The predictive localizing value of tonic limb posturing in supplementary sensorimotor seizures.

Abstract

To determine whether early tonic limb posturing is reliable in lateralizing or localizing of the seizure generator in 14 patients with pharmacoresistent supplementary sensorimotor area (SSMA) seizures. All patients underwent high-quality MRI scans and stereo-EEG recordings. The SSMA seizure semiology predicted focal or regional ictal onset in the SSMA in six (43%) patients: Three had a focal SSMA seizure onset, and three had a regional seizure onset with involvement of one SSMA plus adjacent neocortex. The eight remaining patients had diffuse uni- or bilateral seizure onset. Eight of 14 patients underwent a frontal or central cortical resection, but a good outcome was seen in only 3: 2 with no SSMA resection and 1 with an extensive central removal. SSMA semiology is suggestive of early involvement of this region but is by no means a reliable indicator that the primary SSMA contains the seizure focus.