Seizure Semiology — Interactive Study Reference

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Weighted-Evidence Summary

460 signs have a reported relationship on this axis. Each row keeps the manuscripts, findings, and reported values for that sign together. Clinical relationship labels come directly from the reviewed evidence. Manuscript weights summarize support; they never create or remove an anatomical or lateralizing relationship.

How weighting works

Class I (3) applies to an exact-row guideline/consensus or a systematic review/meta-analysis contributing its own synthesis; class II (2) requires an approved primary-study design (CASE_SERIES, DIAGNOSTIC_STUDY, PROSPECTIVE_COHORT, RETROSPECTIVE_COHORT) and an independent primary result in that row; class III (1) covers case observations, narrative or educational evidence, and cited restatements.

Directness multipliers: Postoperative outcome 1.50; SEEG 1.50; Other intracranial EEG 1.35; Video EEG 1.20; Imaging concordance 1.15; Scalp EEG 1.10; Review 1.00; No direct confirmation 0.90.

Directness and the capped sample-size factor apply only to an exact-row independent primary contribution. Unresolved structured design remains visible with numerical weight 0.

All 77 reviewed reports are accounted for and represent 73 distinct manuscripts after duplicate files and report versions are combined. 69 manuscripts contribute weighted evidence; 3 await evidence-weight review; and 1 provide context without a sign-specific localization or lateralization result.

Source-reported directions, regions, percentages, and denominators remain attached to their exact findings. They are displayed below each row and are not converted into a new pooled target percentage.

Order

Colored chips show reviewed relationships, not calculated percentages 1, 2, or 3+ contributing manuscripts (volume only)Weights summarize support; they are not reliability, certainty, sensitivity, or specificity.

Somatosensory aura (tingling, numbness, paresthesia - contralateral, somatotopic)Source terms: Somatosensory auraReported: BilateralAlso reported: ContralateralAlso reported: IpsilateralAlso reported: Left hemisphereAlso reported: Non-dominant hemisphereAlso reported: Right hemisphereNo single reliable side27 manuscripts · 102 findings · 93 reported values

Weighted evidence supportevidence weight 58.02 across 27 manuscripts · 1 manuscript weight pending · 5 independent primary study · 6 systematic review or meta-analysis · 4 case report or observation · 11 narrative, educational, or cited context · 1 structured design not resolved

Contralateral somatosensory manifestations were the predominant or joint-predominant directional category in both TL and T+ groups, with ipsilateral and bilateral manifestations also reported. The review describes elementary sensory aura in pure fronto-opercular epilepsy as mainly contralateral to the epileptogenic zone. The review reports contralateral non-painful paresthesia in the compared fronto-opercular and pure-insular contexts. This alternate-version atomic row restates contralateral somatosensory aura at 38% in the first cited parietal surgical series. This alternate-version atomic row restates contralateral somatosensory aura at 38% in the second cited parietal surgical series. The review states that seizures from primary sensory cortex in the postcentral gyrus tend to begin with contralateral tingling or numbness. The review describes unilateral sensory aura as contralateral to the cerebral hemisphere of seizure onset. In the illustrated case, painful tingling in the left hand was contralateral to right-insular seizure onset. The source explicitly classifies the assessed somatic-aura category as non-lateralizing. Table 3 explicitly classifies somatic aura as non-lateralizing and reports a 5.9–10.5% study-level range. Table 4 explicitly labels the somatic aura non-lateralizing and reports odds of occurrence of 0.09 (95% CI 0.03–0.31). The source explicitly labels the modeled somatic-aura category as non-lateralizing. The modeled somatic-aura category is explicitly source-labeled non-lateralizing. Table 5 repeats the 5.9–10.5% lateral-TLE range for the source-labeled non-lateralizing somatic aura. The source explicitly classifies the somatic aura category as non-lateralizing and reports a mesial-TLE prevalence range of 0–18.8%. The chapter restates that painful sensation has been described more frequently in the nondominant hemisphere. The reported unilateral somatosensory manifestations were contralateral (upper limb or hemibody), and ipsilateral paresthesia was not observed. Tingling or numbness was contralateral to the epileptogenic zone in 51 of 52 patients. One of 52 patients with tingling or numbness had a bilateral distribution. For stimulation-evoked sensations involving midline face or trunk, responses were predominantly bilateral (68.2%), with contralateral (24.2%) and ipsilateral (7.6%) exceptions. After insular stimulation, limb responses were predominantly contralateral (94%), whereas midline face/trunk responses were mostly bilateral (68.2%); ipsilateral responses were uncommon in both subgroups. Somatosensory aura in insular seizures is described over contralateral limbs, while a widely distributed bilateral painful non-Jacksonian pattern is a specific phenotype favoring posterior insular involvement. Somatosensory auras are described as usually contralateral to the focus; right hemibody pain in the illustrative case suggested a left focus. The cited-study restatement reports predominantly contralateral onset (89%) for seizures with unilateral somatosensory aura, with ipsilateral onset in a minority. Unilateral somatosensory phenomena are described as predominantly contralateral to the focus, with occasional ipsilateral or bilateral distributions, particularly with insular, SMA, or secondary sensory involvement. The reproduced table lists contralateral somatosensory aura for primary somatosensory cortex and SSMA, but ipsilateral aura when unilateral for secondary somatosensory cortex. The review describes unilateral distal somatosensory aura as contralateral, bilateral or widespread sensations as potentially arising from SSMA or S2, and poorly localized all-body sensations as nonlateralizing. The review reports contralateral somatosensory aura as the most common aura in two cited parietal surgical series, at 38% in each. One of six typical anterior cingulate cases had a source-explicit contralateral indistinct somatosensory aura. The review assigns contralateral discrete-body-part symptoms to SI, bilateral or ipsilateral symptoms to SII, and primarily contralateral proximal poorly localized symptoms to SSMA. The review links somatosensory body-schema illusions, specifically, to nondominant inferior parietal or TPO activation. In one patient, a right-foot sensory aura preceded bilateral asymmetric tonic posturing and generalized tonic-clonic seizures. Unilateral somatosensory aura is described as usually contralateral to the suspected epileptogenic zone, with ipsilateral auras reported as a minority exception. The cited study reported unilateral somatosensory auras contralateral to the suspected epileptogenic zone when a lesion was known. In the cited cohort restatement, the suspected epileptogenic zone was contralateral to the sensory aura in 46%, ipsilateral in 6%, not lateralized in 25%, and had no identifiable unilateral lesion in 24%. No hemisphere-direction relationship is reported. The fronto-opercular onset prevalence reports no hemisphere direction. The prefrontal-operculum subgroup count reports no hemisphere direction. The precentral Rolandic-operculum subgroup count reports no hemisphere direction. The cited pure-insular series reports no hemisphere direction. The cited anterior-insular subgroup count reports no hemisphere direction. The posterior-insular subgroup count reports no hemisphere direction. The cited pure-insular series reports no hemisphere direction for face and hand paresthesia. The somatosensory frequencies report no body-side or hemisphere direction. The review table specifies no hemisphere or body-side direction for tingling or numbness. The source term hemisensory is preserved, but no side relation is reported. The stimulation statement reports no side direction. The cited insular stimulation result reports no hemisphere direction. The cited stimulation synthesis reports no hemisphere direction. A left hemibody sensory manifestation is reported, but no relation between body side and seizure-onset side is claimed. The combined somatosensory and auditory aura observation reports no hemisphere direction. No hemisphere or side-relative direction is reported. The qualitative review table reports no hemispheric direction for somatosensory symptoms. No hemisphere or body-side direction is reported. The table aggregate does not report side. Laterality is assessed elsewhere and is absent from this aggregate. The finding reports no cerebral lateralization. No hemisphere or body-side relationship is reported. The case reports right-sided symptoms but no relation to a seizure-onset hemisphere. The propagation model reports no hemisphere direction. No side or hemisphere relation is reported. No lateralization relationship is reported. The localizing probability reports no hemisphere direction. The localization confidence interval reports no hemisphere direction. The parietal localizing odds ratio reports no hemisphere direction. The insular localizing odds ratio reports no hemisphere direction. The insular odds-ratio interval reports no hemisphere direction. The basal-temporal somatosensory prevalence reports no hemisphere direction. The review does not state the side of the facial manifestations. The Table 3 somatosensory prevalence reports no hemisphere direction. The table does not report side. The restricted basal-temporal subset prevalence reports no hemisphere direction. The nonthermal, nonpainful response subtype reports no body-side direction. No lateralizing direction is reported. The symptom is described as lateralized, but no body side or hemisphere relation is reported. No hemisphere or body-side relationship is assigned. No seizure lateralization is reported. The cited parietal cohort prevalence reports no hemisphere direction. The cited parietal-cohort prevalence reports no hemisphere direction. This atomic finding reports regional associations and symptom frequencies but no hemisphere direction. The review synthesis reports no hemisphere direction for the aura combination or propagation pathway. A clearly defined body region is required, but no side-to-hemisphere relationship is reported.

Source-defined result groups 44

Localization: InsularSource-defined values retained separatelyAll reported · somato-sensory response body territory1 manuscript · 1 reported value · not pooled

Localization: ParietalSource-defined values retained separatelyprimary somatosensory/parietal localization relative to all other semiologies · localizing data point1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 18.2%contralateral upper limb · patient1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyMidline face/trunk · midline body regions versus limbs; laterality categories · body-region-specific somato-sensory response1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyT+ · TL 15.3% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 16.7%All reported · other typical anterior patients · patients1 manuscript · 1 reported value · not pooled

Lateralization: BilateralObserved proportion 1.9%All reported · contralateral distribution · patients with tingling or numbness1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyLimbs · midline body regions versus limbs; laterality categories · body-region-specific somato-sensory response1 manuscript · 1 reported value · not pooled

Lateralization: nonlateralizingSource-defined values retained separatelyAll reported · reported sign prevalence across included studies1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyLimbs · midline body regions versus limbs; laterality categories · body-region-specific somato-sensory response1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyinsular localization given somatosensory aura · localizing data point1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyMidline face/trunk · midline body regions versus limbs; laterality categories · body-region-specific somato-sensory response1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelysomato-sensory response analysis set · all other stimulated contacts, including non-eloquent contacts · stimulation contact1 manuscript · 1 reported value · not pooled

Localization: ParietalSource-defined values retained separatelyparietal localization given somatosensory aura · localizing data point1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyipsilateral paresthesia · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTL · T+ 26.1% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 9.1%contralateral hemibody · patient1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyTalairach z coordinate · all other stimulated contacts · stimulation contact1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyAll reported · somato-sensory response body territory1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 66.7%9 patients with EZ in the precentral Rolandic operculum · prefrontal operculum group (N=12) · patients in the precentral Rolandic operculum group1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyinsular localization relative to all other semiologies · localizing data point1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyT+ · TL 11.9% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 98.1%All reported · ipsilateral or bilateral aura · patients with tingling or numbness1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyTL · T+ 26.1% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Localization: FrontalSource-defined values retained separatelyfrontal localization given somatosensory aura · localizing data point1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelytemporal localization given somatosensory aura · localizing data point1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 33.3%All reported · prefrontal operculum versus precentral Rolandic operculum · all included patients1 manuscript · 1 reported value · not pooled

Lateralization: nonlateralizingSource-defined values retained separatelyAll reported · absence of the same sign in lateral TLE · random-effects summary odds of sign occurrence1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyTL · T+ 8.7% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 8.3%12 patients with EZ in the prefrontal operculum · precentral Rolandic operculum group (N=9) · patients in the prefrontal operculum group1 manuscript · 1 reported value · not pooled

Lateralization: nonlateralizingSource-defined values retained separatelyMesial TLE patients assessed for Non-lateralizing somatic aura · lateral TLE percentage shown separately · reported mesial-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyAll reported · thermal and painful somato-sensory subtypes · evoked somato-sensory response1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyT+ · TL 16.9% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyTalairach y coordinate · all other stimulated contacts · stimulation contact1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 27

Alphabetical by manuscript.

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdfSystematic review or meta-analysis · 15 findings · 7 reported values

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

This is a primary systematic-review/database analysis, not a new prospective cohort. The authors report 11,230 localizing and 2,391 lateralizing data points from 4,643 patients across 309 articles. The analysis uses source-described semiologies, 103 hierarchical regions, mixed ground truths, patient-level normalization, 10,000 bootstrap samples for 95% CIs, and ORs from two-by-two contingency tables. Figure 3 and Figure 4 show plotted values, but exact point estimates for every plotted region/semiology cell are not tabulated in the source; only exact values stated in the prose or printed labels are entered as atomic findings below.

Findings

somatosensoryTable 1 defines or exemplifies the the source's own semiology category “somatosensory” as Tingling or touch sensation.PDF p.7, Table 1 Semiology descriptions and frequencies
somatosensorySomatosensory semiology comprised 2.9% of non-topological data.PDF p.7, Table 1 Semiology descriptions and frequencies
somatosensory; Figure 3 all-data subsetFigure 3 reports N = 629 for the all-data somatosensory panel.PDF p.9, Figure 3 and caption
somatosensory; Figure 3 non-topological subsetFigure 3 reports N = 102 for the non-topological somatosensory panel.PDF p.9, Figure 3 and caption
somatosensory aura; frontal lobeUndifferentiated somatosensory auras implicated the frontal lobe in 23%.PDF p.8, Seizure semiology localizing values
somatosensory aura; frontal lobeThe 95% CI for somatosensory aura; frontal lobe was 15%–32%.PDF p.8, Seizure semiology localizing values
somatosensory aura; temporal lobeUndifferentiated somatosensory auras implicated the temporal lobe in 31%.PDF p.8, Seizure semiology localizing values
somatosensory aura; temporal lobeThe 95% CI for somatosensory aura; temporal lobe was 21%–42%.PDF p.8, Seizure semiology localizing values
somatosensory aura; parietal lobeUndifferentiated somatosensory auras implicated the parietal lobe in 38%.PDF p.8, Seizure semiology localizing values
somatosensory aura; parietal lobeThe 95% CI for somatosensory aura; parietal lobe was 28%–48%.PDF p.8, Seizure semiology localizing values
somatosensory aura; insulasomatosensory aura indicated insular localization in 59%.PDF p.8, Seizure semiology localizing values
somatosensory aura; primary somatosensory cortex/parietalSomatosensory auras had an intrinsic localizing OR of 7.6 for primary somatosensory cortex within the parietal lobe.PDF p.8, Relative localizing values of semiologies
somatosensory aura; primary somatosensory cortex/parietalThe 95% CI for somatosensory aura; primary somatosensory cortex/parietal was 5.1–11.3.PDF p.8, Relative localizing values of semiologies
somatosensory aura; insulaSomatosensory symptoms had an intrinsic localizing OR of 1.9 for the insula.PDF p.8, Relative localizing values of semiologies
somatosensory aura; insulaThe 95% CI for somatosensory aura; insula was 0.7–4.9.PDF p.8, Relative localizing values of semiologies

Reported values

somatosensory 2.9%somatosensoryPercentage · non-topological Semio2Brain dataPDF p.7, Table 1 Semiology descriptions and frequencies
somatosensory aura; frontal lobe 23%somatosensory aura; frontal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
somatosensory aura; temporal lobe 31%somatosensory aura; temporal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
somatosensory aura; parietal lobe 38%somatosensory aura; parietal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
somatosensory aura; insula 59%somatosensory aura; insulaPercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
OR 7.6somatosensory aura; primary somatosensory cortex/parietalOdds ratio · non-topological Semio2Brain data unless otherwise statedPDF p.8, Relative localizing values of semiologies
OR 1.9somatosensory aura; insulaOdds ratio · non-topological Semio2Brain data unless otherwise statedPDF p.8, Relative localizing values of semiologies

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfCase report or observation · 1 finding · 1 reported value

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

The authors retrospectively identified consecutive cases from Cleveland Clinic and University of Texas Southwestern databases, using MRI-defined lesions confined to the cingulate gyrus and source-defined follow-up/outcome criteria. Visual MRI analysis divided the cingulate into anterior and posterior portions using Talairach and Tournoux coordinates; invasive data were used when lesion overlap made localization uncertain. Fourteen cases were included, with 10 anterior and 4 posterior cingulate lesions; the report’s direct EEG/PET denominators are retained only where stated.

Findings

typical anterior contralateral somatosensory auraOne typical anterior patient had a contralateral indistinct somatosensory aura.PDF p.3, Clinical Presentation

Reported values

1/6 contralateral indistinct somatosensory auratypical anterior contralateral somatosensory auraProportion · n/N 1/6 · 6 typical anterior cingulate cases · auraPDF p.3, Clinical Presentation

asadollahi-drug-resistant-parietal-lobe-epilepsy-clinical-manifestations-surgery-outcome-2017.pdfNarrative, educational, or cited context · 7 findings · 7 reported values

asadollahi-drug-resistant-parietal-lobe-epilepsy-clinical-manifestations-surgery-outcome-2017.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

The authors reviewed patients with drug-resistant parietal lobe epilepsy evaluated for surgery at Jefferson Comprehensive Epilepsy Center from 1986 through 2015. The diagnosis was based on ictal semiology, MRI lesion, and EEG findings; presurgical evaluation included brain MRI and prolonged video-EEG, and all patients underwent resective surgery. Sufficient data were available for 18 patients in the present cohort; denominator-specific EEG and MRI analyses are represented only when source-explicit.

Findings

Bartolomei et al. 2011 somatosensory auraTable 1 reports 58% somatosensory aura in the cited Bartolomei et al. 2011 cohort.PDF p.3, Table 1
Salanova et al. 1995a somatosensory auraTable 1 reports 63.4% somatosensory aura in the cited Salanova et al. 1995a cohort.PDF p.3, Table 1
Salanova et al. 1995b somatosensory auraTable 1 reports 62% somatosensory aura in the cited Salanova et al. 1995b cohort.PDF p.3, Table 1
Kim et al. 2004b somatosensory auraTable 1 reports 32.5% somatosensory aura in the cited Kim et al. 2004b cohort.PDF p.3, Table 1
Kim et al. 2004a somatosensory auraTable 1 reports 31.6% somatosensory aura in the cited Kim et al. 2004a cohort.PDF p.3, Table 1
Francione et al. 2015 somatosensory auraTable 1 reports 62.5% somatosensory aura in the cited Francione et al. 2015 cohort.PDF p.3, Table 1
Asadollahi et al. 2017 (this study) somatosensory auraTable 1 reports 38.8% somatosensory aura in the cited Asadollahi et al. 2017 (this study) cohort.PDF p.3, Table 1

Reported values

58% somatosensory auraBartolomei et al. 2011 somatosensory auraPercentage · Bartolomei et al. 2011 cohort · auraPDF p.3, Table 1
63.4% somatosensory auraSalanova et al. 1995a somatosensory auraPercentage · Salanova et al. 1995a cohort · auraPDF p.3, Table 1
62% somatosensory auraSalanova et al. 1995b somatosensory auraPercentage · Salanova et al. 1995b cohort · auraPDF p.3, Table 1
32.5% somatosensory auraKim et al. 2004b somatosensory auraPercentage · Kim et al. 2004b cohort · auraPDF p.3, Table 1
31.6% somatosensory auraKim et al. 2004a somatosensory auraPercentage · Kim et al. 2004a cohort · auraPDF p.3, Table 1
62.5% somatosensory auraFrancione et al. 2015 somatosensory auraPercentage · Francione et al. 2015 cohort · auraPDF p.3, Table 1
38.8% somatosensory auraAsadollahi et al. 2017 (this study) somatosensory auraPercentage · Asadollahi et al. 2017 (this study) cohort · auraPDF p.3, Table 1

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 1 finding · 9 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 5.65 · 2 × 1.5 × 1.882

The study was retrospective and included 80 of 212 consecutive patients with medically intractable seizures operated on after SEEG at Grenoble Hospital from 1990 to 1998. Eligibility required no detectable MRI lesion except hippocampal sclerosis, SEEG involvement of at least mesial and/or lateral temporal structures, SEEG-guided surgery, and at least 5 years of postoperative follow-up. The cohort comprised 42 females and 38 males; the reported mean age at SEEG was 29.3 ± 8.7 years, mean age at epilepsy onset 10.1 ± 7.9 years, mean epilepsy duration 19 ± 8 years, and mean seizure frequency 13.5 ± 17.5 per month. Sixty-six patients had unilateral hippocampal sclerosis; 14 had no clear MRI abnormality before surgery, with hamartoma or non-Taylor cortical dysplasia found in two of those at neuropathology. Long-term scalp video-EEG recorded 432 seizures in 79 patients; SEEG used 888 chronically implanted electrodes and recorded 607 seizures in 79 patients, with one patient not captured because the SEEG study was interrupted. The epileptogenic zone was defined by the first clear preclinical ictal SEEG change consisting of low-voltage fast activity or recruiting fast spikes and by the cortex considered for removal; 58 patients were classified TL and 22 T+, with T+ subgroups temporo-frontal (TF, n=9), temporo-sylvian (TS, n=7), and temporo-parieto-occipital (TPO, n=6). Clinical semiology was assessed on one typical seizure per patient, giving 80 analyzed seizures, because the number of recorded seizures per patient ranged from 1 to 44. The comparison used relative frequencies and contingency tables; Phi and Cramer V significance was set at P≤0.05. Scalp-EEG findings were classified by type, lateralization, and 10–20 localization; ictal onset included low-voltage fast activity, localized flattening, disappearance of localized interictal abnormalities, or rhythmic theta when the other patterns were absent. Tailored resections included at least the temporal pole and mesio-temporal structures; 18 of 22 T+ cases had extension outside the temporal lobe, and postoperative Engel classes were reported as context rather than as semiologic findings. The introduction also cites surgical outcome examples involving temporo-perisylvian, temporo-insular, temporo-parietal, and posterior basal temporal onsets; these cited reports are represented separately only where the outcome is inseparable from the localizing claim.

