Nondominant parietotemporal cortical dysplasia manifesting as hypermotor seizures

We describe the case of a 33-year-old man with nondominant right parietotemporal cortical dysplasia. Habitual seizures were violent, ballistic movements of the extremities with pelvic thrusting, resembling complex gestural automatisms or “hypermotor seizures.” Scalp electroencephalography (EEG) and interictal [123I]iomazenil single-photon-emission computed tomography revealed an epileptogenic zone including a lesion observed on magnetic resonance imaging. Corticectomy of the inferior parietal lobule was performed via invasive EEG monitoring, but resulted in failed seizure control. The middle and posterior temporal cortices were additionally resected in the second surgery. The patient experienced contralateral hemianopsia postoperatively, but no hemispatial neglect. Hypermotor seizures have not been seen for 1.5 years since surgery. This is the first description of a patient with a parietal lobe lesion experiencing hypermotor seizures. The middle and posterior temporal cortices were considered epileptogenic together with the inferior parietal lobule in the present case.