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March 1994

Postictal Behavior: A Clinical and Subdural Electroencephalographic Study

Author Affiliations

From the Clinical Epilepsy Section (Drs Devinsky, Yacubian, and Theodore and Ms Kelley), the EEG and Neurophysiology Laboratory (Dr Sato), the Surgical Neurology Branch (Dr Kufta), and the Office of the Director (Dr Porter), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md. Dr Devinsky is now with the Department of Neurology, New York University School of Medicine, Hospital for Joint Diseases, New York.

Arch Neurol. 1994;51(3):254-259. doi:10.1001/archneur.1994.00540150048015

Objective:  To examine postictal behaviors after temporal lobe complex partial seizures (CPSs) and to correlate these behavioral phenomena with side of origin and ictal spread pattern.

Design:  Review language and other behavioral phenomena after seizures defined by subdural electroencephalography.

Setting:  A surgical epilepsy center.

Patients:  We studied postictal behavior following 65 CPSs in 18 patients with left hemisphere language dominance using subdural electrode recordings.

Intervention:  Subdural electrodes.

Main Outcome Measures:  Language function, affect, orientation, and postictal automatisms.

Results:  Following the CPS ictal discharge, the mean interval for initial nonreflexive response to an environmental stimulus was 43 seconds (left foci, 57 seconds; right foci, 29 seconds; not significant) and for first correct verbal response was 219 seconds (left foci, 275 seconds; right foci, 167 seconds; not significant). Impaired comprehension with fluent but unintelligible speech, as well as anomia, occurred after seizures arising from either temporal lobe. All nine seizures followed by global or nonfluent aphasia originated on the left side. Paraphasic errors were significantly more common after left temporal CPSs. Prolonged disorientation for place and flat affect were significantly more common after right temporal CPS. Postictal automatisms were frequent and included rubbing of the face, fumbling and picking hand movements, and repetitive oral movements.

Conclusions:  Postictal paraphasias, disorientation for place, and flat affect most likely reflect the functions of the area from which seizures arise but not the areas involved by spread.

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