Findings

somatosensory auraSomatosensory auras did not differ significantly between TL and T+ groups across the source's ipsilateral, contralateral, and bilateral subcategories.PDF p.6, Table 2

Reported values

TL 16.9%somatosensory auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictal onsetPDF p.6, Table 2
T+ 8.7%somatosensory auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictal onsetPDF p.6, Table 2
T+ 26.1%somatosensory auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictal onsetPDF p.6, Table 2
TL 11.9%somatosensory auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictal onsetPDF p.6, Table 2
P=0.3somatosensory auraP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictal onsetPDF p.6, Table 2
TL 11.9%somatosensory auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictal onsetPDF p.6, Table 2
TL 15.3%somatosensory auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictal onsetPDF p.6, Table 2
T+ 26.1%somatosensory auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictal onsetPDF p.6, Table 2
T+ 26.1%somatosensory auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictal onsetPDF p.6, Table 2

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfSystematic review or meta-analysis · 6 findings · 6 reported values

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

The authors state that the review followed PRISMA. Eligible peer-reviewed English, French, German, Spanish, or Italian papers had relevant video-EEG, semiology, stimulation, surgical, electrical-source-imaging, or anatomical data focused on basal temporal epilepsy; papers limited to stimulation were excluded. Two reviewers screened and extracted data, with a third resolving disagreements. Descriptive statistics summarized demographics, imaging, semiology, and outcomes. QUADAS-2-guided assessment addressed enrollment and symptom assessment. Epileptogenic-zone (EZ) confidence was graded very high, high, moderate, or low using MRI, intracerebral EEG, and postoperative outcome; selective/tailored surgery was considered for high evidence grading.

Findings

somatosensory sensationsSomatosensory sensations accounted for 2% of the sensory manifestations in the narrative summary.PDF p.4, Semiology and clinical features; PDF p.6, Table 3
facial somatomotor or sensory modificationsFacial somatomotor or sensory modifications were reported in 10% of reviewed cases.PDF p.4, Semiology and clinical features; PDF p.6, Table 3
Somato-sensory (Table 3)Table 3 reports somato-sensory symptoms in 2 cases (2%), with propagation timing marked uncertain.PDF p.6, Table 3
Facial somato-sensory or motor (Table 3)Table 3 reports facial somato-sensory or motor signs in 8 cases (10%), more during propagation.PDF p.6, Table 3
Somato-sensory (Table 4)In the 60 high/very-high-confidence cases, Table 4 reports somato-sensory symptoms in 1 case (2%).PDF p.7, Table 4
Facial somato-sensory or motor (Table 4)In the 60 high/very-high-confidence cases, Table 4 reports facial somato-sensory or motor signs in 3 cases (5%).PDF p.7, Table 4

Reported values

2% somatosensory sensationssomatosensory sensationsPercentage · reviewed basal temporal seizure cases · ictal propagation uncertain in Table 3PDF p.4, Semiology and clinical features; PDF p.6, Table 3
10% facial somatomotor or sensory modificationsfacial somatomotor or sensory modificationsPercentage · reviewed basal temporal seizure cases · ictal propagation in Table 3PDF p.4, Semiology and clinical features; PDF p.6, Table 3
2 cases (2%)Somato-sensory (Table 3)Percentage · Table 3 basal temporal seizure cases · propagation?PDF p.6, Table 3
8 cases (10%)Facial somato-sensory or motor (Table 3)Percentage · Table 3 basal temporal seizure cases · propagationPDF p.6, Table 3
1/60 (2%)Somato-sensory (Table 4)Percentage · n/N 1/60 · 60 basal temporal seizure cases with high or very-high EZ confidence · ictalPDF p.7, Table 4
3/60 (5%)Facial somato-sensory or motor (Table 4)Percentage · n/N 3/60 · 60 basal temporal seizure cases with high or very-high EZ confidence · ictalPDF p.7, Table 4

blair-temporal-lobe-epilepsy-semiology-2012.pdfNarrative, educational, or cited context · 1 finding

blair-temporal-lobe-epilepsy-semiology-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

The document reports a narrative review and does not report a systematic-search method, single enrollment cohort, eligibility criteria, pooled analysis, or source-wide reference standard. Population descriptors are claim-specific and heterogeneous, including temporal-lobe, mesial-temporal, neocortical-temporal, frontal-versus-temporal, childhood, older-adult, benign mesial-temporal, and cited study cohorts. The review discusses 31 Engel class 1 patients in one cited symptom-cluster analysis and a 50-patient sample in one cited facial-asymmetry result; those cohort descriptors are retained only with the corresponding findings. It also reports lesion/etiologic context, including mesial temporal sclerosis or hippocampal sclerosis as a common cause of TLE and HS evidence in benign mTLE, but those context statements are not treated as stand-alone semiologic findings. No source-wide analysis unit, surgery-outcome analysis, or mortality-outcome analysis is reported. Cited-study restatements remain unverified against the cited articles under this review boundary.

Findings

Somatosensory symptomsTable 1 reports somatosensory symptoms as rare in temporal lobe seizures and common in frontal lobe seizures.PDF p.2, Table 1

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 1 finding

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

The review searched PubMed and Embase through December 2023, used adapted QUADAS-2 and GRADE assessments, and included primary adult/pediatric presurgical or surgical studies with explicit anatomo-electroclinical correlations. Fresh text from all 10 pages was read, and the abstract, PRISMA flow, individual-study table, aggregate table, symptom meta-analysis table, and discussion layouts were visually inspected. Table 1 cells are retained as cited-study restatements; Table 2 and Table 3 aggregate cells are retained as primary review results. Each count, percentage, subgroup component, confidence category, heterogeneity statistic, and p value is represented independently.

Findings

sensory phenomena; sensory aura; paresthesiaSensory phenomena associated with SMA epilepsy may be diffuse and poorly localized, including nonspecific cephalic sensations, paresthesia, or a sense of impending movement.PDF p.7, Discussion

chauvel-mcgonigal-emergence-semiology-epileptic-seizures-2014.pdfCase report or observation · 1 finding

chauvel-mcgonigal-emergence-semiology-epileptic-seizures-2014.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

This is a narrative review with no single study cohort, unified eligibility population, or common comparator. The evidence discussed spans heterogeneous SEEG recordings, cortical stimulation observations, clinical/video studies, ictal SPECT, and cited cases or series. Finding-specific populations and analysis units are retained below; where the review does not report a denominator, it is marked Not reported rather than inferred.

Findings

perisylvian sensorimotor–sensory sequenceThe review gives a perisylvian example in which initial tingling in cheek, tongue, or throat is followed by hemifacial twitching or facial disgust with hypersalivation, then auditory hallucinations or language deficit; intracerebral recordings are described as showing repetitive spikes moving from one area to the next with strict anatomo-clinical correlations.PDF p.4, section 6

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 7 findings · 4 reported values

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdf; chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

The article is labelled a Review and states that it summarizes current literature, focuses on common semiologies, and provides cases from the authors’ centre with online supplemental videos. No systematic search strategy, eligibility criteria, pooled analysis, or formal reference standard is reported. Cited-study populations remain those of the cited reports; the article also describes seven illustrative cases with patient ages, seizure histories, imaging, EEG, and outcomes. Patient consent for publication was obtained. The source integrates history, examination, neuroimaging, neurophysiology, and neuropsychology for presurgical interpretation and repeatedly cautions that semiology may reflect propagation rather than onset.

Findings

contralateral somatosensory auraIn one of two larger surgical series of parietal lobe epilepsy, contralateral somatosensory aura was the most commonly reported aura in 38% of cases.PDF p.7, Parietal lobe seizures
contralateral somatosensory auraIn the second larger surgical series of parietal lobe epilepsy, contralateral somatosensory aura was also reported in 38% of cases.PDF p.7, Parietal lobe seizures
primary sensory cortex; contralateral tingling and numbnessSeizures arising from primary sensory cortex in the postcentral gyrus tend to start with contralateral tingling or numbness, which may spread along adjacent body parts through the sensory homunculus; pain or altered thermal sensation may also occur and propagation to the frontal lobe may produce clonic activity with tonic posturing.PDF p.7, Primary sensory cortex; PDF p.3, Figure 1
unilateral sensory auraUnilateral sensory aura is described as a contralateral sign.PDF p.10, Lateralising signs
contralateral somatosensory auraIn two of the larger surgical series of patients with parietal lobe epilepsy, the most commonly reported aura was a contralateral somatosensory aura, reported in 38% in both series.PDF p.7, Parietal lobe seizures
tingling; numbness auraTable 3 lists tingling or numbness as localising to primary or secondary somatosensory cortex, supplementary motor area, or insula.PDF p.10, Table 3
hippocampal propagation to insula; complex visceral and somatosensory auraThe review states that seizures arising from hippocampus almost always propagate to the insula, so abdominal aura is also common in mesiotemporal seizures; nevertheless, the combination of complex visceral and somatosensory auras points toward insular onset.PDF p.8, Insular seizures; PDF p.9, Insular seizures

Reported values

contralateral somatosensory aura 38%contralateral somatosensory auraPercentage · one larger surgical series of parietal lobe epilepsy · aura/early ictalPDF p.7, Parietal lobe seizures
contralateral somatosensory aura 38%contralateral somatosensory auraPercentage · second larger surgical series of parietal lobe epilepsy · aura/early ictalPDF p.7, Parietal lobe seizures
Contralateral somatosensory aura 38% in second cited surgical seriescontralateral somatosensory auraPercentage · Patients in two surgical series of parietal lobe epilepsy · Second cited large parietal surgical series · AuraPDF p.7, Parietal lobe seizures
Contralateral somatosensory aura 38% in first cited surgical seriescontralateral somatosensory auraPercentage · Patients in two surgical series of parietal lobe epilepsy · First cited large parietal surgical series · AuraPDF p.7, Parietal lobe seizures

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.37 · 1 × 0.9 × 1.521

This is a narrative/systematic literature review with 21 included studies selected from 171 considered studies. The source reports 87 confidently included cases involving OFC onset, of which 26 were analyzed as OFC-restricted and 33 as OFC-extended based on resection evidence; extended cases were grouped by frontal, insular, or temporal accessory resection. The review applies the proposed ILAE seizure-description framework and a published EZN confidence grading score. Search counts, study-list cells, standalone resection/imaging/surgery/outcome counts, and generic method/risk-of-bias statements remain context here rather than individual findings.

Findings

somatosensory and auditory aura; frontal subgroupOne frontal-subgroup aura combined a nonpainful somatosensory aura with an auditory sensation.PDF p.3, Aura

Reported values

1 patientsomatosensory and auditory aura; frontal subgroupCount · n/N 1/11 · Frontal subgroup of OFC-extended EZN · Frontal subgroup of OFC-extended EZN · ictal auraPDF p.3, Aura

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdfSystematic review or meta-analysis · 11 findings · 4 reported values

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

The review used a PRISMA-based systematic search of PubMed and EMBASE and included six studies with 94 patients; the source states that only an estimated 56–69 patients had unambiguous lateral temporal epilepsy because other neocortical temporal structures were included. The review used random-effects meta-analysis for sign odds and diagnostic accuracy, with sensitivity analysis for studies in which more than half of patients unequivocally had lateral seizure onset. Search/duplicate/exclusion counts, reviewer details, eligibility thresholds, Table 1/2 imaging and surgery cells, and standalone population/outcome facts are retained as compact context here rather than individual findings.

Findings

Non-lateralizing somatic auraTable 3 reports 2 studies assessing Non-lateralizing somatic aura.PDF p.6, Table 3
Non-lateralizing somatic auraTable 3 reports 36 patients assessed for Non-lateralizing somatic aura.PDF p.6, Table 3
Non-lateralizing somatic auraTable 3 reports 5.9–10.5% as the percentage range or value for Non-lateralizing somatic aura; the overall association grade is Low.PDF p.6, Table 3
odds of occurrence; Non-lateralizing somatic auraTable 4 reports overall odds of 0.09 for occurrence of Non-lateralizing somatic aura in lateral TLE.PDF p.7, Table 4; PDF p.8, Figure 2
odds confidence interval; Non-lateralizing somatic auraTable 4 reports a 95% confidence interval of 0.03–0.31 for the overall odds of Non-lateralizing somatic aura.PDF p.7, Table 4; PDF p.8, Figure 2
heterogeneity test; Non-lateralizing somatic auraThe heterogeneity test for the Table 4 odds estimate for Non-lateralizing somatic aura has p=0.6194.PDF p.7, Table 4
Non-lateralizing somatic aura; lateral versus mesial comparisonTable 5 reports 2 studies comparing Non-lateralizing somatic aura in lateral and mesial TLE.PDF p.9, Table 5
Non-lateralizing somatic aura; lateral TLE patient denominatorTable 5 reports 36 lateral-TLE patients assessed for Non-lateralizing somatic aura.PDF p.9, Table 5
Non-lateralizing somatic aura; mesial TLE patient denominatorTable 5 reports 36 mesial-TLE patients assessed for Non-lateralizing somatic aura.PDF p.9, Table 5
Non-lateralizing somatic aura; lateral TLE prevalenceTable 5 reports a lateral-TLE percentage of 5.9–10.5% for Non-lateralizing somatic aura.PDF p.9, Table 5
Non-lateralizing somatic aura; mesial TLE prevalenceTable 5 reports a mesial-TLE percentage of 0–18.8% for Non-lateralizing somatic aura.PDF p.9, Table 5

Reported values

5.9–10.5%Non-lateralizing somatic auraPercentage Range · Lateral temporal epilepsy patients assessed for Non-lateralizing somatic aura · ictalPDF p.6, Table 3
odds 0.09odds of occurrence; Non-lateralizing somatic auraOdds · Lateral temporal epilepsy patients assessed for Non-lateralizing somatic aura · ictalPDF p.7, Table 4; PDF p.8, Figure 2
5.9–10.5%Non-lateralizing somatic aura; lateral TLE prevalencePercentage Range · Lateral TLE patients assessed for Non-lateralizing somatic aura · Lateral TLE patients assessed for Non-lateralizing somatic aura · ictalPDF p.9, Table 5
0–18.8%Non-lateralizing somatic aura; mesial TLE prevalencePercentage Range · Mesial TLE patients assessed for Non-lateralizing somatic aura · Mesial TLE patients assessed for Non-lateralizing somatic aura · ictalPDF p.9, Table 5

elwan-kotagal-lateralizing-localizing-seizure-semiology-2018.pdfStructured design not resolved · 1 finding

elwan-kotagal-lateralizing-localizing-seizure-semiology-2018.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1

The cohort comprised consecutive patients operated between 1999 and 2007: temporal lobe epilepsy (30 patients, 63 seizures), frontal lobe epilepsy (27 patients, 51 seizures), parietal lobe epilepsy (8 patients, 14 seizures), and occipital lobe epilepsy (8 patients, 18 seizures). Patients were at least 12 years old, had one focal resection without hemispherectomy or multilobar resection, and had Engel class Ia outcome for at least 1 year; the study population was 73 patients and 145 seizures. Three investigators independently reviewed one or two best video examples of each seizure type while blinded to clinical details, with charted auras supplied by an unblinded investigator. A positive result required agreement of at least two of three raters; the same rule defined presence of a sign, correct lateralization, and correct lobar or sublobar localization. The surgical resection and lasting seizure freedom were used as the reference for the epileptogenic zone. Free Marginal Kappa and positive predictive value were calculated. Noninvasive EEG, MRI, and PET had been reviewed in the presurgical conference; PET was available for 40/73 patients and ictal SPECT for 20/73.

Findings

Somatosensory aura and parietal localizationThe source authors state that a somatosensory aura is the main feature localizing to the parietal lobe, whereas other symptoms may result from spread to frontal or temporal lobes.PDF p.5, §6.2

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 2 findings

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

This is a narrative review rather than a single original cohort or systematic quantitative synthesis. The discussed populations include patients with focal epilepsy, temporal lobe epilepsy, mesial and neocortical temporal lobe epilepsy, extratemporal and posterior-cortex epilepsy, children and infants, and presurgical epilepsy-surgery candidates. The review draws on clinical history, video/EEG and electrical-stimulation observations and on cited case series and cohorts; a single review-wide analysis population, eligibility rule, reference standard, and common denominator are not reported.

Findings

somatosensory aurasSomatosensory auras arising from SI involve discrete body parts contralateral to the ictal discharge; SII produces similar symptoms that may be bilateral or ipsilateral to the seizure focus; and SSMA symptoms are poorly localized and primarily involve contralateral proximal body parts. The source table likewise lists SI and SSMA as mainly contralateral and SII as ipsilateral when unilateral.PDF p.2, section 3.1 Auras; PDF p.2, Table 1
well-localized somatosensory auras and somatosensory illusionsWell-localized somatosensory auras that evolve to motor features are usually associated with a perirolandic epileptogenic zone close to the symptomatogenic zone, whereas illusions of swelling, shrinking, or movement of body parts are often elicited by activation of the nondominant inferior parietal lobe or TPO junction.PDF p.2, section 3.1 Auras

gibbs-clinical-features-sleep-related-hypermotor-epilepsy-2019.pdfIndependent primary study · 1 finding

gibbs-clinical-features-sleep-related-hypermotor-epilepsy-2019.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

The study retrospectively identified 155 patients with drug-resistant sleep-related epilepsy from 1433 consecutive epilepsy-surgery patients treated from October 1997 through July 2015; sleep-related epilepsy required more than 90% of seizures during sleep. After exclusion of 20 patients with nocturnal temporal lobe epilepsy who did not meet confirmed SHE criteria, 135 patients comprised the SHE series. SOZ location was assigned from presurgical anatomo-electroclinical data, including stereo-EEG when performed, postoperative MRI, and postoperative Engel outcome. Six patients with overlapping frontal and extrafrontal SOZs were assigned to the principal SOZ location; seven patients with incomplete resection but confidently localized SOZs were retained using stereo-EEG; 20 patients with unclear or widespread SOZs were excluded from the semiology analysis. The semiology analysis therefore included 115 patients: 74 frontal and 41 extrafrontal, comprising 14 temporal, 18 operculoinsular, and 9 posterior cases. Clinical descriptions came from patients and family members, and the earliest nonmotor manifestation was selected when more than one was reported. All patients had at least one typical sleep-related event captured during video-EEG and stereo-EEG monitoring when performed. Five epileptologists reviewed captured events; two independently categorized the four video-documented semiology patterns, and four reviewed discordant assignments. One semiology pattern was assigned per patient because seizures were considered stereotyped, with early motor semiology weighted more heavily than late semiology. Seventeen patients (15%) required consensus review for discordant categorization. Postictal confusion was assessed from the clinical assessment during ictal recordings. Welch-corrected unpaired t tests, two-tailed Fisher exact tests, and kappa statistics were used; significance was retained at P < 0.05. Context reported by the source: mean seizure-onset age was 5.8 +/- 4.4 years, mean disease duration was 17.9 +/- 10.3 years, 64% had at least one seizure per night, and 90% had at least one seizure per week. An MRI-identifiable lesion was present in 88/135 patients (65%); probable focal cortical dysplasia was the most common MRI diagnosis (52%). The most common postoperative histopathologic diagnosis was FCD type II (67%). At least 2 years of postoperative outcome data were available for 127/135 patients (94%); Engel I outcome occurred in 104/127 (82%) and Engel class Ia in 86/127 (68%). Mortality outcomes were Not reported.

