Abstract
Purpose Hyperkinetic seizures are described as seizure onset in the frontal or temporal lobe.
Additional localizing information is important for diagnostic workup and surgical
therapy. We describe diagnostic workup and surgical outcomes in three patients with
pharmacoresistant focal emotional seizures with hyperkinetic elements.
Methods/Results High-resolution 3 Tesla (T) magnetic resonance imaging (MRI) did not reveal clear-cut
lesions. Invasive video-electroencephalography (EEG) with depth electrodes along the
cingulate sulcus (bilateral; patients 1 and 3), right; patient 2 provided congruent
results for a circumscribed seizure onset zone within the medial frontal lobe (right:
patients 1 and 2; left: patient 3). Topectomies were performed in all patients. Histopathology
revealed a small focal cortical dysplasia in the three cases (focal cortical dysplasia
[FCD] IIA: patient 1; FCD IIB: patients 2 and 3). All patients remained completely
seizure-free since surgery (Engel 1A; follow-up: 9–28 months).
Conclusion Ictal fear associated with hyperkinetic semiology points to a seizure-onset zone
within the anteromedial frontal lobe (anterior cingulate gyrus). Ictal semiology is
crucial for the placement of depth electrodes, especially in MRI-negative cases. These
cases illustrate a clinical advantage to the new International League against Epilepsy
(ILAE) seizure classification, emphasizing initial clinical symptoms.
Keywords
epilepsy surgery - ictal semiology - nonlesional - frontal lobe seizures
