) in patients with temporal lobe epilepsy (TLE; n = 38) and frontal lobe epilepsy (FLE; n = 20). Movement speed, extent, length, and duration of ULAs were quantitatively analyzed with motion capturing techniques. Upper limb automatisms had a larger extent (p < 0.001), covered more distance (p < 0.05), and were faster (p < 0.001) in FLE than in TLE. In TLE, the maximum speed of ULAs was higher ipsilaterally than contralaterally (173 vs. 84 pixels/s; p = 0.02), with no significant difference in FLE (511 vs. 428). The duration of ictal automatisms in relation to the total seizure duration was shorter in TLE than in FLE (median 36% vs. 63%; p < 0.001), with no difference in the absolute duration (26 s vs. 27 s). These results demonstrate that quantitative movement analysis of ULAs differentiates FLE from TLE, which may aid in the localization of the epileptogenic zone.