Findings

lateralized paresthesia followed by SP1 or SP2A lateralized paresthesia evolved into SP1 or SP2 in all of the frontal SHE cases described by the authors, suggesting a more posterior frontal seizure organization.PDF p.8, section 4.3

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdfSystematic review or meta-analysis · 11 findings · 7 reported values

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

This is a systematic review of non-idiopathic focal fronto-opercular epilepsy. The included population is 21 patients from 16 studies, including case series and case reports; the source reports 13 adults and 8 children in its population context. The review used anatomical and electroclinical evidence to define the EZ and divided the cohort into 12 prefrontal-operculum and 9 precentral Rolandic-operculum patients. Study-selection counts, Table 1 demographic/exploration cells, publication details, and risk-of-bias statements are retained here as context rather than individual findings. The source states that quantitative meta-analysis was not possible because of heterogeneity and low patient numbers; Fisher's exact tests compared semiological variables between the two EZ groups.

Findings

contralateral elementary sensory aura; somatosensory auraSeizures originating in the fronto-opercular region are described as commonly associated with contralateral elementary sensory aura, especially for the Rolandic operculum.PDF p.1, Abstract; PDF p.2, Key points
insular epilepsy; opercular epilepsy; non-painful paresthesiaThe source states that non-painful paresthesia does not discriminate between insular and frontal-opercular involvement, although pure-insular series described more extensive, variable, or multi-territory paresthesia than the face/upper-limb pattern in the review.PDF p.8, Discussion
somatosensory aura; precentral Rolandic operculum; prefrontal operculumThe source reports that the only significant semiological difference between prefrontal and precentral Rolandic operculum groups was the more frequent somatosensory aura in the Rolandic group.PDF p.6, Anatomical and clinical correlations; PDF p.8, Discussion
Somatosensory (arm and/or face)Table 2 reports 7/21 (33%) for Somatosensory (arm and/or face); timing is onset, and the source's overall agreement that the sign is suggestive of fronto-opercular epilepsy is graded High.PDF p.7, Table 2
Somatosensory (arm and/or face)Table 2 reports 1/12 patients with Somatosensory (arm and/or face) in the prefrontal operculum group.PDF p.7, Table 2
Somatosensory (arm and/or face)Table 2 reports 6/9 patients with Somatosensory (arm and/or face) in the precentral Rolandic operculum group.PDF p.7, Table 2
Somatosensory (arm and/or face)Fisher's exact comparison of Somatosensory (arm and/or face) between the prefrontal and precentral Rolandic operculum groups has p=0.016.PDF p.7, Table 2
non-painful paresthesia; pure insular epilepsyThe cited Peltola series reported non-painful paresthesia in 8 of 11 patients (72%).PDF p.8, Discussion
non-painful paresthesia; anterior insulaWithin the cited Peltola series, four patients with non-painful paresthesia had an EZ in the anterior insula.PDF p.8, Discussion
non-painful paresthesia; posterior insulaWithin the cited Peltola series, four patients with non-painful paresthesia had an EZ in the posterior insula.PDF p.8, Discussion
face and hand paresthesia; pure insular epilepsyThe cited Singh series reported face and hand paresthesia in 3 of 9 patients.PDF p.8, Discussion

Reported values

7/21 (33%)Somatosensory (arm and/or face)Percentage · n/N 7/21 · 21 included fronto-opercular epilepsy patients · OnsetPDF p.7, Table 2
1/12 patientsSomatosensory (arm and/or face)Proportion · n/N 1/12 · 12 patients with EZ in the prefrontal operculum · 12 patients with EZ in the prefrontal operculum · OnsetPDF p.7, Table 2
6/9 patientsSomatosensory (arm and/or face)Proportion · n/N 6/9 · 9 patients with EZ in the precentral Rolandic operculum · 9 patients with EZ in the precentral Rolandic operculum · OnsetPDF p.7, Table 2
8/11 (72%)non-painful paresthesia; pure insular epilepsyPercentage · n/N 8/11 · 11 patients in the cited Peltola pure-insular series · 11 patients in the cited Peltola pure-insular series · ictal onsetPDF p.8, Discussion
4 patientsnon-painful paresthesia; anterior insulaCount · n/N 4/8 · Peltola patients with non-painful paresthesia · ictal onsetPDF p.8, Discussion
4 patientsnon-painful paresthesia; posterior insulaCount · n/N 4/8 · Peltola patients with non-painful paresthesia · ictal onsetPDF p.8, Discussion
three (33%) patientsface and hand paresthesia; pure insular epilepsyPercentage · n/N 3/9 · 9 patients in the cited Singh pure-insular series · 9 patients in the cited Singh pure-insular series · ictal onsetPDF p.8, Discussion

jobst-insula-and-its-epilepsies-2019.pdfCase report or observation · 6 findings · 1 reported value

jobst-insula-and-its-epilepsies-2019.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

This is a multi-author narrative review with educational sections and cited-study restatements rather than a single primary cohort. Denominators therefore belong to the cited series named in each finding. The review includes insular stimulation series, noninvasive-test series, SEEG observations, and case reports. The source's own distinctions between insular, operculo-insular, insulo-opercular, extrainsular, temporal-like, and frontal-like are preserved.

Findings

Figure 3 painful tingling in left handThe patient in Figure 3 described a painful tingling sensation in the left hand after right-insular onset.PDF p.4, Figure 3B
hemisensory symptoms in perisylvian spreadHemisensory symptoms follow the perioral symptoms in the source-described perisylvian propagation sequence.PDF p.1, Abstract
central-sulcus insular stimulation paresthesiasElectrical stimulation around the central sulcus of the insula produces paresthesias.PDF p.1, Abstract; PDF p.5, Somatosensory Sensations
somatosensory stimulation responsesSomatosensory sensations accounted for 335 of 550 evoked symptoms (61%) in the cited insular stimulation series.PDF p.5, Somatosensory Sensations
paresthesias most frequent somatosensory responseParesthesias were the most frequent somatosensory response in the cited insular stimulation series.PDF p.5, Somatosensory Sensations
left hemibody sensory seizures in SUDEP-related caseA 33-year-old patient in a SUDEP-related case had left hemibody sensory seizures.PDF p.8, Is SUDEP Risk Increased in Insular Epilepsy?

Reported values

335/550 (61%) somatosensory sensationssomatosensory stimulation responsesPercentage · n/N 335/550 · 550 positive responses in the cited insular stimulation series · stimulation-evoked semiologyPDF p.5, Somatosensory Sensations

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdfIndependent primary study · 1 finding · 2 reported values

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdf

Independent primary study · Class II · Evidence weight 5.11 · 2 × 1.35 × 1.893

Electronic records were reviewed for all individuals who underwent frontal lobe epilepsy surgery at the National Hospital for Neurology & Neurosurgery, London, UK, between 1 January 2011 and 31 December 2020; 61 individuals were included after excluding operations performed primarily for reasons other than epilepsy. All had presurgical multidisciplinary review after scalp video-EEG telemetry, neuropsychology and neuropsychiatry assessment, MRI, and, in selected cases, FDG-PET, ictal SPECT, or intracranial EEG. Ictal semiology and its evolution came from video-EEG telemetry reports and multidisciplinary-team summaries, were documented in a predetermined format, and were independently categorized by two investigators with discrepancies resolved by discussion. Surgical records and postoperative MRI identified resection site and extent; the final resection site was the presumed EZ surrogate, and only the first resection was retained for the one individual with more than one procedure. At 12 months, outcomes came from a prospective epilepsy-surgery database and were classified with the ILAE surgery outcome scale. The cohort had median age at surgery 33.9 years (IQR 28.1-43.1) and median epilepsy duration 21.9 years (IQR 21.3-25.1); 43/61 (70%) had abnormal MRI, including 35 (57%) focal and 8 (13%) diffuse abnormalities, while 18 had normal MRI; 41/61 (67%) underwent intracranial EEG. Operations included 52/61 (85%) cortical resections and 9/61 (15%) lesionectomies; resections were left-sided in 32/61 (53%) and right-sided in 29/61 (47%), with orbitofrontal, frontomedial, dorsolateral, frontocentral, and combined extensive resections reported in Table 1. Twenty-three individuals (38%) had anterior cingulate extension and one had insular extension.

Findings

Focal sensory (somatosensory)Focal sensory (somatosensory) semiology occurred in 6/61 individuals (10%) as initial semiology and 9/61 (15%) in the combined set-of-semiology.PDF p.3, Results; PDF p.5, Table 2

Reported values

Combined 9/61 (15%)Focal sensory (somatosensory)Percentage · n/N 9/61 · 61 individuals undergoing frontal lobe epilepsy surgery · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.3, Results; PDF p.5, Table 2
Initial 6/61 (10%)Focal sensory (somatosensory)Percentage · n/N 6/61 · 61 individuals undergoing frontal lobe epilepsy surgery · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.3, Results; PDF p.5, Table 2

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 4 findings · 4 reported values

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

The authors report a PubMed literature review using the search terms “seizure”, “ictal”, “postictal”, “testing”, “examination”, and “interview”, followed by selection of relevant literature and references for a narrative review. The intended setting is an epilepsy long-term monitoring unit with video-EEG and ictal/postictal bedside testing. The source contains no single original cohort, unified analysis population, or uniform reference standard; cited populations and analysis units vary and are retained at the finding level when reported. Cited evidence includes video-EEG seizure series, temporal-lobe cohorts, stereo-EEG language observations, electrical cortical stimulation studies, and PNES diagnostic studies. Cohort demographics, lesion prevalence, etiology, surgery outcomes, and mortality outcomes are not reported as a unified study dataset. The review reports contextual testing metrics, including 27% of seizures assessed within 30 seconds and 50% unassessed in one UK study, and describes PNES comorbidity and induction literature; these are not treated as atlas findings.

Findings

Unilateral somatosensory auraThe review reports unilateral somatosensory auras in less than 10% of LTM series, with 89% of seizures having contralateral onset; a clear sensory march in a well-localized area increases sign reliability.PDF p.7, section 1.15
Somatosensory phenomena by region and distributionThe review states that somatosensory phenomena can arise from mesial temporal structures, insula, secondary somatosensory region, or SSMA; unilateral phenomena are predominantly contralateral but may be ipsilateral or bilateral, particularly with insular, SMA, or secondary sensory involvement, and secondary sensory involvement is more likely to affect face and distal extremities with proximal sparing.PDF p.7, section 1.15
Somatosensory aura in Table 2Table 2 associates somatosensory aura with primary somatosensory cortex (BA 1, 2, 3b), secondary somatosensory areas (parietal operculum/SSII), and SSMA; it lists contralateral lateralisation to primary cortex, ipsilateral lateralisation if unilateral for secondary somatosensory cortex, and contralateral lateralisation for SSMA.PDF p.3, Table 2
Somatosensory aura symptomsIn large cohort studies, somatosensory auras were present in 12%; 77% of patients with somatosensory auras reported tingling, while pain or thermal changes were less common and more suggestive of secondary somatosensory area involvement; somatosensory auras correlated with centroparietal epilepsy, particularly with a clear march, but also occurred in temporal-lobe, mesial-frontal, and multifocal epilepsy.PDF p.7, section 1.15

Reported values

Contralateral onset in 89% of seizuresUnilateral somatosensory auraPercentage · LTM series; seizures with unilateral somatosensory aura · Seizures with unilateral somatosensory aura · ictal auraPDF p.7, section 1.15
Unilateral somatosensory auras in <10% of LTM seriesUnilateral somatosensory auraPercentage · LTM series; seizures with unilateral somatosensory aura · LTM series · ictal auraPDF p.7, section 1.15
77% tingling among patients with somatosensory aurasSomatosensory aura symptomsPercentage · Large cohort studies; patients with somatosensory auras · patients with somatosensory auras · ictal auraPDF p.7, section 1.15
12% aura prevalenceSomatosensory aura symptomsPercentage · Large cohort studies; patients with somatosensory auras · large cohort studies · ictal auraPDF p.7, section 1.15

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdfNarrative, educational, or cited context · 3 findings · 11 reported values

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

This is a narrative review with a subjective selection of semiological features. The summarized populations vary across epilepsy monitoring units, focal epilepsy and temporal/frontal/occipital lobe epilepsy cohorts, infants, surgical series, case reports, and stimulation or lesion studies. Reference standards include video/EEG, EEG, MRI, CT, PET, SPECT, Wada testing, presurgical evaluation, seizure freedom or seizure reduction after surgery, and combinations of these; the source frequently states when the standard was incomplete or unavailable.

Findings

Somatosensory auraThe review describes unilateral somatosensory auras as generally pointing to a contralateral suspected epileptogenic zone, with greater reliability when the aura is well localized to a distal extremity and associated with a sensory march; ipsilateral sensory auras have also been reported.PDF p.2, section 2.1 Sensory auras; PDF p.2, section 2.1.1 Mechanism; PDF p.12, Table 1
Somatosensory auraMauguiere and Courjon described 127 patients with somatosensory auras selected among an epilepsy population of 8938; all except one had unilateral symptoms, and all patients with a known lesion and unilateral auras had symptoms contralateral to the suspected epileptogenic zone.PDF p.2, section 2.1 Sensory auras
Somatosensory auraTuxhorn et al. reviewed 600 patients and found 72 patients with sensory auras; among the reported suspected-zone classifications, 46% were contralateral to the aura, 6% ipsilateral, 24% had no identifiable unilateral lesion, and 25% were not lateralized.PDF p.2, section 2.1 Sensory auras

Reported values

frequency 1–60% of patientsSomatosensory auraRange · Patients with epilepsy or focal epilepsy as summarized by the review · reviewed populations · Ictal auraPDF p.2, section 2.1 Sensory auras; PDF p.2, section 2.1.1 Mechanism; PDF p.12, Table 1
89% contralateralSomatosensory auraPercentage · Patients with epilepsy or focal epilepsy as summarized by the review · unilateral somatosensory auras · Ictal auraPDF p.2, section 2.1 Sensory auras; PDF p.2, section 2.1.1 Mechanism; PDF p.12, Table 1
6.1% of epilepsy patientsSomatosensory auraPercentage · Patients with epilepsy or focal epilepsy as summarized by the review · epilepsy patients · Ictal auraPDF p.2, section 2.1 Sensory auras; PDF p.2, section 2.1.1 Mechanism; PDF p.12, Table 1
92 with structural lesionSomatosensory auraCount · 127 patients selected among 8938 patients with epilepsy; 92 had an identifiable structural lesion and 32 had EEG seizures recorded · structural lesion · Ictal auraPDF p.2, section 2.1 Sensory auras
127 patients among 8938Somatosensory auraPercentage · n/N 127/8938 · 127 patients selected among 8938 patients with epilepsy; 92 had an identifiable structural lesion and 32 had EEG seizures recorded · somatosensory aura patients · Ictal auraPDF p.2, section 2.1 Sensory auras
32 with EEG seizuresSomatosensory auraCount · 127 patients selected among 8938 patients with epilepsy; 92 had an identifiable structural lesion and 32 had EEG seizures recorded · EEG seizures recorded · Ictal auraPDF p.2, section 2.1 Sensory auras
Not lateralized 25% of 72Somatosensory auraPercentage · 600 reviewed patients; 72 patients with sensory auras · Not lateralized · Ictal auraPDF p.2, section 2.1 Sensory auras
Suspected zone ipsilateral to aura 6% of 72Somatosensory auraPercentage · 600 reviewed patients; 72 patients with sensory auras · Ipsilateral · Ictal auraPDF p.2, section 2.1 Sensory auras
Sensory auras 72/600 (12%)Somatosensory auraPercentage · n/N 72/600 · 600 reviewed patients; 72 patients with sensory auras · Ictal auraPDF p.2, section 2.1 Sensory auras
Suspected zone contralateral to aura 46% of 72Somatosensory auraPercentage · 600 reviewed patients; 72 patients with sensory auras · Contralateral · Ictal auraPDF p.2, section 2.1 Sensory auras
No identifiable unilateral lesion 24% of 72Somatosensory auraPercentage · 600 reviewed patients; 72 patients with sensory auras · No identifiable unilateral lesion · Ictal auraPDF p.2, section 2.1 Sensory auras

luders-semiological-seizure-classification-1998.pdfNarrative, educational, or cited context · 1 finding

luders-semiological-seizure-classification-1998.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

The authors describe a classification based exclusively on ictal seizure semiology as reported by patients or observers or analyzed during video monitoring. EEG and other test results do not influence the semiological classification, although EEG may be used to distinguish epileptic from nonepileptic paroxysmal events. The authors state that the classification had been tested for more than 10 years in selected epilepsy centers and that the present version or variants had been used in daily practice for more than 10 years, without reporting a defined cohort, eligibility criteria, sample size, or evaluation design.

Findings

Somatosensory auraSomatosensory auras are abnormal somatosensory sensations or paresthesias limited to a clearly defined somatosensory region of the body; poorly localized or vague sensations are classified only as unclassifiable auras.PDF p.3, Auras, subsection Somatosensory auras; PDF p.2, Table 1

mazzola-electrical-stimulation-human-insula-ictal-semiology-2017.pdfNarrative, educational, or cited context · 4 findings · 12 reported values

mazzola-electrical-stimulation-human-insula-ictal-semiology-2017.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.80 · 1 × 0.9 × 2

The authors reviewed stimulation data from 222 patients (107 women, 114 men; mean age 35.5 years, range 20-59) explored for atypical temporal or perisylvian epilepsy between March 1997 and April 2015; 669 insular sites were stimulated through transopercular electrodes orthogonal to the midsagittal plane using bipolar 50-Hz stimulation, 0.5-ms pulses, 5-second trains, and 0.2-3.5-mA intensity. Subjective reports and clinical observations were collected immediately after stimulation, with EEG and video reviewed retrospectively; stimulations in or around lesions or inducing an after-discharge were excluded, and multivariate logistic regression compared coordinates of contacts evoking each sensation with all other stimulated contacts, including non-eloquent contacts.

Findings

somato-sensory skin territory sizeThe median skin territory involved by somato-sensory sensations after insula stimulation was 3% of total skin surface, with a range of 0.1%-100%.PDF p.4, Somato-sensory Responses
somato-sensory response lateralization by body regionWhen the midline body was involved, face or trunk sensations were mostly bilateral, whereas limb sensations were predominantly contralateral to stimulation.PDF p.4, Somato-sensory Responses; PDF p.7, Somato-sensory Responses
somato-sensory responsesSomato-sensory response sites were broadly distributed across the insular cortex but were preferentially located in the postero-superior insula.PDF p.4, Somato-sensory Responses and Fig. 3; PDF p.7, Somato-sensory Responses
somato-sensory nonthermal and nonpainful sensationsNonthermal and nonpainful somato-sensory responses numbered 214 (39%), were described as neutral or unpleasant tingling, light touch, or slight electric current, and arose from sites distributed mainly across the posterior three quarters of the insular cortex.PDF p.3, Results; PDF p.4, Somato-sensory Responses and Fig. 3A

Reported values

range 0.1%–100%somato-sensory skin territory sizeRange · Somato-sensory responses evoked by insular stimulation · stimulation-evoked somato-sensory responsePDF p.4, Somato-sensory Responses
median involved skin territory 3% of total skin surfacesomato-sensory skin territory sizeMedian · Somato-sensory responses evoked by insular stimulation · stimulation-evoked somato-sensory responsePDF p.4, Somato-sensory Responses
Limbs 94%somato-sensory response lateralization by body regionPercentage · Somato-sensory responses involving the midline body or limbs after insular stimulation · Limbs · stimulation-evoked somato-sensory responsePDF p.4, Somato-sensory Responses; PDF p.7, Somato-sensory Responses
Midline face/trunk 24.2%somato-sensory response lateralization by body regionPercentage · Somato-sensory responses involving the midline body or limbs after insular stimulation · Midline face/trunk · stimulation-evoked somato-sensory responsePDF p.4, Somato-sensory Responses; PDF p.7, Somato-sensory Responses
Midline face/trunk 7.6%somato-sensory response lateralization by body regionPercentage · Somato-sensory responses involving the midline body or limbs after insular stimulation · Midline face/trunk · stimulation-evoked somato-sensory responsePDF p.4, Somato-sensory Responses; PDF p.7, Somato-sensory Responses
Midline face/trunk 68.2%somato-sensory response lateralization by body regionPercentage · Somato-sensory responses involving the midline body or limbs after insular stimulation · Midline face/trunk · stimulation-evoked somato-sensory responsePDF p.4, Somato-sensory Responses; PDF p.7, Somato-sensory Responses
Limbs 3%somato-sensory response lateralization by body regionPercentage · Somato-sensory responses involving the midline body or limbs after insular stimulation · Limbs · stimulation-evoked somato-sensory responsePDF p.4, Somato-sensory Responses; PDF p.7, Somato-sensory Responses
Limbs 3%somato-sensory response lateralization by body regionPercentage · Somato-sensory responses involving the midline body or limbs after insular stimulation · Limbs · stimulation-evoked somato-sensory responsePDF p.4, Somato-sensory Responses; PDF p.7, Somato-sensory Responses
335somato-sensory responsesCount · 335 insular contacts or responses classified as somato-sensory in the stimulation series · somato-sensory response analysis set · stimulation-evoked somato-sensory responsePDF p.4, Somato-sensory Responses and Fig. 3; PDF p.7, Somato-sensory Responses
OR=0.98somato-sensory responsesOdds ratio · 335 insular contacts or responses classified as somato-sensory in the stimulation series · Talairach y coordinate · stimulation-evoked somato-sensory responsePDF p.4, Somato-sensory Responses and Fig. 3; PDF p.7, Somato-sensory Responses
OR=1.05somato-sensory responsesOdds ratio · 335 insular contacts or responses classified as somato-sensory in the stimulation series · Talairach z coordinate · stimulation-evoked somato-sensory responsePDF p.4, Somato-sensory Responses and Fig. 3; PDF p.7, Somato-sensory Responses
214 responses (39% of 550 clinically eloquent responses)somato-sensory nonthermal and nonpainful sensationsPercentage · 214 nonthermal and nonpainful somato-sensory responses in the 550-response series · stimulation-evoked somato-sensory responsePDF p.3, Results; PDF p.4, Somato-sensory Responses and Fig. 3A

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdfNarrative, educational, or cited context · 3 findings

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

No formal search strategy, eligibility criteria, pooled analysis, common comparator, or uniform reference standard is reported. The chapter includes two individual case observations: Case 1 is a 27-year-old right-handed woman with seizure onset at age 9, and Case 2 is a 46-year-old right-handed man with seizures since age 16. Other populations are cited literature populations as reported in individual findings, including a review of 153 patients and a 22-patient nonlesional operculo-insular series; these are not an original chapter cohort.

