Classical Localization of Simple Partial Seizures
Frontal frontopolar - forced thoughts, head and eye contraversion orbitofrontal - complex gestures, olfactory hallucinations dorsolateral - early tonic or clonic movements, contraversion supplementary motor presylvian motor cingulate
- fencer posturing, speech arrest, gestures
- Jacksonian march, clonus
- autonomic symptoms, emotional changes
Opercular gustatory hallucinations, oral automatisms, facial clonic movements, mastication, swallowing, speech arrest
Temporal mesiobasal (amygdalo-hippocampal) - midepigastric rising is most common, fear, autonomic symptoms including flushing, sweating, may also include olfactory hallucinations (i.e., uncinate) lateral temporal - auditory hallucinations in the superior temporal gyrus neocortex, dysphasia or speech arrest, illusions traditionally felt by Penfield to originate in neocortex include deja vu, jamais vu, macropsia, micropsia -- some recent evidence indicates that these illusions may originate in either mesial or lateral areas
Parietal focal positive sensory symptoms, pain nondominant - misperception of body parts, spatial distortion dominant - receptive language problems
Temporo-parieto-occipital junction vertigo, heutoscopy (see self)
Occipital white or colored, still or moving visual hallucinations, scotomata, oculoversion, pallinopsia, patterns, metamorphosia
(more complex illusions are theoretically more anterior)
A final caveat, seizures propagate rapidly!
LMS