Findings

somatosensory auraThe source describes somatosensory aura as the most common aura in insular seizures, with tingling, electrical-current, warmth, or painful sensations over contralateral limbs; a widely distributed, bilateral, painful, non-Jacksonian aura and/or accompanying sensory auras favors posterior two-thirds insular involvement over a parietal onset.PDF p.5, Ictal Semiology; PDF p.13, What localizations are suggested by the seizure semiology?
painful somatosensory seizure and contralateral auraIn the Case 2 discussion, the source states that somatosensory auras are usually localized to primary sensory cortex, secondary somatosensory cortex in the parietal operculum, or the posterior third of the insular cortex; painful seizures likely arise in the same regions, although supplementary motor, inferior parietal, and cingulate localizations have been proposed, and somatosensory auras are usually contralateral to the epileptic focus even when the insula is involved.PDF p.13, What localizations are suggested by the seizure semiology?
stimulation-evoked somatosensory, auditory, vestibular, olfactory, gustatory, and viscerosensory symptomsThe chapter reports that electrical stimulation studies evoked somatosensory symptoms, including pain, from the posterior two-thirds of the insula; auditory and vestibular symptoms from the posterior insula; and olfactory, gustatory, and viscerosensory symptoms, including laryngeal constriction, from the midinsula, whereas stimulation of the most anterior portion rarely evoked symptoms unless a larger network seizure was elicited.PDF p.3, insular functional differentiation and electrical cortical stimulation

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdfIndependent primary study · 8 findings · 6 reported values

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdf

Independent primary study · Class II · Evidence weight 5.28 · 2 × 1.35 × 1.957

The source studied 82 medically refractory patients whose seizure foci largely involved the parietal association area. Patients with large resections extending into anterior occipital, posterior temporal, or precentral regions and patients with parietal tumours were excluded. Surface EEG was available in 66 patients, seizures were recorded in 36, pre-resection ECoG was performed in 63, and intra-operative cortical stimulation was performed in 80. Denominators remain specific to each modality and subgroup. The source’s “parietal association area,” epileptogenic-zone definition, functional anatomy, and the source's own terms are preserved without a forced Brodmann, Lüders, or ILAE mapping.

Findings

contralateral tingling or numbnessTingling or numbness was contralateral to the epileptogenic zone in 51 of the 52 patients with this reported somatosensory aura.PDF p.3, Results, Aurae
bilateral tingling or numbnessOne patient with tingling or numbness had a bilateral distribution.PDF p.3, Results, Aurae
somatosensory aura entries in Table 1Table 1 lists 63 source-reported somatosensory aura entries and notes that aura entries can exceed patient counts because some patients had multiple aurae.PDF p.4, Table 1
tingling or numbness in extremitiesTingling or numbness in the extremities was reported by 52 patients, corresponding to 63% of the cohort.PDF p.3, Results, Aurae; PDF p.8, Discussion
epigastric aura preceded by foot numbnessOne patient had an epigastric aura preceded by numbness in one foot.PDF p.4, Results, Aurae
tingling as common reproduced auraThe most common stimulation-reproduced habitual aura was a tingling sensation.PDF p.5, Electrical cortical stimulation
right-fingertip tingling and pain in Fig. 1Figure 1 shows an aura of tingling and pain in the fingertips of the right hand followed by rightward head deviation and right-arm tonic posturing.PDF p.4, Fig. 1
somatosensory aura after spread to post-central gyrusThe source states that somatosensory aurae can occur with lesions limited to parietal association cortex, suggesting ictal spread to the more eloquent somatosensory cortex.PDF p.8, Discussion

Reported values

51/52 patientscontralateral tingling or numbnessProportion · n/N 51/52 · 52 patients with tingling or numbness · aura or seizure onsetPDF p.3, Results, Aurae
1/52 patientsbilateral tingling or numbnessProportion · n/N 1/52 · 52 patients with tingling or numbness · aura or seizure onsetPDF p.3, Results, Aurae
63 source-reported aura entriessomatosensory aura entries in Table 1Count · 82-patient parietal epilepsy series · aura or seizure onsetPDF p.4, Table 1
52/82 (63%) patientstingling or numbness in extremitiesPercentage · n/N 52/82 · 82 patients with parietal lobe epilepsy · aura or seizure onsetPDF p.3, Results, Aurae; PDF p.8, Discussion
1 patientepigastric aura preceded by foot numbnessCount · 82-patient parietal epilepsy series · aura sequencePDF p.4, Results, Aurae
1 caseright-fingertip tingling and pain in Fig. 1Count · n/N 1/1 · patient 7 (M.B.) · aura and ictal evolutionPDF p.4, Fig. 1

suzuki-sensory-motor-networks-reflex-seizure-case-report-2017.pdfCase report or observation · 1 finding

suzuki-sensory-motor-networks-reflex-seizure-case-report-2017.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Single case report: an 18-year-old right-handed girl with medically refractory reflex and spontaneous seizures since age 12. The evaluation included MRI, FDG-PET, scalp and long-term video EEG, two MEG analyses, two chronic subdural-electrode evaluations with functional mapping, ictal SPECT during provocation, resections, histopathology, and postoperative follow-up. No comparator or reference standard was reported.

Findings

reflex seizures; hypermotor seizures; right foot sensory auraIn this patient, the two seizure types were hypermotor seizures and a right-foot sensory aura followed by bilateral asymmetric tonic posturing and generalized tonic-clonic seizures; the latter occurred spontaneously and was also provoked by loud sounds, more commonly by somatosensory stimulation of the right foot, and reflex seizures were exaggerated by sudden unexpected stimulation.PDF p.1, Case Report; PDF p.3, Discussion

trebuchon-drane-electrical-stimulation-functional-mapping-seeg-2025.pdfNarrative, educational, or cited context · 1 finding

trebuchon-drane-electrical-stimulation-functional-mapping-seeg-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

The source describes clinical SEEG functional mapping using stimulation of sampled contacts during patient-specific tasks and summarizes cited studies involving patients with epilepsy, plus selected non-SEEG and awake-mapping studies in Table 10.1. Cited-study populations, sampling frames, analysis units, and denominators are frequently not reported in this chapter. One source-described clinical example is a 17-year-old patient with left temporo-perisylvian epilepsy and MRI-negative imaging (Fig. 10.4). The source distinguishes stimulation-induced clinical/electrophysiological responses from spontaneous seizures and treats afterdischarges as interpretation context.

Findings

anesthesia; paresthesia; thermic dispersion; painful sensationThe source reports anesthesia, paresthesia, or thermic dispersion mainly with parietal stimulation, with the main effect in postcentral gyrus but additional involvement of precuneus and posterior cingulum; insular stimulation induced paresthesias and localized warmth, and painful sensations were preferentially associated with the posterior two thirds of the insula and were more frequently described in the nondominant hemisphere.PDF p.14, Somato-sensory sensations and pain

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdfNarrative, educational, or cited context · 1 finding

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

The document is a narrative literature review organized by a semiological classification of paroxysmal events, auras, autonomic, dialeptic, motor, special, and additional lateralizing signs. It does not report a systematic search method, eligibility criteria, aggregate review population, cohort size, comparator, or common reference standard. Individual findings retain the population, phase, comparator, and cited-study attribution stated in the review.

Findings

somatosensory aurasThe review states that unilateral distal somatosensory auras confined to a clearly defined body region usually correspond to the contralateral primary sensory cortex, whereas bilateral or widespread sensations can arise from the supplementary sensorimotor area or S2; S2 stimulation can produce heat or pain, and poorly localized or lateralized “all body sensations” have no localizing or lateralizing value. Low-intensity motor-area stimulation may be perceived as a somatosensory aura when contractions do not produce actual movement.PDF p.1, Somatosensory auras; PDF p.2, Somatosensory auras (continued)

wang-electroclinical-insulo-opercular-epilepsy-seeg-pet-2019.pdfIndependent primary study · 2 findings · 11 reported values

wang-electroclinical-insulo-opercular-epilepsy-seeg-pet-2019.pdf

Independent primary study · Class II · Evidence weight 5.01 · 2 × 1.5 × 1.671

The study retrospectively identified 22 consecutive medication-resistant patients evaluated between January 2015 and March 2018; 12 were adults and 10 were pediatric patients. Insulo-opercular seizure origin was defined by SEEG, and patients without complete presurgical evaluation or clear seizure-semiology video were excluded. At least two habitual seizures were reviewed per patient for scalp video-EEG (53 seizures total), and EI was computed for two habitual seizures per patient. PET visual/MRI-coregistration analyses involved the patient group; the voxel-based PET comparison used 17 patients after excluding three with previous epilepsy surgery and two younger than 7 years, compared with 18 healthy subjects.

Findings

somatosensory and viscerosensory manifestationsThe reported manifestations included unpleasant nonpainful paresthesia in the contralateral upper limb, indescribable sensations in the contralateral hemibody or whole body, head/face/perioral paresthesia, auditory phenomena, epigastric sensation, and pharyngolaryngeal numbness or constriction; painful aura and ipsilateral paresthesia were not observed.PDF p.3, Results—Seizure semiology
autonomic; somatosensory/viscerosensory symptomsIn the 22-patient SEEG-defined insulo-opercular epilepsy series, autonomic symptoms and somatosensory/viscerosensory symptoms, separately or in combination, were the most prevalent auras and/or early seizure semiologies.PDF p.3, Results—Seizure semiology

Reported values

6/22 (27%)somatosensory and viscerosensory manifestationsPercentage · n/N 6/22 · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · head, face, or perioral · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology
1/22 (5%)somatosensory and viscerosensory manifestationsPercentage · n/N 1/22 · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · whole body · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology
not observedsomatosensory and viscerosensory manifestationsCount · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · ipsilateral paresthesia · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology
2/22 (9%)somatosensory and viscerosensory manifestationsPercentage · n/N 2/22 · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · contralateral hemibody · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology
1/22 (5%)somatosensory and viscerosensory manifestationsPercentage · n/N 1/22 · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · epigastric · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology
4/22 (18%)somatosensory and viscerosensory manifestationsPercentage · n/N 4/22 · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · contralateral upper limb · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology
1/22 (5%)somatosensory and viscerosensory manifestationsPercentage · n/N 1/22 · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · pharyngolaryngeal · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology
not observedsomatosensory and viscerosensory manifestationsCount · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · painful aura · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology
1/22 (5%)somatosensory and viscerosensory manifestationsPercentage · n/N 1/22 · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · auditory · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology
Autonomic symptoms 7/22 (32%)autonomic; somatosensory/viscerosensory symptomsPercentage · n/N 7/22 · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology
Somatosensory/viscerosensory symptoms 13/22 (59%)autonomic; somatosensory/viscerosensory symptomsPercentage · n/N 13/22 · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology

27 contributing manuscripts; source-reported values remain separate and are not pooled.

Abdominal / visceral pain sensation (interoceptive)Source terms: Abdominal auraReported: BilateralAlso reported: ContralateralAlso reported: IpsilateralAlso reported: Left hemisphereAlso reported: Non-dominant hemisphereAlso reported: Right hemisphere27 manuscripts · 90 findings · 86 reported values

Weighted evidence supportevidence weight 56.85 across 27 manuscripts · 2 manuscript weight pending · 6 independent primary study · 6 systematic review or meta-analysis · 11 narrative, educational, or cited context · 2 case report or observation · 2 structured design not resolved

In one case with a left amygdala/hippocampal cavernoma and left temporal EEG onset, right head/eye version and a figure-of-4 posture preceded rare focal-to-bilateral tonic-clonic seizures. The reported unilateral somatosensory manifestations were contralateral (upper limb or hemibody), and ipsilateral paresthesia was not observed. The reproduced table explicitly describes abdominal aura as non-lateralising. Right head/eye version and right-arm extension in the figure-of-4 posture were contralateral to the case's left-hemisphere onset. The review states that an abdominal aura combined with vomiting suggests a nondominant temporal epileptogenic zone. Epigastric aura occurred in 4 of 10 right-temporal patients versus 1 of 9 left-temporal patients. The review reports temporal abnormalities as unilateral or bilateral and provides no fixed hemisphere direction for abdominal-pain seizures. The 71% digestive-symptom frequency gives no body-side or hemisphere information. No hemisphere or body-side direction is reported. The cited comparison contains no lateralization information. The finding reports no cerebral lateralization. The probability statement contains no lateralization information. The mesiotemporal-versus-lateral temporal comparison contains no hemisphere direction. The stimulation-response frequency contains no lateralization information. The stimulation-site count contains no lateralization information. The visceral response description contains no body-side or hemisphere information. The cited stimulation response provides no hemispheric direction. The single-case observation contains no lateralization information. The mesial-versus-lateral temporal comparison provides no hemispheric direction. No hemispheric lateralization is supplied. The heterogeneity test contains no lateralization information. The study count contains no lateralization information. The denominator contains no lateralization information. The case description gives no body-side or hemisphere information. No lateralizing direction is reported. The educational epigastric definition gives no hemisphere or lateralization direction. The panel denominator carries no hemisphere or lateralization information. The non-topological probability contains no lateralization information. The confidence interval contains no lateralization information. The mesial-temporal probability contains no lateralization information. The insular percentage contains no lateralization information. This finding reports temporal localization but no cerebral lateralization. The odds-ratio confidence interval contains no lateralization information. The mesial-temporal odds ratio contains no lateralization information. The prevalence restatement contains no lateralization information. The prevalence summary contains no lateralization information. The restricted-subset prevalence contains no lateralization information. The source reports no significant difference in evoked-sensation type between right- and left-insular stimulation. No hemisphere or body-side relation to a cerebral reference is reported. The stimulation responses contain no lateralization information. No lateralization information is supplied. The cited anterior-versus-posterior insular comparison provides no lateralizing information. No seizure lateralization is reported. No hemisphere or body-side relationship is reported. The probability estimates contain no lateralization information. No hemisphere direction is reported. The review synthesis reports no hemisphere direction for the aura combination or propagation pathway. The patient-level falling, gustatory, and abdominal aura entry gives no body-side or hemisphere information. The case lists déjà vu, jamais vu, and abdominal aura terms without a side or lateralization direction. No hemisphere or lateralizing direction is reported. The temporo-polar frequency contains no lateralization information. The reported range contains no lateralization information. The sequential aura finding contains no lateralization information. The frequency and symptom-quality report gives no body-side or hemisphere information.

Source-defined result groups 41

Localization: FrontalObserved proportion 23.8%All reported · prefrontal operculum versus precentral Rolandic operculum · all included patients1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 18.2%contralateral upper limb · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 50.0%ML · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: InsularObserved proportion 7.5%All reported · other visceral response subtypes · evoked constrictive response1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 45.8%M · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelytemporal localization relative to the EUD-Loc prior · localizing data point1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 7.7%L · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: Frontal / TemporalSource-defined values retained separatelyFrontal SOZ · frontal, temporal, operculoinsular, and posterior SOZ subgroups · patient1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 22.2%9 patients with EZ in the precentral Rolandic operculum · prefrontal operculum group (N=12) · patients in the precentral Rolandic operculum group1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 23.1%L · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: medio-lateral rapid temporo-lateral/temporo-mesial propagationSource-defined values retained separatelyAll reported · other Table 6 medio-lateral sign frequencies · Table 6 sign-frequency estimate1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 11.1%9 patients with EZ in the precentral Rolandic operculum · prefrontal operculum group (N=12) · patients in the precentral Rolandic operculum group1 manuscript · 1 reported value · not pooled

Localization: InsularObserved proportion 14.9%All reported · all other stimulation sites · evoked visceral response1 manuscript · 1 reported value · not pooled

Localization: Frontal / TemporalSource-defined values retained separatelyTemporal SOZ · frontal, temporal, operculoinsular, and posterior SOZ subgroups · patient1 manuscript · 1 reported value · not pooled

Localization: Frontal / TemporalSource-defined values retained separatelyOperculoinsular SOZ · frontal, temporal, operculoinsular, and posterior SOZ subgroups · patient1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyipsilateral paresthesia · patient1 manuscript · 1 reported value · not pooled

Localization: T+ group / TL groupSource-defined values retained separatelyT+ group · TL group versus T+ group · seizures1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyWithin visceral responses · all other stimulation sites · evoked visceral response1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelymesial temporal localization relative to prior distribution · localizing data point1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyVisceral-response contacts versus other stimulation sites · All other stimulation sites · stimulation contact1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 9.1%contralateral hemibody · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelytemporal lobe localization given epigastric aura · localizing data point1 manuscript · 1 reported value · not pooled

Localization: OccipitalObserved proportion 14.3%All reported · no epigastric sensation after visual aura · patients1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyAll reported · other visceral response subtypes · evoked constrictive response1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 25.0%12 patients with EZ in the prefrontal operculum · precentral Rolandic operculum group (N=9) · patients in the prefrontal operculum group1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyWithin visceral responses · all other stimulation sites · evoked visceral response1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Right hemisphereObserved proportion 11.1%LTL · patient1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 9.5%All reported · prefrontal operculum versus precentral Rolandic operculum · all included patients1 manuscript · 1 reported value · not pooled

Localization: InsularObserved proportion 17.1%Visceral responses · viscero-psychic symptom presentations · evoked visceral response1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyinsular localization given epigastric aura · localizing data point1 manuscript · 1 reported value · not pooled

Localization: InsularObserved proportion 50.0%Viscero-psychic responses · viscero-psychic symptom presentations · evoked viscero-psychic response1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelymesial temporal localization given epigastric aura · localizing data point1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 79.2%M · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyWithin visceral responses · all other stimulation sites · evoked visceral response1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Right hemisphereObserved proportion 40.0%RTL · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 38.9%ML · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: InsularObserved proportion 50.0%Viscero-psychic responses · viscero-psychic symptom presentations · evoked viscero-psychic response1 manuscript · 1 reported value · not pooled

Localization: T+ group / TL groupSource-defined values retained separatelyTL group · TL group versus T+ group · seizures1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 27

Alphabetical by manuscript.

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdfSystematic review or meta-analysis · 13 findings · 6 reported values

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

epigastricTable 1 defines or exemplifies the the source's own semiology category “epigastric” as Abdominal rising sensation, for example a butterfly sensation.PDF p.7, Table 1 Semiology descriptions and frequencies
epigastricEpigastric semiology comprised 6.1% of non-topological data.PDF p.7, Table 1 Semiology descriptions and frequencies
epigastric; Figure 3 all-data subsetFigure 3 reports N = 740 for the all-data epigastric panel.PDF p.9, Figure 3 and caption
epigastric; Figure 3 non-topological subsetFigure 3 reports N = 214 for the non-topological epigastric panel.PDF p.9, Figure 3 and caption
epigastric aura; temporal lobeAn epigastric aura was associated with an 83% probability that the seizure originated from the temporal lobe in the non-topological analysis.PDF p.8, Seizure semiology localizing values
epigastric aura; temporal lobeThe 95% CI for the temporal-lobe probability given an epigastric aura was 72%–94%.PDF p.8, Seizure semiology localizing values
epigastric aura; mesial temporal structuresAn epigastric aura was associated with a 61% probability of mesial temporal localization.PDF p.8, Seizure semiology localizing values
epigastric aura; mesial temporal structuresThe 95% CI for mesial temporal localization given an epigastric aura was 52%–71%.PDF p.8, Seizure semiology localizing values
epigastric aura; insulaepigastric aura indicated insular localization in 10%.PDF p.8, Seizure semiology localizing values
epigastric aura; temporal lobeEpigastric aura had an intrinsic localizing OR of 2.4 for temporal-lobe localization.PDF p.8, Relative localizing values of semiologies
epigastric aura; temporal lobeThe 95% CI for epigastric aura; temporal lobe was 1.9–2.9.PDF p.8, Relative localizing values of semiologies
epigastric aura; mesial temporal structuresThe abstract reports an OR of 2.8 for mesial temporal structures given an epigastric aura.PDF p.1, Abstract; PDF p.12, Relative localizing values using odds ratios
epigastric aura; mesial temporal structuresThe 95% CI for the mesial-temporal OR given an epigastric aura was 2.3–2.9.PDF p.1, Abstract; PDF p.12, Relative localizing values using odds ratios

Reported values

epigastric 6.1%epigastricPercentage · non-topological Semio2Brain dataPDF p.7, Table 1 Semiology descriptions and frequencies
epigastric aura; temporal lobe 83%epigastric aura; temporal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
epigastric aura; mesial temporal structures 61%epigastric aura; mesial temporal structuresPercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
epigastric aura; insula 10%epigastric aura; insulaPercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
OR 2.4epigastric aura; temporal lobeOdds ratio · non-topological Semio2Brain data unless otherwise statedPDF p.8, Relative localizing values of semiologies
OR 2.8epigastric aura; mesial temporal structuresOdds ratio · non-topological EUD-Loc comparisonPDF p.1, Abstract; PDF p.12, Relative localizing values using odds ratios

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfStructured design not resolved · 3 findings · 1 reported value

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.301

Findings

posterior cingulate abdominal auraThe source reports 2 posterior cingulate patients with abdominal aura.PDF p.5, Clinical Presentation
patient 12 falling/gustatory/abdominal auraFalling, gustatory, and abdominal aura terms were listed for patient 12.PDF p.4, Figure 3
patient 13 déjà/jamais/abdominal auraDéjà vu, jamais vu, and abdominal aura terms were listed for patient 13.PDF p.4, Figure 3

Reported values

2/4 abdominal auraposterior cingulate abdominal auraProportion · n/N 2/4 · 4 posterior cingulate cases · auraPDF p.5, Clinical Presentation

asadollahi-drug-resistant-parietal-lobe-epilepsy-clinical-manifestations-surgery-outcome-2017.pdfIndependent primary study · 1 finding · 1 reported value

asadollahi-drug-resistant-parietal-lobe-epilepsy-clinical-manifestations-surgery-outcome-2017.pdf

Independent primary study · Class II · Evidence weight 3.91 · 2 × 1.2 × 1.628

Findings

epigastric auraOne patient reported an epigastric aura.PDF p.2, Results

Reported values

1/18 (5.5%) epigastric auraepigastric auraPercentage · n/N 1/18 · 18-patient drug-resistant parietal lobe epilepsy cohort · auraPDF p.2, Results

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 3 findings · 11 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

digestive auraThe source states that the auras were mainly characterized by digestive symptoms, reported in 71% of the analyzed aura events.PDF p.5, Seizure clinical semiology; PDF p.7, Auras
digestive auraDigestive auras overall were more frequent in TL than T+ seizures (71.2% versus 43.5%, P=0.02); the source is internally inconsistent about which digestive subcategory carries P=0.05, so no subcategory-specific effect is resolved.PDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3 and Auras
abdominal auraThe source states that previous reports found abdominal aura more common in TL seizures than in other seizure types, especially in mesio-temporal lobe epilepsy with hippocampal sclerosis.PDF p.7, Auras

Reported values

digestive symptoms 71%digestive auraPercentage · 80 analyzed seizures, one typical seizure per patient · ictal onsetPDF p.5, Seizure clinical semiology; PDF p.7, Auras
overall digestive aura TL 71.2%digestive auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3 and Auras
Table 2 first component T+ 13%digestive auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3 and Auras
Table 2 third component T+ 4.3%digestive auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3 and Auras
Table 2 second component T+ 30.4%digestive auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3 and Auras
Table 2 second component TL 54.2%digestive auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3 and Auras
P=0.02digestive auraP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3 and Auras
Table 2 first component TL 16.9%digestive auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3 and Auras
Table 2 third component TL 6.8%digestive auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3 and Auras
P=0.05digestive auraP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3 and Auras
overall digestive aura T+ 43.5%digestive auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3 and Auras

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfSystematic review or meta-analysis · 3 findings · 3 reported values

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

epigastric sensationsThe narrative describes epigastric sensations as rare, at 5%.PDF p.4, Semiology and clinical features
Epigastric (Table 3)Table 3 reports epigastric symptoms in 3 cases (4%), more at seizure onset.PDF p.6, Table 3
Epigastric (Table 4)In the 60 high/very-high-confidence cases, Table 4 reports epigastric symptoms in 4 cases (7%).PDF p.7, Table 4

Reported values

5% epigastric sensationsepigastric sensationsPercentage · reviewed basal temporal seizure cases · ictal onsetPDF p.4, Semiology and clinical features
3 cases (4%)Epigastric (Table 3)Percentage · Table 3 basal temporal seizure cases · onsetPDF p.6, Table 3
4/60 (7%)Epigastric (Table 4)Percentage · n/N 4/60 · 60 basal temporal seizure cases with high or very-high EZ confidence · ictalPDF p.7, Table 4

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 8 findings · 5 reported values

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdf; chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

psychic aura; abdominal aura; automotor seizure; figure-of-4 signIn an illustrative 36-year-old right-handed man with a left amygdala/hippocampal cavernoma, seizures began with déjà vu and epigastric rising, evolved to automotor features and rarely focal-to-bilateral tonic-clonic seizures, and showed right head/eye version plus a figure-of-4 posture before generalisation; left temporal EEG onset and the posture were consistent with left hemispheric onset.PDF p.5, Video case 3; PDF p.6, Video case 3 and Figure 4 caption
psychic and abdominal aura; figure-of-4 signIn video case 3, a 36-year-old right-handed man with a left amygdala/hippocampal-head cavernoma had déjà vu and epigastric rising followed by oral and manual automatisms and loss of awareness; before generalization, right head and eye version and a figure-of-4 posture with the left arm flexed and right arm extended lateralised onset to the left hemisphere, concordant with left temporal EEG onset.PDF p.6, Video case 3 and Figure 4
abdominal auraAn abdominal aura, including a rising epigastric sensation or abdominal discomfort, is reported as highly associated with temporal lobe epilepsy with a probability of 74%.PDF p.5, Auras
abdominal aura evolving to automotor seizureThe review states that evolution of an abdominal aura into an automotor seizure increases the probability of temporal lobe epilepsy to 98%.PDF p.5, Auras
abdominal aura; experiential phenomena; elemental auditory auraIn a cited study of 187 temporal lobe seizures assessed with intracranial stereo-EEG, abdominal aura and experiential phenomena such as fear, déjà vu, and jamais vu indicated mesiotemporal seizures, whereas elemental auditory aura indicated lateral onset involving Heschl’s gyrus/primary auditory cortex.PDF p.5, Auras
abdominal aura; automotor evolutionAn abdominal aura, such as a rising epigastric sensation or abdominal discomfort, is reported as highly associated with temporal lobe epilepsy with a probability of 74%, and evolution of the abdominal aura into an automotor seizure increases the probability to 98%.PDF p.5, Auras
abdominal aura; experiential phenomena; elemental auditory auraIn a cited study of 187 temporal lobe seizures assessed by intracranial stereo-EEG, abdominal aura and experiential phenomena including fear, déjà vu, and jamais vu indicated mesiotemporal seizures, whereas elemental auditory aura indicated lateral onset involving Heschl’s gyrus or primary auditory cortex.PDF p.5, Auras
hippocampal propagation to insula; complex visceral and somatosensory auraThe review states that seizures arising from hippocampus almost always propagate to the insula, so abdominal aura is also common in mesiotemporal seizures; nevertheless, the combination of complex visceral and somatosensory auras points toward insular onset.PDF p.8, Insular seizures; PDF p.9, Insular seizures

Reported values

probability of temporal lobe epilepsy 74%abdominal auraPercentage · focal epilepsy patients with abdominal aura in the cited study · aura/early ictalPDF p.5, Auras
probability of temporal lobe epilepsy 98%abdominal aura evolving to automotor seizurePercentage · focal epilepsy patients with abdominal aura in the cited study · aura to ictal evolutionPDF p.5, Auras
98%abdominal aura; automotor evolutionPercentage · Patients with focal epilepsies in the cited study; exact cohort Not reported · abdominal aura evolving into automotor seizure · Aura and subsequent ictal automotor evolutionPDF p.5, Auras
74%abdominal aura; automotor evolutionPercentage · Patients with focal epilepsies in the cited study; exact cohort Not reported · abdominal aura alone · Aura and subsequent ictal automotor evolutionPDF p.5, Auras
Qualitative association in 187 seizuresabdominal aura; experiential phenomena; elemental auditory auraCount · 187 temporal lobe seizures assessed by intracranial stereo-EEG · Aura and ictal onsetPDF p.5, Auras

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.37 · 1 × 0.9 × 1.521

Findings

epigastric aura; frontal subgroupOne frontal-subgroup aura was an epigastric sensation.PDF p.3, Aura

Reported values

1 patientepigastric aura; frontal subgroupCount · n/N 1/11 · Frontal subgroup of OFC-extended EZN · Frontal subgroup of OFC-extended EZN · ictal auraPDF p.3, Aura

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdfSystematic review or meta-analysis · 12 findings · 4 reported values

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

epigastric aura; olfactory/gustatory auraThe source states that absence of epigastric or olfactory/gustatory auras may be more indicative of lateral than mesial temporal seizures, whereas their presence points toward mesial rather than lateral onset.PDF p.7, Discussion; PDF p.10, Conclusions
Epigastric auraTable 3 reports 4 studies assessing Epigastric aura.PDF p.6, Table 3
Epigastric auraTable 3 reports 66 patients assessed for Epigastric aura.PDF p.6, Table 3
Epigastric auraTable 3 reports 0–13.6% as the percentage range or value for Epigastric aura; the overall association grade is Low.PDF p.6, Table 3
odds of occurrence; Epigastric auraTable 4 reports overall odds of 0.11 for occurrence of Epigastric aura in lateral TLE.PDF p.7, Table 4; PDF p.8, Figure 2
odds confidence interval; Epigastric auraTable 4 reports a 95% confidence interval of 0.04–0.26 for the overall odds of Epigastric aura.PDF p.7, Table 4; PDF p.8, Figure 2
heterogeneity test; Epigastric auraThe heterogeneity test for the Table 4 odds estimate for Epigastric aura has p=0.6299.PDF p.7, Table 4
Epigastric aura; lateral versus mesial comparisonTable 5 reports 3 studies comparing Epigastric aura in lateral and mesial TLE.PDF p.9, Table 5
Epigastric aura; lateral TLE patient denominatorTable 5 reports 44 lateral-TLE patients assessed for Epigastric aura.PDF p.9, Table 5
Epigastric aura; mesial TLE patient denominatorTable 5 reports 56 mesial-TLE patients assessed for Epigastric aura.PDF p.9, Table 5
Epigastric aura; lateral TLE prevalenceTable 5 reports a lateral-TLE percentage of 0–12.5% for Epigastric aura.PDF p.9, Table 5
Epigastric aura; mesial TLE prevalenceTable 5 reports a mesial-TLE percentage of 31.3–40% for Epigastric aura.PDF p.9, Table 5

Reported values

0–13.6%Epigastric auraPercentage Range · Lateral temporal epilepsy patients assessed for Epigastric aura · ictalPDF p.6, Table 3
odds 0.11odds of occurrence; Epigastric auraOdds · Lateral temporal epilepsy patients assessed for Epigastric aura · ictalPDF p.7, Table 4; PDF p.8, Figure 2
0–12.5%Epigastric aura; lateral TLE prevalencePercentage Range · Lateral TLE patients assessed for Epigastric aura · Lateral TLE patients assessed for Epigastric aura · ictalPDF p.9, Table 5
31.3–40%Epigastric aura; mesial TLE prevalencePercentage Range · Mesial TLE patients assessed for Epigastric aura · Mesial TLE patients assessed for Epigastric aura · ictalPDF p.9, Table 5

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdfStructured design not resolved · 1 finding · 2 reported values

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.5

Patients were admitted to an epilepsy unit over 30 months and underwent 5-14 days of scalp and sphenoidal EEG-CCTV monitoring with antiepileptic-drug discontinuation; all had head MRI, 16 had PET, 18 had neuropsychological testing, 16 had Wada testing, and 6 had repeat monitoring with implanted subdural grids. The 19 patients were divided by unilateral temporal onset using interictal discharges, ictal EEG onset, MRI lesions including mesiotemporal sclerosis, PET hypometabolism, neuropsychological testing, Wada testing, preoperative evaluation, and surgical outcome; 10 patients had RTL onset and 9 had LTL onset, yielding 54 and 73 recorded seizures, respectively. Only complex partial seizures (CPS) and secondarily generalized or partial-evolving-to-generalized (PE) seizures were analyzed. Clinical features were compared with chi-square or Fisher's exact tests.

Findings

Epigastric auraAn epigastric aura occurred in 4 RTL patients and 1 LTL patient.PDF p.4, numbered clinical-feature results

Reported values

LTL patients with epigastric aura 1/9Epigastric auraPercentage · n/N 1/9 · 10 RTL/RTLE patients and 9 LTL/LTLE patients · LTL · Preictal auraPDF p.4, numbered clinical-feature results
RTL patients with epigastric aura 4/10Epigastric auraPercentage · n/N 4/10 · 10 RTL/RTLE patients and 9 LTL/LTLE patients · RTL · Preictal auraPDF p.4, numbered clinical-feature results

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 1 finding · 2 reported values

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

abdominal aurasAbdominal auras are described as the most common autonomic aura and are localized to the anterior insula, frontal operculum, mesial temporal structures, and SSMA. In isolation they carry a reported 74% probability of TLE, rising to 98% when they evolve into an automotor component; when combined with vomiting they suggest an epileptogenic zone in the nondominant temporal lobe.PDF p.3, section 3.1 Auras; PDF p.2, Table 1

Reported values

TLE probability with isolated abdominal aura 74%abdominal aurasPercentage · patients with focal epilepsy; review-reported abdominal-aura series · Isolated abdominal aura · isolated aura versus evolution to automotor component; vomiting-associated auraPDF p.3, section 3.1 Auras; PDF p.2, Table 1
TLE probability when abdominal aura evolves to automotor component 98%abdominal aurasPercentage · patients with focal epilepsy; review-reported abdominal-aura series · Abdominal aura evolving to automotor component · isolated aura versus evolution to automotor component; vomiting-associated auraPDF p.3, section 3.1 Auras; PDF p.2, Table 1

gibbs-clinical-features-sleep-related-hypermotor-epilepsy-2019.pdfIndependent primary study · 1 finding · 5 reported values

gibbs-clinical-features-sleep-related-hypermotor-epilepsy-2019.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

epigastric and autonomic manifestationsTable 2 lists epigastric manifestations as n=8 frontal, n=3 temporal, and n=2 operculoinsular, with no posterior entry; it lists autonomic manifestations as n=6 frontal and n=2 temporal, with no operculoinsular or posterior entry. The narrative states that epigastric and autonomic features were present in all but the posterior subgroup.PDF p.6, Table 2; PDF p.7, section 3.3

Reported values

Autonomic manifestations, temporal n=2epigastric and autonomic manifestationsCount · 115 SHE patients in the early nonmotor semiology table and SOZ subgroups · Temporal SOZ · early nonmotor seizure onsetPDF p.6, Table 2; PDF p.7, section 3.3
Epigastric manifestations, temporal n=3epigastric and autonomic manifestationsCount · 115 SHE patients in the early nonmotor semiology table and SOZ subgroups · Temporal SOZ · early nonmotor seizure onsetPDF p.6, Table 2; PDF p.7, section 3.3
Epigastric manifestations, operculoinsular n=2epigastric and autonomic manifestationsCount · 115 SHE patients in the early nonmotor semiology table and SOZ subgroups · Operculoinsular SOZ · early nonmotor seizure onsetPDF p.6, Table 2; PDF p.7, section 3.3
Epigastric manifestations, frontal n=8epigastric and autonomic manifestationsCount · 115 SHE patients in the early nonmotor semiology table and SOZ subgroups · Frontal SOZ · early nonmotor seizure onsetPDF p.6, Table 2; PDF p.7, section 3.3
Autonomic manifestations, frontal n=6epigastric and autonomic manifestationsCount · 115 SHE patients in the early nonmotor semiology table and SOZ subgroups · Frontal SOZ · early nonmotor seizure onsetPDF p.6, Table 2; PDF p.7, section 3.3

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdfSystematic review or meta-analysis · 8 findings · 6 reported values

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

Viscero-sensoryTable 2 reports 5/21 (24%) for Viscero-sensory; timing is onset, and the source's overall agreement that the sign is suggestive of fronto-opercular epilepsy is graded High.PDF p.7, Table 2
Viscero-sensoryTable 2 reports 3/12 patients with Viscero-sensory in the prefrontal operculum group.PDF p.7, Table 2
Viscero-sensoryTable 2 reports 2/9 patients with Viscero-sensory in the precentral Rolandic operculum group.PDF p.7, Table 2
Viscero-sensoryFisher's exact comparison of Viscero-sensory between the prefrontal and precentral Rolandic operculum groups has p=1.PDF p.7, Table 2
EpigastricTable 2 reports 2/21 (10%) for Epigastric; timing is onset, and the source's overall agreement that the sign is suggestive of fronto-opercular epilepsy is graded Low.PDF p.7, Table 2
EpigastricTable 2 reports 1/12 patients with Epigastric in the prefrontal operculum group.PDF p.7, Table 2
EpigastricTable 2 reports 1/9 patients with Epigastric in the precentral Rolandic operculum group.PDF p.7, Table 2
EpigastricFisher's exact comparison of Epigastric between the prefrontal and precentral Rolandic operculum groups has p=1.PDF p.7, Table 2

Reported values

5/21 (24%)Viscero-sensoryPercentage · n/N 5/21 · 21 included fronto-opercular epilepsy patients · OnsetPDF p.7, Table 2
3/12 patientsViscero-sensoryProportion · n/N 3/12 · 12 patients with EZ in the prefrontal operculum · 12 patients with EZ in the prefrontal operculum · OnsetPDF p.7, Table 2
2/9 patientsViscero-sensoryProportion · n/N 2/9 · 9 patients with EZ in the precentral Rolandic operculum · 9 patients with EZ in the precentral Rolandic operculum · OnsetPDF p.7, Table 2
2/21 (10%)EpigastricPercentage · n/N 2/21 · 21 included fronto-opercular epilepsy patients · OnsetPDF p.7, Table 2
1/12 patientsEpigastricProportion · n/N 1/12 · 12 patients with EZ in the prefrontal operculum · 12 patients with EZ in the prefrontal operculum · OnsetPDF p.7, Table 2
1/9 patientsEpigastricProportion · n/N 1/9 · 9 patients with EZ in the precentral Rolandic operculum · 9 patients with EZ in the precentral Rolandic operculum · OnsetPDF p.7, Table 2

hwang-painful-seizures-review-ictal-pain-2019.pdfNarrative, educational, or cited context · 3 findings · 3 reported values

hwang-painful-seizures-review-ictal-pain-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Narrative literature review; no original study population or independent patient-level analysis is reported. The review summarizes retrospective cohorts, EMU series, case series, individual cases, electrical-stimulation and functional-neuroimaging studies, and prior reviews. Populations therefore vary by finding and include patients with epilepsy, focal or temporal/occipital epilepsy, EMU admissions, painful somatosensory seizures, abdominal epilepsy, and cited literature case collections. Exact ascertainment, subgroup denominators, and reference standards are retained only where the source reports them.

Findings

abdominal-pain seizure localizationThe review states that interictal scalp EEG abnormalities in abdominal epilepsy most commonly involve temporal lobes, unilaterally or bilaterally, with case reports of ictal temporal abnormalities; parietal foci are less common, and insula or operculum should be considered as mimics or possible sources of the sensations.PDF p.2, Table 1; PDF p.5, Abdominal Pain as a Symptom of Seizures, Localization; PDF p.6, Localization (continued)
ictal abdominal painThe review reports ictal abdominal pain in 2 of 4,736 patients with epilepsy evaluated at a tertiary epilepsy center; it distinguishes true abdominal pain from common epigastric rising sensations and describes ictal episodes as usually shorter than 10 minutes, sometimes clustered, with sharp or colicky discomfort.PDF p.2, Table 1; PDF p.5, Abdominal Pain as a Symptom of Seizures, Description
insular electrical stimulation and abdominal sensationsThe review reports that the largest published study of insular electrical stimulation elicited visceral sensations of abdominal heaviness and constriction in several insular regions.PDF p.6, Abdominal Pain as a Symptom of Seizures, Localization

Reported values

episodes usually less than 10 minutes and may clusterictal abdominal painCount · n/N 2/4736 · 4,736 patients with epilepsy evaluated at a tertiary epilepsy center · IctalPDF p.2, Table 1; PDF p.5, Abdominal Pain as a Symptom of Seizures, Description
2/4,736 patientsictal abdominal painCount · n/N 2/4736 · 4,736 patients with epilepsy evaluated at a tertiary epilepsy center · IctalPDF p.2, Table 1; PDF p.5, Abdominal Pain as a Symptom of Seizures, Description
sharp or colicky qualityictal abdominal painCount · n/N 2/4736 · 4,736 patients with epilepsy evaluated at a tertiary epilepsy center · IctalPDF p.2, Table 1; PDF p.5, Abdominal Pain as a Symptom of Seizures, Description

ictal-paraphasia-atypical-temporal-lobe-epilepsy.pdfCase report or observation · 1 finding

ictal-paraphasia-atypical-temporal-lobe-epilepsy.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Single case assessed by clinical history, examination, brain MRI, video-EEG, and pathology; 12 typical seizures were recorded; no comparator or formal independent reference standard was reported, and the authors used an anatomo-electro-clinical correlation.

Findings

epigastric uncomfortable sensation and nauseaThe patient described occasional epigastric discomfort and nausea before loss of awareness.PDF p.2, Materials and Methods

jobst-insula-and-its-epilepsies-2019.pdfNarrative, educational, or cited context · 9 findings · 3 reported values

jobst-insula-and-its-epilepsies-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

visceral sensations after insular stimulationVisceral sensations are described as the next most common response after insular stimulation.PDF p.1, Abstract; PDF p.5, Visceral Symptoms
viscerosensory auraViscerosensory auras are among the reported clinical manifestations of insular seizures.PDF p.2, Clinical Features
visceral stimulation responsesVisceral symptoms accounted for 82 of 550 positive insular stimulation responses (15%).PDF p.5, Visceral Symptoms
constrictive visceral sensationsConstrictive sensations were observed at 41 electrical stimulation sites.PDF p.5, Visceral Symptoms
abdominal constrictive sensationAbdominal constrictive sensations were among the locations of constrictive responses.PDF p.5, Visceral Symptoms
constrictive sensation rangeConstrictive visceral responses ranged from simple discomfort to a frightening sensation of strangulation.PDF p.5, Visceral Symptoms
viscero-psychic responsesViscero-psychic symptoms were elicited at 14 insular stimulation sites.PDF p.5, Visceral Symptoms
abdominal heavinessAbdominal heaviness was one of the viscero-psychic symptoms elicited by insular stimulation.PDF p.5, Visceral Symptoms
fear associated with viscero-psychic symptomsThoracic or abdominal heaviness was associated with a feeling of fear in viscero-psychic responses.PDF p.5, Visceral Symptoms

Reported values

82/550 (15%) visceral symptomsvisceral stimulation responsesPercentage · n/N 82/550 · 550 positive responses in the cited insular stimulation series · stimulation-evoked semiologyPDF p.5, Visceral Symptoms
41 stimulation sites with constrictive sensationsconstrictive visceral sensationsCount · visceral responses in the cited insular stimulation series · stimulation-evoked visceral semiologyPDF p.5, Visceral Symptoms
14 stimulation sites with viscero-psychic symptomsviscero-psychic responsesCount · visceral responses in the cited insular stimulation series · stimulation-evoked autonomic/affective semiologyPDF p.5, Visceral Symptoms

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 1 finding

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Abdominal auraTable 2 associates abdominal aura with anterior insula, frontal operculum, mesial temporal lobe, and SSMA and describes it as non-lateralising.PDF p.3, Table 2

luders-semiological-seizure-classification-1998.pdfNarrative, educational, or cited context · 1 finding

luders-semiological-seizure-classification-1998.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Abdominal auraThe authors state that patients with temporal lobe epilepsy frequently have abdominal sensations; some abdominal auras most probably reflect increased abdominal peristalsis and belong to the autonomic group, whereas others may reflect activation of sensory cortical areas of the abdominal viscera, and the category is retained independently because of its close relation to temporal lobe epilepsy.PDF p.3, Auras, subsection Abdominal auras; PDF p.2, Table 1

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdfIndependent primary study · 3 findings · 6 reported values

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdf

Independent primary study · Class II · Evidence weight 5.07 · 2 × 1.5 × 1.69

The study retrospectively evaluated 55 patients with medically intractable unilateral temporal lobe epilepsy selected from 132 consecutive surgical-evaluation patients seen in Rennes (1994–1997) and Marseille (1997–2001). A total of 187 SEEG-recorded seizures were analyzed, with a reported mean of 3.4 seizures per patient. Clinical variables included initial ictal subjective symptoms, early and late ictal signs, loss of contact, seizure duration, and postictal deficits. Clinical data were acquired during video-SEEG testing and retrospectively reviewed by two independent investigators; seizure onset and termination were determined from the earliest and latest ictal SEEG changes. Group comparisons used Pearson’s chi-square or Fisher’s exact test, with two-sided p<0.05 considered significant. The tabulated percentages use patient subgroup sizes M=24, ML=18, and L=13 unless otherwise stated.

Findings

viscerosensory symptomsInitial viscerosensory symptoms were more frequent in M than ML and especially L patients.PDF p.5, Semiologic analysis and Table 2
epigastric sensationInitial epigastric sensation was more frequent in M and ML than L patients, but the comparison did not reach the source’s p<0.05 threshold.PDF p.5, Semiologic analysis; PDF p.5, Table 2; PDF p.7, Viscerosensory sensations, epigastric sensation
prior diagnostic value of viscerosensory and epigastric sensationsThe discussion restates that prior authors reported diagnostic value for initial viscerosensory sensations, especially epigastric sensation, in differentiating medial temporal lobe epilepsy from lateral temporal lobe epilepsy.PDF p.7, Viscerosensory sensations, epigastric sensation

Reported values

M 19/24 (79.2%)viscerosensory symptomsPercentage · n/N 19/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · initial ictal subjective symptomPDF p.5, Semiologic analysis and Table 2
ML 9/18 (50%)viscerosensory symptomsPercentage · n/N 9/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · initial ictal subjective symptomPDF p.5, Semiologic analysis and Table 2
L 3/13 (23.1%)viscerosensory symptomsPercentage · n/N 3/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · initial ictal subjective symptomPDF p.5, Semiologic analysis and Table 2
1/13 (7.7%)epigastric sensationPercentage · n/N 1/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · initial ictal subjective symptomPDF p.5, Semiologic analysis; PDF p.5, Table 2; PDF p.7, Viscerosensory sensations, epigastric sensation
11/24 (45.8%)epigastric sensationPercentage · n/N 11/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · initial ictal subjective symptomPDF p.5, Semiologic analysis; PDF p.5, Table 2; PDF p.7, Viscerosensory sensations, epigastric sensation
7/18 (38.9%)epigastric sensationPercentage · n/N 7/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · initial ictal subjective symptomPDF p.5, Semiologic analysis; PDF p.5, Table 2; PDF p.7, Viscerosensory sensations, epigastric sensation

mazzola-electrical-stimulation-human-insula-ictal-semiology-2017.pdfNarrative, educational, or cited context · 4 findings · 10 reported values

mazzola-electrical-stimulation-human-insula-ictal-semiology-2017.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.80 · 1 × 0.9 × 2

Findings

viscero-sensitive sensationsVisceral sensations were the second major response group, occurring in 82 responses (14.9%) and comprising constrictive, viscero-vegetative, and viscero-psychic responses; their contacts were significantly more anterior than other stimulation sites, especially around or rostral to the central insular sulcus.PDF p.3, Results; PDF p.4, Visceral Sensations and Fig. 4; PDF p.7, Visceral Sensations
constrictive sensationsConstrictive sensations occurred in 41 responses (reported in the discussion as 7.4% of evoked responses), were located in pharyngo-laryngeal, retrosternal, or abdominal regions, and ranged from simple discomfort to frightening strangulation.PDF p.4, Visceral Sensations; PDF p.5, continuation of Visceral Sensations; PDF p.7, Visceral Sensations
viscero-psychic symptomsThe 14 viscero-psychic responses combined a visceral sensation with anxiety or fear; thoracic or abdominal constriction/heaviness accompanied anxiety in 7 of 14, and anxiety ranged from mild to panic and could be isolated in 7 of 14 cases.PDF p.3, Results and Table 1; PDF p.5, Visceral Sensations and Fig. 4C
visceral responses and temporal-lobe seizure auraRestating observations attributed to Penfield and Faulk, the source reports a high frequency of visceral responses from the antero-inferior insular quadrant exposed after temporal-operculum removal, with patients describing those symptoms as identical to their ictal aura during surgery for temporal-lobe epilepsy.PDF p.7, Visceral Sensations

Reported values

14 viscero-psychic responsesviscero-sensitive sensationsCount · 82 visceral responses in the 550-response series · Within visceral responses · stimulation-evoked visceral sensationPDF p.3, Results; PDF p.4, Visceral Sensations and Fig. 4; PDF p.7, Visceral Sensations
41 constrictive responsesviscero-sensitive sensationsCount · 82 visceral responses in the 550-response series · Within visceral responses · stimulation-evoked visceral sensationPDF p.3, Results; PDF p.4, Visceral Sensations and Fig. 4; PDF p.7, Visceral Sensations
y-coordinate OR=1.045viscero-sensitive sensationsOdds ratio · 82 visceral responses in the 550-response series · Visceral-response contacts versus other stimulation sites · stimulation-evoked visceral sensationPDF p.3, Results; PDF p.4, Visceral Sensations and Fig. 4; PDF p.7, Visceral Sensations
27 viscero-vegetative responsesviscero-sensitive sensationsCount · 82 visceral responses in the 550-response series · Within visceral responses · stimulation-evoked visceral sensationPDF p.3, Results; PDF p.4, Visceral Sensations and Fig. 4; PDF p.7, Visceral Sensations
Visceral responses 82/550 (14.9%)viscero-sensitive sensationsPercentage · n/N 82/550 · 82 visceral responses in the 550-response series · stimulation-evoked visceral sensationPDF p.3, Results; PDF p.4, Visceral Sensations and Fig. 4; PDF p.7, Visceral Sensations
41 constrictive responsesconstrictive sensationsCount · n/N 41/550 · 41 constrictive responses within the 82 visceral responses · stimulation-evoked visceral sensationPDF p.4, Visceral Sensations; PDF p.5, continuation of Visceral Sensations; PDF p.7, Visceral Sensations
source reports 7.4% of evoked responses in Discussionconstrictive sensationsPercentage · 41 constrictive responses within the 82 visceral responses · stimulation-evoked visceral sensationPDF p.4, Visceral Sensations; PDF p.5, continuation of Visceral Sensations; PDF p.7, Visceral Sensations
Isolated anxiety 7/14viscero-psychic symptomsCount · n/N 7/14 · 14 viscero-psychic responses within the 82 visceral responses · Viscero-psychic responses · stimulation-evoked visceral and affective sensationPDF p.3, Results and Table 1; PDF p.5, Visceral Sensations and Fig. 4C
14 viscero-psychic responses within 82 visceral responsesviscero-psychic symptomsCount · n/N 14/82 · 14 viscero-psychic responses within the 82 visceral responses · Visceral responses · stimulation-evoked visceral and affective sensationPDF p.3, Results and Table 1; PDF p.5, Visceral Sensations and Fig. 4C
Thoracic/abdominal constriction or heaviness with anxiety 7/14viscero-psychic symptomsCount · n/N 7/14 · 14 viscero-psychic responses within the 82 visceral responses · Viscero-psychic responses · stimulation-evoked visceral and affective sensationPDF p.3, Results and Table 1; PDF p.5, Visceral Sensations and Fig. 4C

mcgonigal-on-seizure-semiology-2021-5ba29d.pdfNarrative, educational, or cited context · 1 finding · 2 reported values

mcgonigal-on-seizure-semiology-2021-9127f2.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

No systematic-search method or unified study cohort is reported. The review focuses mainly on spontaneous focal seizures in patients undergoing presurgical evaluation for intractable focal epilepsy and discusses SEEG recordings, signal analysis, cortical stimulation, and complementary imaging. Tables 1 and 2 retain the study-specific numbers of subjects and seizures, controls or comparators, brain regions, and analysis approaches; the review does not pool their results.

Findings

hyperkinetic signs; speech modifications; viscerosensory symptoms; pain; asymmetric tonic; focal clonic; tonic symptomsIn the summarized Peltola et al. study of pure insular epilepsies, hyperkinetic signs, speech modifications, and viscerosensory symptoms were related to an anterior insular seizure-onset zone, whereas pain, asymmetric tonic, focal clonic, and tonic symptoms were more frequent in patients with a posterior insular seizure onset.PDF p.7, Table 2 (continued), Peltola et al. 2020 row

Reported values

79 seizureshyperkinetic signs; speech modifications; viscerosensory symptoms; pain; asymmetric tonic; focal clonic; tonic symptomsCount · 11 subjects with pure insular epilepsy; 79 seizures · Peltola et al. study · ictal onset and semiologic expressionPDF p.7, Table 2 (continued), Peltola et al. 2020 row
11 subjectshyperkinetic signs; speech modifications; viscerosensory symptoms; pain; asymmetric tonic; focal clonic; tonic symptomsCount · 11 subjects with pure insular epilepsy; 79 seizures · Peltola et al. pure insular epilepsy study · ictal onset and semiologic expressionPDF p.7, Table 2 (continued), Peltola et al. 2020 row

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdfNarrative, educational, or cited context · 2 findings

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

stimulation-evoked somatosensory, auditory, vestibular, olfactory, gustatory, and viscerosensory symptomsThe chapter reports that electrical stimulation studies evoked somatosensory symptoms, including pain, from the posterior two-thirds of the insula; auditory and vestibular symptoms from the posterior insula; and olfactory, gustatory, and viscerosensory symptoms, including laryngeal constriction, from the midinsula, whereas stimulation of the most anterior portion rarely evoked symptoms unless a larger network seizure was elicited.PDF p.3, insular functional differentiation and electrical cortical stimulation
viscerosensory auraViscerosensory aura is described as the second most common aura in insular seizures; abdominal, epigastric, or chest sensations may be indistinguishable from medial temporal lobe epilepsy, whereas pharyngo-laryngeal constriction, strangulation, or suffocation is presented as more specific, and the aura generally suggests ictal involvement of the middle insula.PDF p.5, Ictal Semiology; PDF p.14, What locations should be sampled based on semiology and EEG findings?

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdfIndependent primary study · 1 finding · 1 reported value

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdf

Independent primary study · Class II · Evidence weight 4.89 · 2 × 1.35 × 1.812

The source reports 42 medically refractory patients with clinically and electrographically supported occipital lobe epilepsy who underwent surgery during 1930-1991. Clinical history, serial scalp EEG, imaging when available, pre- and post-excision electrocorticography, depth recordings in selected patients, and intra-operative cortical stimulation were used. The EEG and electrocorticography denominators vary by available study and are preserved per result. The source’s operational occipital localization and its historical terminology are retained without adding a Brodmann-area mapping or a Lüders/ILAE classification not stated by the source.

Findings

epigastric sensation after elementary hallucinationIn six patients, elementary visual hallucinations were followed by an epigastric sensation.PDF p.6, Results, Visual auras

Reported values

6 patientsepigastric sensation after elementary hallucinationCount · n/N 6/42 · 42-patient cohort · seizure evolution from visual auraPDF p.6, Results, Visual auras

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdfCase report or observation · 1 finding · 1 reported value

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

epigastric aura preceded by foot numbnessOne patient had an epigastric aura preceded by numbness in one foot.PDF p.4, Results, Aurae

Reported values

1 patientepigastric aura preceded by foot numbnessCount · 82-patient parietal epilepsy series · aura sequencePDF p.4, Results, Aurae

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdfSystematic review or meta-analysis · 5 findings · 4 reported values

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

The source is a systematic review of temporal-polar and medio-lateral temporal seizure semiology. It reports 129 patients overall; the abstract prints 78/129 temporal-pole cases and 51/120 mesio-lateral cases. The temporal-polar section describes 11 publications with a maximum of 23 patients, and the medio-lateral section describes two publications. The printed 51/120 denominator is preserved as source context and is flagged as an internal denominator question below. Search-flow counts, reviewer counts, generic eligibility or risk-of-bias details, and standalone Table 1/2 demographic, imaging, surgery, and outcome cells are not findings.

Findings

epigastric sensation; dreamy states; oro-alimentary automatisms; long seizure durationThe source states that focal-aware epigastric sensation, dreamy states, oro-alimentary automatisms, and long seizure duration are shared with medial temporal seizures.PDF p.5, Discussion
epigastric auraTable 3 reports epigastric aura in 22% of the temporo-polar synthesis (evidence grade Low).PDF p.5, Table 3
epigastric auraTable 3 reports a 0–43% range for epigastric aura across the temporo-polar reports (evidence grade Low).PDF p.5, Table 3
viscerosensory auraTable 6 reports viscerosensory aura in 73% of the medio-lateral synthesis (evidence grade Low).PDF p.6, Table 6
viscerosensory auraTable 6 reports a 50–85% range for viscerosensory aura across the medio-lateral reports (evidence grade Low).PDF p.6, Table 6

Reported values

22%epigastric auraPercentage · Temporo-polar semiology synthesis represented in Table 3 · clinical onsetPDF p.5, Table 3
range 0–43%epigastric auraPercentage Range · Temporo-polar semiology synthesis represented in Table 3 · clinical onsetPDF p.5, Table 3
73%viscerosensory auraPercentage · Medio-lateral temporal seizure semiology synthesis represented in Table 6 · earlyPDF p.6, Table 6
range 50–85%viscerosensory auraPercentage Range · Medio-lateral temporal seizure semiology synthesis represented in Table 6 · earlyPDF p.6, Table 6

trebuchon-drane-electrical-stimulation-functional-mapping-seeg-2025.pdfNarrative, educational, or cited context · 1 finding

trebuchon-drane-electrical-stimulation-functional-mapping-seeg-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

epigastric, retrosternal, and oropharyngeal digestive sensationsThe source associates epigastric sensations with temporal pole BA 38, hippocampus, amygdala, and anterior cingulate cortex; retrosternal sensations preferentially with anterior cingulate cortex; and oropharyngeal sensations mainly with suprasylvian opercular cortex and insula. It emphasizes substantial variability and a widely distributed region for induced digestive and associated symptoms.PDF p.14, Digestive sensations

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdfNarrative, educational, or cited context · 1 finding

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

abdominal aurasThe review states that abdominal auras are frequent and usually secondary to temporal lobe epilepsy, but can occasionally be triggered by extratemporal epilepsy, mainly frontal or insular. The sensation usually begins in the epigastrium or midline stomach and may rise to the chest, throat, head, or face; when it rises to the neck or face, loss of consciousness is described as almost invariable. The review also reports that Van Buren's balloon studies found no gastromotor effect except rare gastric inhibition, and that stimulation has elicited similar sensations from the insula and other structures, with spread-related afterdischarges not excluded.PDF p.2, Abdominal auras

wang-electroclinical-insulo-opercular-epilepsy-seeg-pet-2019.pdfIndependent primary study · 1 finding · 9 reported values

wang-electroclinical-insulo-opercular-epilepsy-seeg-pet-2019.pdf

Independent primary study · Class II · Evidence weight 5.01 · 2 × 1.5 × 1.671

Findings

somatosensory and viscerosensory manifestationsThe reported manifestations included unpleasant nonpainful paresthesia in the contralateral upper limb, indescribable sensations in the contralateral hemibody or whole body, head/face/perioral paresthesia, auditory phenomena, epigastric sensation, and pharyngolaryngeal numbness or constriction; painful aura and ipsilateral paresthesia were not observed.PDF p.3, Results—Seizure semiology

Reported values

6/22 (27%)somatosensory and viscerosensory manifestationsPercentage · n/N 6/22 · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · head, face, or perioral · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology
1/22 (5%)somatosensory and viscerosensory manifestationsPercentage · n/N 1/22 · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · whole body · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology
not observedsomatosensory and viscerosensory manifestationsCount · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · ipsilateral paresthesia · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology
2/22 (9%)somatosensory and viscerosensory manifestationsPercentage · n/N 2/22 · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · contralateral hemibody · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology
1/22 (5%)somatosensory and viscerosensory manifestationsPercentage · n/N 1/22 · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · epigastric · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology
4/22 (18%)somatosensory and viscerosensory manifestationsPercentage · n/N 4/22 · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · contralateral upper limb · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology
1/22 (5%)somatosensory and viscerosensory manifestationsPercentage · n/N 1/22 · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · pharyngolaryngeal · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology
not observedsomatosensory and viscerosensory manifestationsCount · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · painful aura · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology
1/22 (5%)somatosensory and viscerosensory manifestationsPercentage · n/N 1/22 · 22 medication-resistant patients with SEEG-defined insulo-opercular epilepsy · auditory · aura and/or early seizure semiologyPDF p.3, Results—Seizure semiology

27 contributing manuscripts; source-reported values remain separate and are not pooled.

Oral automatisms (lip smacking, chewing, swallowing, licking)Source terms: Oral automatismsReported: BilateralAlso reported: ContralateralAlso reported: Left hemisphereAlso reported: Right hemisphere22 manuscripts · 110 findings · 92 reported values

Weighted evidence supportevidence weight 55.35 across 22 manuscripts · 2 manuscript weight pending · 6 independent primary study · 2 case report or observation · 6 narrative, educational, or cited context · 6 systematic review or meta-analysis · 2 structured design not resolved

This phenotype includes contralateral upper-limb tonic or asymmetric posturing after eye and oral/hand manifestations. The case observation records right-sided version during habitual partial seizures. Patient 8 had sudden stiffening of the left arm with oral automatisms. The cited review restates early facial activity and contralateral motor activity as suggestive of neocortical temporal epilepsy. Oroalimentary automatisms did not differ significantly between right and left temporal-lobe seizures. The cited Chassoux series restatement includes bilateral tonic-clonic seizures alongside oro-alimentary, salivation, dystonic, and head-deviation phenomena. This record provides no seizure lateralization. No lateralizing direction is reported for the visual-aura-to-automatism phenotype. No hemisphere or body-side direction is reported. No lateralizing direction is reported. No hemisphere direction is asserted. No seizure lateralization is reported. No lateralization axis information is reported for oro-alimentary automatisms in the restricted-OFC cases. No lateralization axis information is reported for non-HkB oro-alimentary automatisms. No lateralization axis information is reported for the entire OFC-involving group. No lateralization axis information is reported for the restricted-OFC EZN group. No lateralization axis information is reported for the oral-automatisms comparison. The row reports the number of studies with onset-timing data, not lateralization evidence. No lateralization axis information is reported for the oral-automatism onset latency. No lateralization axis information is reported for the oral-automatism odds result. No hemisphere direction is reported. The row reports a heterogeneity p value, not lateralization evidence. The row reports the number of comparison studies, not lateralization evidence. The row reports a lateral-TLE sample size, not lateralization evidence. The row reports a mesial-TLE sample size, not lateralization evidence. No lateralization axis information is reported for the lateral-TLE oral-automatism prevalence range. No lateralization axis information is reported for the mesial-TLE oral-automatism prevalence range. No lateralization axis information is reported for oral-automatism sensitivity. No lateralization axis information is reported for oral-automatism specificity. No source-supported hemispheric lateralization is reported. The semiology category definition contains no lateralization evidence. The row reports an all-data panel sample size, not lateralization evidence. The row reports a non-topological panel sample size, not lateralization evidence. No lateralization axis information is reported for oral and manual automatisms in the cingulate context. No lateralization axis information is reported. No hemisphere or lateralizing direction is reported. No lateralization axis information is reported for motor gestural/oro-alimentary automatisms. The row reports an overall association grade, not lateralization evidence. No lateralization axis information is reported for the Figure 4 oro-alimentary-automatism rate. No lateralization axis information is reported for motor gestural/oral automatisms. No lateralization axis information is reported for the restated oro-alimentary-automatism rate. No lateralization axis information is reported for oro-alimentary automatisms versus affective/autonomic aura. Figure 6 reports OR 13.3 for Affective/autonomic aura relative to Oro-alimentary automatisms, with no hemisphere or lateralization direction. No lateralization axis information is reported for smacking and swallowing. No body-side, seizure-onset side, or seizure-lateralization direction is reported.

Source-defined result groups 18

Localization: TemporalSource-defined values retained separately3 diagnostic-accuracy studies comparing lateral and mesial TLE for Oral automatism · lateral TLE versus mesial TLE · random-effects diagnostic-accuracy estimate1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 62.5%M · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 61.1%ML · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 58.3%M · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyMesial TLE patients assessed for Oral automatisms · lateral TLE percentage shown separately · reported mesial-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 22.2%ML · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 55.6%ML · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Right hemisphereObserved proportion 27.8%RTL · seizure1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 15.4%L · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · reported sign prevalence across included studies1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · absence of the same sign in lateral TLE · random-effects summary odds of sign occurrence1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyLateral TLE patients assessed for Oral automatisms · mesial TLE percentage shown separately · reported lateral-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 7.7%L · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Right hemisphereObserved proportion 19.2%LTL · seizure1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 25.0%M · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyanterior temporal localization relative to all other semiologies · localizing data point1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 22

Alphabetical by manuscript.

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdfSystematic review or meta-analysis · 12 findings · 5 reported values

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

oral and manual automatismsTable 1 defines or exemplifies the the source's own semiology category “oral and manual automatisms” as Upper-limb automatisms, automotor stereotyped distal limb movements, fiddling, pedal automatisms, lip smacking, chewing, oro-alimentary/orofacial automatisms, ictal drinking, or ictal swallowing.PDF p.7, Table 1 Semiology descriptions and frequencies
oral and manual automatismsOral and manual automatisms comprised 9.7% of non-topological data.PDF p.7, Table 1 Semiology descriptions and frequencies
oral and manual automatisms; Figure 3 all-data subsetFigure 3 reports N = 2298 for the all-data oral and manual automatisms panel.PDF p.9, Figure 3 and caption
oral and manual automatisms; Figure 3 non-topological subsetFigure 3 reports N = 342 for the non-topological oral and manual automatisms panel.PDF p.9, Figure 3 and caption
oral and manual automatisms; temporal lobeOral and manual automatisms were temporal in origin in 47%.PDF p.8, Seizure semiology localizing values
oral and manual automatisms; temporal lobeThe 95% CI for oral and manual automatisms; temporal lobe was 40%–53%.PDF p.8, Seizure semiology localizing values
oral and manual automatisms; frontal lobeOral and manual automatisms were frontal in origin in 31%.PDF p.8, Seizure semiology localizing values
oral and manual automatisms; frontal lobeThe 95% CI for oral and manual automatisms; frontal lobe was 25%–36%.PDF p.8, Seizure semiology localizing values
oral and manual automatisms; cingulateoral and manual automatisms semiology was cingulate in 10%.PDF p.8, Seizure semiology localizing values
oral and manual automatisms; cingulateThe 95% CI for oral and manual automatisms; cingulate was 7%–13%.PDF p.8, Seizure semiology localizing values
oral and manual automatisms; anterior temporalOral and manual automatisms had an intrinsic OR of 2.4 for the anterior temporal subregion.PDF p.8, Relative localizing values of semiologies
oral and manual automatisms; anterior temporalThe 95% CI for oral and manual automatisms; anterior temporal was 1.7–3.3.PDF p.8, Relative localizing values of semiologies

Reported values

oral and manual automatisms 9.7%oral and manual automatismsPercentage · non-topological Semio2Brain dataPDF p.7, Table 1 Semiology descriptions and frequencies
oral and manual automatisms; temporal lobe 47%oral and manual automatisms; temporal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
oral and manual automatisms; frontal lobe 31%oral and manual automatisms; frontal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
oral and manual automatisms; cingulate 10%oral and manual automatisms; cingulatePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
OR 2.4oral and manual automatisms; anterior temporalOdds ratio · non-topological Semio2Brain data unless otherwise statedPDF p.8, Relative localizing values of semiologies

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfCase report or observation · 1 finding

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

patient 8 left-arm stiffening and oral automatismsSudden stiffening of the left arm and oral automatisms were listed for patient 8.PDF p.4, Figure 3

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 3 findings · 7 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 5.86 · 2 × 1.5 × 1.952

Findings

oroalimentary automatismsComplex behaviours were common and mainly consisted of oroalimentary automatisms, reported in 75% of analyzed seizures.PDF p.5, Seizure clinical semiology
oroalimentary automatismsOroalimentary automatisms did not differ significantly between TL and T+ groups across chewing and swallowing.PDF p.6, Table 2; PDF p.7, Table 3
chewing automatisms and amygdalaThe source states that the amygdala appears to play a pivotal role in ictal chewing and suggests that it might also contribute to rapid bilateralization of TL discharges when chewing automatisms accompany post-ictal amnesia.PDF p.9, Post-ictal signs

Reported values

oroalimentary automatisms 75%oroalimentary automatismsPercentage · 80 analyzed seizures, one typical seizure per patient · ictalPDF p.5, Seizure clinical semiology
TL 76.3%oroalimentary automatismsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictalPDF p.6, Table 2; PDF p.7, Table 3
TL 27.1%oroalimentary automatismsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictalPDF p.6, Table 2; PDF p.7, Table 3
TL 59.3%oroalimentary automatismsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictalPDF p.6, Table 2; PDF p.7, Table 3
T+ 56.5%oroalimentary automatismsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictalPDF p.6, Table 2; PDF p.7, Table 3
T+ 13%oroalimentary automatismsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictalPDF p.6, Table 2; PDF p.7, Table 3
T+ 65.2%oroalimentary automatismsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictalPDF p.6, Table 2; PDF p.7, Table 3

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfSystematic review or meta-analysis · 4 findings · 4 reported values

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

oro-alimentary automatismsOro-alimentary automatisms were reported in 7% of reviewed cases and were described as the least frequent objective ictal sign in the narrative summary.PDF p.4, Semiology and clinical features; PDF p.6, Table 3
Oro-alimentary automatisms (Table 3)Table 3 reports oro-alimentary automatisms in 6 cases (7%), more during propagation.PDF p.6, Table 3
Oro-alimentary automatisms (Table 4)In the 60 high/very-high-confidence cases, Table 4 reports oro-alimentary automatisms in 23 cases (38%).PDF p.7, Table 4
oro-alimentary automatisms plus aphasiaThe co-occurrence analysis identified oro-alimentary automatisms with aphasia in 22% of the 18-patient detailed-data set.PDF p.7, Figure 2 discussion

Reported values

7% oro-alimentary automatismsoro-alimentary automatismsPercentage · reviewed basal temporal seizure cases · ictal propagation in Table 3PDF p.4, Semiology and clinical features; PDF p.6, Table 3
6 cases (7%)Oro-alimentary automatisms (Table 3)Percentage · Table 3 basal temporal seizure cases · propagationPDF p.6, Table 3
23/60 (38%)Oro-alimentary automatisms (Table 4)Percentage · n/N 23/60 · 60 basal temporal seizure cases with high or very-high EZ confidence · ictalPDF p.7, Table 4
22% co-occurrenceoro-alimentary automatisms plus aphasiaPercentage · 18 patients with detailed semiology data · ictal; timing not otherwise reportedPDF p.7, Figure 2 discussion

blair-temporal-lobe-epilepsy-semiology-2012.pdfNarrative, educational, or cited context · 1 finding

blair-temporal-lobe-epilepsy-semiology-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Hand and mouth automatisms in mesial temporal onsetAutomatisms occur in almost two thirds of CPSs of mesial temporal lobe onset and often involve the hands, including fumbling, picking, or fidgeting, or the mouth, including chewing, lip smacking, or swallowing.PDF p.3, section 2.5 Automatisms

chassoux-ictal-semiology-anterior-cingulate-epilepsy-systematic-review-2025.pdfSystematic review or meta-analysis · 34 findings · 32 reported values

chassoux-ictal-semiology-anterior-cingulate-epilepsy-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

The review includes 23 studies and 93 patients, with ACC involvement defined through anatomical, invasive-electrophysiological, imaging, and clinical correlations. Study selection, demographic, imaging, surgery, pathology, confidence, and risk-of-bias details are retained as compact population/context here; they are not individual findings unless directly tied to an ictal sign, phase, or localization association. The review extracted aura type, vocalization/verbalization, laughter, autonomic and facial signs, automatisms, hypermotor behavior, dystonic/tonic-clonic signs, deviations, loss of consciousness, postictal confusion, timing, duration, sleep, and interictal behavior, then performed one-sided typicality tests and pairwise odds-ratio comparisons.

Findings

motor gestural/oro-alimentary automatismsThe source reports a frequency of 43% for motor gestural/oro-alimentary automatisms.PDF p.13, Table 3
motor gestural/oro-alimentary automatisms; reported frequency rangeThe source reports a frequency range of 0–91% for motor gestural/oro-alimentary automatisms.PDF p.13, Table 3
motor gestural/oro-alimentary automatisms; ACC association gradeTable 3 assigns the source's High overall association grade to motor gestural/oro-alimentary automatisms.PDF p.13, Table 3
oro-alimentary automatisms; Figure 4 rateFigure 4 displays a 8.6% rate for oro-alimentary automatisms.PDF p.10, Figure 4
motor gestural/oral automatismsMotor gestural/oral automatisms were reported in 43% of patients.PDF p.9, Objective symptomatology
oro-alimentary automatismsOro-alimentary automatisms were reported in 9% of patients.PDF p.9, Objective symptomatology
pairwise OR: Oro-alimentary automatisms relative to Vocalization/verbalizationFigure 6 reports an odds ratio of <0.1 for Oro-alimentary automatisms relative to Vocalization/verbalization.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of <0.1 for Oro-alimentary automatisms relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to Affective/autonomic auraFigure 6 reports an odds ratio of <0.1 for Oro-alimentary automatisms relative to Affective/autonomic aura.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to Autonomic signsFigure 6 reports an odds ratio of 0.1 for Oro-alimentary automatisms relative to Autonomic signs.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to Facial expression changeFigure 6 reports an odds ratio of 0.1 for Oro-alimentary automatisms relative to Facial expression change.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 0.1 for Oro-alimentary automatisms relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to Loss of consciousnessFigure 6 reports an odds ratio of 0.2 for Oro-alimentary automatisms relative to Loss of consciousness.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to Post-ictal confusion/behavior change disinhibitionFigure 6 reports an odds ratio of 0.2 for Oro-alimentary automatisms relative to Post-ictal confusion/behavior change disinhibition.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to Chapeau de gendarmeFigure 6 reports an odds ratio of 0.4 for Oro-alimentary automatisms relative to Chapeau de gendarme.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to Dystonic posturingFigure 6 reports an odds ratio of 0.4 for Oro-alimentary automatisms relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to Head-eye deviationFigure 6 reports an odds ratio of 0.6 for Oro-alimentary automatisms relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to LaughterFigure 6 reports an odds ratio of 0.9 for Oro-alimentary automatisms relative to Laughter.PDF p.12, Figure 6
pairwise OR: Vocalization/verbalization relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 16.5 for Vocalization/verbalization relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 15.6 for Hypermotor-complex motor behavior relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Affective/autonomic aura relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 13.3 for Affective/autonomic aura relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Autonomic signs relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 9.8 for Autonomic signs relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Facial expression change relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 9 for Facial expression change relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 7.9 for Motor (gestural) automatisms relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Loss of consciousness relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 5.8 for Loss of consciousness relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Post-ictal confusion/behavior change disinhibition relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 4.6 for Post-ictal confusion/behavior change disinhibition relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Chapeau de gendarme relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 2.7 for Chapeau de gendarme relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 2.5 for Dystonic posturing relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 1.7 for Head-eye deviation relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Laughter relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 1.1 for Laughter relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Tonic-clonic relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 1.1 for Tonic-clonic relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: F to BTC relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 0.6 for F to BTC relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to Tonic-clonicFigure 6 reports an odds ratio of 1.9 for Oro-alimentary automatisms relative to Tonic-clonic.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to F to BTCFigure 6 reports an odds ratio of 1.9 for Oro-alimentary automatisms relative to F to BTC.PDF p.12, Figure 6

Reported values

43% (frequency range 0–91%)motor gestural/oro-alimentary automatismsPercentage · Reviewed ACC seizure cases with reported semiology · ictal onset and propagationPDF p.13, Table 3
8.6%oro-alimentary automatisms; Figure 4 ratePercentage · Reviewed ACC seizure cases with reported semiology · ictal onset and propagationPDF p.10, Figure 4
43%motor gestural/oral automatismsPercentage · Reviewed ACC seizure cases with reported semiology · Reviewed ACC seizure casesPDF p.9, Objective symptomatology
9%oro-alimentary automatismsPercentage · Reviewed ACC seizure cases with reported semiology · Reviewed ACC seizure casesPDF p.9, Objective symptomatology
OR <0.1pairwise OR: Oro-alimentary automatisms relative to Vocalization/verbalizationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR <0.1pairwise OR: Oro-alimentary automatisms relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR <0.1pairwise OR: Oro-alimentary automatisms relative to Affective/autonomic auraOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.1pairwise OR: Oro-alimentary automatisms relative to Autonomic signsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.1pairwise OR: Oro-alimentary automatisms relative to Facial expression changeOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.1pairwise OR: Oro-alimentary automatisms relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.2pairwise OR: Oro-alimentary automatisms relative to Loss of consciousnessOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.2pairwise OR: Oro-alimentary automatisms relative to Post-ictal confusion/behavior change disinhibitionOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.4pairwise OR: Oro-alimentary automatisms relative to Chapeau de gendarmeOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.4pairwise OR: Oro-alimentary automatisms relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.6pairwise OR: Oro-alimentary automatisms relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.9pairwise OR: Oro-alimentary automatisms relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 16.5pairwise OR: Vocalization/verbalization relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 15.6pairwise OR: Hypermotor-complex motor behavior relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 13.3pairwise OR: Affective/autonomic aura relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 9.8pairwise OR: Autonomic signs relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 9pairwise OR: Facial expression change relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 7.9pairwise OR: Motor (gestural) automatisms relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 5.8pairwise OR: Loss of consciousness relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 4.6pairwise OR: Post-ictal confusion/behavior change disinhibition relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 2.7pairwise OR: Chapeau de gendarme relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 2.5pairwise OR: Dystonic posturing relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.7pairwise OR: Head-eye deviation relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.1pairwise OR: Laughter relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.6pairwise OR: Tonic-clonic relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.6pairwise OR: F to BTC relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.7pairwise OR: Oro-alimentary automatisms relative to Tonic-clonicOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.7pairwise OR: Oro-alimentary automatisms relative to F to BTCOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 1 finding · 1 reported value

chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

behavioural arrest; manual and oral automatismsTemporal lobe seizures are described as typically comprising behavioural arrest and manual and oral automatisms in two thirds of cases, with variable loss of awareness and postictal confusion.PDF p.4, Temporal lobe seizures

Reported values

behavioural arrest and manual/oral automatisms in two thirdsbehavioural arrest; manual and oral automatismsProportion · temporal lobe seizure literature · ictal and postictalPDF p.4, Temporal lobe seizures

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdfNarrative, educational, or cited context · 11 findings · 9 reported values

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.54 · 1 × 0.9 × 1.707

Findings

OFC + group (EZN extending beyond OFC); aura; oro-alimentary automatisms; gestural automatismsThe source characterizes EZN extending beyond the OFC as having richer semiological profiles, with temporal extension more often associated with aura, oro-alimentary automatisms, and sleep.PDF p.6, Semiological profile; PDF p.7, Conclusion
oro-alimentary automatismsOro-alimentary automatisms may indicate an EZN extending beyond the OFC into the temporal lobe, but the source also reports them with an EZN restricted to the OFC.PDF p.3, Complex motor phenomena—automatisms
oro-alimentary automatismsOro-alimentary automatisms were reported in six of 26 restricted-OFC cases.PDF p.2, Semiology patterns of seizures with EZN restricted to the OFC
oro-alimentary automatisms; HkB subgroupOne of the 14 HkB cases had oro-alimentary automatisms.PDF p.2, Semiology patterns of seizures with EZN restricted to the OFC
oro-alimentary automatisms; non-HkB subgroupSix of the non-HkB cases had oro-alimentary automatisms.PDF p.2, Semiology patterns of seizures with EZN restricted to the OFC
oro-alimentary automatisms; entire groupThe source reports 18% for oro-alimentary automatisms in the entire ofc-involving group.PDF p.3, Complex motor phenomena—automatisms
oro-alimentary automatisms; OFC-restricted EZNThe source reports 27% for oro-alimentary automatisms in the ofc-restricted ezn group.PDF p.3, Complex motor phenomena—automatisms
oro-alimentary automatisms; OFC-extended EZNThe source reports 12% for oro-alimentary automatisms in the ofc-extended ezn group.PDF p.3, Complex motor phenomena—automatisms
oro-alimentary automatisms; temporal subgroupThe source reports 33% for oro-alimentary automatisms in the temporal subgroup of ofc-extended ezn.PDF p.3, Complex motor phenomena—automatisms
oro-alimentary automatisms; insular subgroupThe source reports 0% for oro-alimentary automatisms in the insular subgroup of ofc-extended ezn.PDF p.3, Complex motor phenomena—automatisms
oro-alimentary automatisms; frontal subgroupThe source reports 0% for oro-alimentary automatisms in the frontal subgroup of ofc-extended ezn.PDF p.3, Complex motor phenomena—automatisms

Reported values

6/26 (23%)oro-alimentary automatismsPercentage · n/N 6/26 · OFC-restricted EZN group · OFC-restricted EZN group · ictalPDF p.2, Semiology patterns of seizures with EZN restricted to the OFC
1/14 patientsoro-alimentary automatisms; HkB subgroupCount · n/N 1/14 · HkB subgroup within OFC-restricted EZN · HkB subgroup within OFC-restricted EZN · ictalPDF p.2, Semiology patterns of seizures with EZN restricted to the OFC
6/12 (50%)oro-alimentary automatisms; non-HkB subgroupPercentage · n/N 6/12 · Non-HkB subgroup within OFC-restricted EZN · Non-HkB subgroup within OFC-restricted EZN · ictalPDF p.2, Semiology patterns of seizures with EZN restricted to the OFC
18%oro-alimentary automatisms; entire groupPercentage · Entire OFC-involving group · Entire OFC-involving group · ictalPDF p.3, Complex motor phenomena—automatisms
27%oro-alimentary automatisms; OFC-restricted EZNPercentage · OFC-restricted EZN group · OFC-restricted EZN group · ictalPDF p.3, Complex motor phenomena—automatisms
12%oro-alimentary automatisms; OFC-extended EZNPercentage · OFC-extended EZN group · OFC-extended EZN group · ictalPDF p.3, Complex motor phenomena—automatisms
33%oro-alimentary automatisms; temporal subgroupPercentage · Temporal subgroup of OFC-extended EZN · Temporal subgroup of OFC-extended EZN · ictalPDF p.3, Complex motor phenomena—automatisms
0%oro-alimentary automatisms; insular subgroupPercentage · Insular subgroup of OFC-extended EZN · Insular subgroup of OFC-extended EZN · ictalPDF p.3, Complex motor phenomena—automatisms
0%oro-alimentary automatisms; frontal subgroupPercentage · Frontal subgroup of OFC-extended EZN · Frontal subgroup of OFC-extended EZN · ictalPDF p.3, Complex motor phenomena—automatisms

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdfSystematic review or meta-analysis · 20 findings · 7 reported values

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

oral automatisms; manual automatisms; behavioral arrestThe source identifies oral automatisms, manual automatisms, and behavioral arrests as the most common semiologies in lateral temporal epilepsy, while noting that they likely emerge during propagation rather than at seizure onset.PDF p.1, Abstract; PDF p.4, Anatomo-clinical correlations; PDF p.8, Discussion
Oral automatismsTable 3 reports 3 studies assessing Oral automatisms.PDF p.6, Table 3
Oral automatismsTable 3 reports 51 patients assessed for Oral automatisms.PDF p.6, Table 3
Oral automatismsTable 3 reports 29.4–73.3% as the percentage range or value for Oral automatisms; the overall association grade is Low.PDF p.6, Table 3
Oral automatismsTable 3 reports 1 study with onset timing for Oral automatisms.PDF p.6, Table 3
Oral automatismsTable 3 reports an onset latency of 11 s for Oral automatisms.PDF p.6, Table 3
odds of occurrence; Oral automatismsTable 4 reports overall odds of 0.98 for occurrence of Oral automatisms in lateral TLE.PDF p.7, Table 4; PDF p.8, Figure 2
odds confidence interval; Oral automatismsTable 4 reports a 95% confidence interval of 0.36–2.68 for the overall odds of Oral automatisms.PDF p.7, Table 4; PDF p.8, Figure 2
heterogeneity test; Oral automatismsThe heterogeneity test for the Table 4 odds estimate for Oral automatisms has p=0.0571.PDF p.7, Table 4
Oral automatisms; lateral versus mesial comparisonTable 5 reports 3 studies comparing Oral automatisms in lateral and mesial TLE.PDF p.9, Table 5
Oral automatisms; lateral TLE patient denominatorTable 5 reports 51 lateral-TLE patients assessed for Oral automatisms.PDF p.9, Table 5
Oral automatisms; mesial TLE patient denominatorTable 5 reports 67 mesial-TLE patients assessed for Oral automatisms.PDF p.9, Table 5
Oral automatisms; lateral TLE prevalenceTable 5 reports a lateral-TLE percentage of 29.4–73.3% for Oral automatisms.PDF p.9, Table 5
Oral automatisms; mesial TLE prevalenceTable 5 reports a mesial-TLE percentage of 31.3–80.6% for Oral automatisms.PDF p.9, Table 5
Oral automatism; diagnostic sensitivityTable 6 reports overall sensitivity 0.50 for Oral automatism in 3 studies comparing lateral with mesial TLE.PDF p.9, Table 6
Oral automatism; diagnostic sensitivity confidence intervalTable 6 reports a 95% confidence interval of 0.27–0.73 for sensitivity of Oral automatism.PDF p.9, Table 6
Oral automatism; sensitivity heterogeneityThe heterogeneity test for sensitivity of Oral automatism has p=0.0571.PDF p.9, Table 6
Oral automatism; diagnostic specificityTable 6 reports overall specificity 0.21 for Oral automatism in 3 studies comparing lateral with mesial TLE.PDF p.9, Table 6
Oral automatism; diagnostic specificity confidence intervalTable 6 reports a 95% confidence interval of 0.13–0.32 for specificity of Oral automatism.PDF p.9, Table 6
Oral automatism; specificity heterogeneityThe heterogeneity test for specificity of Oral automatism has p=0.8975.PDF p.9, Table 6

Reported values

29.4–73.3%Oral automatismsPercentage Range · Lateral temporal epilepsy patients assessed for Oral automatisms · ictalPDF p.6, Table 3
median onset latency 11 sOral automatismsMedian · Lateral temporal epilepsy study reporting onset timing for Oral automatisms · ictal onsetPDF p.6, Table 3
odds 0.98odds of occurrence; Oral automatismsOdds · Lateral temporal epilepsy patients assessed for Oral automatisms · ictalPDF p.7, Table 4; PDF p.8, Figure 2
29.4–73.3%Oral automatisms; lateral TLE prevalencePercentage Range · Lateral TLE patients assessed for Oral automatisms · Lateral TLE patients assessed for Oral automatisms · ictalPDF p.9, Table 5
31.3–80.6%Oral automatisms; mesial TLE prevalencePercentage Range · Mesial TLE patients assessed for Oral automatisms · Mesial TLE patients assessed for Oral automatisms · ictalPDF p.9, Table 5
sensitivity 0.50Oral automatism; diagnostic sensitivitySensitivity · 3 diagnostic-accuracy studies comparing lateral and mesial TLE for Oral automatism · 3 diagnostic-accuracy studies comparing lateral and mesial TLE for Oral automatism · ictal sign presencePDF p.9, Table 6
specificity 0.21Oral automatism; diagnostic specificitySpecificity · 3 diagnostic-accuracy studies comparing lateral and mesial TLE for Oral automatism · 3 diagnostic-accuracy studies comparing lateral and mesial TLE for Oral automatism · ictal sign presencePDF p.9, Table 6

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdfStructured design not resolved · 1 finding · 2 reported values

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.932

Findings

Oroalimentary automatismsOroalimentary automatisms did not differ significantly between RTL and LTL seizures.PDF p.4, Table 5; PDF p.4, numbered clinical-feature results

Reported values

14/73 (25%)Oroalimentary automatismsPercentage · n/N 14/73 · RTL seizure group, n=54, versus LTL seizure group, n=73 · LTL · IctalPDF p.4, Table 5; PDF p.4, numbered clinical-feature results
15/54 (29%)Oroalimentary automatismsPercentage · n/N 15/54 · RTL seizure group, n=54, versus LTL seizure group, n=73 · RTL · IctalPDF p.4, Table 5; PDF p.4, numbered clinical-feature results

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 1 finding · 4 reported values

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

early dystonia, oral automatisms, and early facial or contralateral motor activity in NTLE versus MTLEDystonic limb posturing within 20 seconds of seizure onset was reported more often in MTLE than NTLE, 52% versus 26%, and oral automatisms were reported 69% versus 11%, respectively. Early facial grimacing or twitching and contralateral motor activity were suggestive of NTLE.PDF p.6, section 8.1 Neocortical temporal lobe epilepsy

Reported values

Oral automatisms in MTLE 69%early dystonia, oral automatisms, and early facial or contralateral motor activity in NTLE versus MTLEPercentage · patients with NTLE and MTLE · MTLE · within 20 seconds of seizure onset; early ictalPDF p.6, section 8.1 Neocortical temporal lobe epilepsy
Early dystonic posturing in NTLE 26%early dystonia, oral automatisms, and early facial or contralateral motor activity in NTLE versus MTLEPercentage · patients with NTLE and MTLE · NTLE · within 20 seconds of seizure onset; early ictalPDF p.6, section 8.1 Neocortical temporal lobe epilepsy
Early dystonic posturing in MTLE 52%early dystonia, oral automatisms, and early facial or contralateral motor activity in NTLE versus MTLEPercentage · patients with NTLE and MTLE · MTLE · within 20 seconds of seizure onset; early ictalPDF p.6, section 8.1 Neocortical temporal lobe epilepsy
Oral automatisms in NTLE 11%early dystonia, oral automatisms, and early facial or contralateral motor activity in NTLE versus MTLEPercentage · patients with NTLE and MTLE · NTLE · within 20 seconds of seizure onset; early ictalPDF p.6, section 8.1 Neocortical temporal lobe epilepsy

jobst-insula-and-its-epilepsies-2019.pdfNarrative, educational, or cited context · 1 finding

jobst-insula-and-its-epilepsies-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

oroalimentary automatismsTemporal-like insular seizures may include oroalimentary automatisms.PDF p.2, Clinical Features

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdfIndependent primary study · 4 findings · 12 reported values

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdf

Independent primary study · Class II · Evidence weight 5.07 · 2 × 1.5 × 1.69

Findings

oroalimentary automatismsOroalimentary automatisms over the whole seizure course were more frequent in M and ML than L patients.PDF p.6, Table 3; PDF p.6, General ictal characteristics; PDF p.8, Oroalimentary automatisms
early oroalimentary automatismsEarly oroalimentary automatisms, occurring during the first half of the seizure, were more frequent in ML than M or L patients.PDF p.6, Table 4; PDF p.6, Early features; PDF p.8, Oroalimentary automatisms
late oroalimentary automatismsLate oroalimentary automatisms, occurring during the second half of the seizure, were more frequent in M than ML or L patients.PDF p.7, Table 5; PDF p.7, Later features; PDF p.8, Oroalimentary automatisms
oroalimentary automatisms and medial-neocortical network involvementThe authors infer that the emergence of oroalimentary automatisms requires widespread dysfunction involving medial and temporal neocortical structures, with early occurrence characteristic of ML and late occurrence more characteristic of M after propagation.PDF p.8, Oroalimentary automatisms

Reported values

M=15/24 (62.5%)oroalimentary automatismsPercentage · n/N 15/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · ictal course, early or late combinedPDF p.6, Table 3; PDF p.6, General ictal characteristics; PDF p.8, Oroalimentary automatisms
ML=11/18 (61.1%)oroalimentary automatismsPercentage · n/N 11/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · ictal course, early or late combinedPDF p.6, Table 3; PDF p.6, General ictal characteristics; PDF p.8, Oroalimentary automatisms
p=0.014oroalimentary automatismsP value · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ictal course, early or late combinedPDF p.6, Table 3; PDF p.6, General ictal characteristics; PDF p.8, Oroalimentary automatisms
L=2/13 (15.4%)oroalimentary automatismsPercentage · n/N 2/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · ictal course, early or late combinedPDF p.6, Table 3; PDF p.6, General ictal characteristics; PDF p.8, Oroalimentary automatisms
L=1/13 (7.7%)early oroalimentary automatismsPercentage · n/N 1/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · early ictal, first half of seizurePDF p.6, Table 4; PDF p.6, Early features; PDF p.8, Oroalimentary automatisms
M=6/24 (25%)early oroalimentary automatismsPercentage · n/N 6/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · early ictal, first half of seizurePDF p.6, Table 4; PDF p.6, Early features; PDF p.8, Oroalimentary automatisms
p=0.015early oroalimentary automatismsP value · 55 patients with unilateral TLE; M=24, ML=18, L=13 · early ictal, first half of seizurePDF p.6, Table 4; PDF p.6, Early features; PDF p.8, Oroalimentary automatisms
ML=10/18 (55.6%)early oroalimentary automatismsPercentage · n/N 10/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · early ictal, first half of seizurePDF p.6, Table 4; PDF p.6, Early features; PDF p.8, Oroalimentary automatisms
p=0.012late oroalimentary automatismsP value · 55 patients with unilateral TLE; M=24, ML=18, L=13 · late ictal, second half of seizurePDF p.7, Table 5; PDF p.7, Later features; PDF p.8, Oroalimentary automatisms
ML=4/18 (22.2%)late oroalimentary automatismsPercentage · n/N 4/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · late ictal, second half of seizurePDF p.7, Table 5; PDF p.7, Later features; PDF p.8, Oroalimentary automatisms
L=2/13 (15.4%)late oroalimentary automatismsPercentage · n/N 2/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · late ictal, second half of seizurePDF p.7, Table 5; PDF p.7, Later features; PDF p.8, Oroalimentary automatisms
M=14/24 (58.3%)late oroalimentary automatismsPercentage · n/N 14/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · late ictal, second half of seizurePDF p.7, Table 5; PDF p.7, Later features; PDF p.8, Oroalimentary automatisms

mcgonigal-on-seizure-semiology-2021-5ba29d.pdfNarrative, educational, or cited context · 2 findings · 4 reported values

mcgonigal-on-seizure-semiology-2021-5ba29d.pdf; mcgonigal-on-seizure-semiology-2021-9127f2.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

The article reports a narrative critical overview rather than a systematic search, primary cohort, or pooled quantitative analysis; search and study-selection methods are not reported. Its emphasis is on spontaneous seizures in patients with intractable focal epilepsy undergoing presurgical evaluation, with additional discussion of SEEG stimulation studies, functional imaging, and broader epilepsy classification. The cited-study summaries in Tables 1 and 2 report study-level numbers of subjects and, where available, seizures; exact subgroup denominators and statistical uncertainty are often not provided in this document.

Findings

oro-alimentary automatisms (OAA)The review reports that Aupy et al. (2018) found increased coherence between mediobasal temporal structures and insulo-opercular cortex before the onset of rhythmic chewing movements in temporal-lobe seizures.PDF p.5, Table 1, Oro-alimentary automatisms row
oro-alimentary automatisms (OAA)In the summarized Aupy et al. study, increased coherence between mediobasal temporal structures and insulo-opercular cortex occurred before rhythmic chewing movements; the table states that 2 of 15 patients had seizures compared with and without OAA.PDF p.5, Table 1 (continued), Aupy et al. 2018 row; PDF p.11, mechanism 1

Reported values

2 of 15oro-alimentary automatisms (OAA)Percentage · n/N 2/15 · 15 subjects with temporal-lobe epilepsy; 2 of 15 had seizures compared with and without oro-alimentary automatisms · within-patient comparison subset · Before onset of rhythmic chewing movementsPDF p.5, Table 1, Oro-alimentary automatisms row
15 subjectsoro-alimentary automatisms (OAA)Count · 15 subjects with temporal-lobe epilepsy; 2 of 15 had seizures compared with and without oro-alimentary automatisms · temporal-lobe epilepsy study · Before onset of rhythmic chewing movementsPDF p.5, Table 1, Oro-alimentary automatisms row
15 subjectsoro-alimentary automatisms (OAA)Count · 15 subjects with temporal-lobe epilepsy; 2/15 patients had seizures compared with and without OAA · Aupy et al. temporal-lobe epilepsy study · pre-onset of rhythmic chewing movements and ictal OAAPDF p.5, Table 1 (continued), Aupy et al. 2018 row; PDF p.11, mechanism 1
2 of 15oro-alimentary automatisms (OAA)Percentage · n/N 2/15 · 15 subjects with temporal-lobe epilepsy; 2/15 patients had seizures compared with and without OAA · within-patient comparison subset · pre-onset of rhythmic chewing movements and ictal OAAPDF p.5, Table 1 (continued), Aupy et al. 2018 row; PDF p.11, mechanism 1

montavont-ictal-dysprosody-nondominant-frontal-operculum-2005.pdfCase report or observation · 1 finding

montavont-ictal-dysprosody-nondominant-frontal-operculum-2005.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

The report concerns one 35-year-old right-handed man with drug-resistant partial epilepsy. Long-term video-EEG captured 6 electroclinical seizures; SEEG recorded 5 stereotyped spontaneous electroclinical seizures using 11 right-hemisphere electrodes and 1 left-amygdala electrode. The report also describes high-frequency stimulation of the right amygdala and right precentral operculum. No control group or independent reference standard is reported.

Findings

recurrent ictal speech utterances; oro-alimentary automatisms; right-sided versionIn the patient’s habitual partial seizures, an aura of nausea was followed by staring gaze, partial loss of consciousness, oro-alimentary automatisms, right-sided version, and postictal confusion; family reported recurrent stereotyped French or English sentence repetitions from age 18.PDF p.2, left column, paragraph beginning “Partial seizures began”; PDF p.2, right column, paragraph beginning “Five stereotyped and spontaneous electroclinical seizures”

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdfIndependent primary study · 2 findings · 1 reported value

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdf

Independent primary study · Class II · Evidence weight 4.89 · 2 × 1.35 × 1.812

Findings

smacking and swallowing in Fig. 2The Figure 2 tracing labels smacking and swallowing during later seizure evolution.PDF p.14, Fig. 2
oral alimentary automatismsOral alimentary automatisms occurred in 21 of 42 patients.PDF p.6, Results, Non-visual manifestations

Reported values

21/42 (50%) patientsoral alimentary automatismsPercentage · n/N 21/42 · 42 medically refractory patients with source-defined occipital lobe epilepsy · ictal propagation or later ictal manifestationPDF p.6, Results, Non-visual manifestations

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdfIndependent primary study · 1 finding · 1 reported value

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdf

Independent primary study · Class II · Evidence weight 5.28 · 2 × 1.35 × 1.957

Findings

oral and gestural automatismsOral and gestural automatisms occurred in 17% of patients.PDF p.4, Results, Other seizure characteristics; PDF p.5, Table 2

Reported values

17%oral and gestural automatismsPercentage · 82-patient parietal epilepsy series · ictal propagation or later ictal phasePDF p.4, Results, Other seizure characteristics; PDF p.5, Table 2

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdfSystematic review or meta-analysis · 2 findings

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

Chassoux cohort; oro-alimentary automatisms; salivation; dystonic signs; head deviation; bilateral tonic-clonic seizuresThe review restates that Chassoux et al. described 33 patients with oro-alimentary automatisms, salivation, motor signs including dystonia and head deviation, and bilateral tonic-clonic seizures in the medio-lateral context.PDF p.4, Medio-lateral temporal origin
epigastric sensation; dreamy states; oro-alimentary automatisms; long seizure durationThe source states that focal-aware epigastric sensation, dreamy states, oro-alimentary automatisms, and long seizure duration are shared with medial temporal seizures.PDF p.5, Discussion

simone-anatomo-functional-organization-insular-networks-2025.pdfStructured design not resolved · 1 finding

simone-anatomo-functional-organization-insular-networks-2025.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1

The paper summarizes prior macaque ICMS mapping performed with 200-microsecond biphasic pulses at 50 Hz, 4 mA, for 3 seconds; a behavior entered the dataset when two observers recognized it and it was evoked in more than 50% of trials. The present analyses used ICMS maps and insular tracer injections in two male rhesus macaques (Mk1 and Mk2), indirect tracer data from 22 additional animals, and resting-state fMRI from 12 male macaques aged 4-8 years. The authors warped the ICMS maps and injection sites onto the INIA19 macaque template and delineated six insular fields. No seizure cohort, ictal or postictal observations, or clinical localization reference standard was studied.

Findings

emotional field; lip-smacking; discomfort reactionsThe macaque ventral middle insula was defined as an ICMS emotion-related field in which stimulation elicited lip-smacking, described as an affiliative gesture during emotionally salient social situations; intermingled stimulation sites also produced difficult-to-interpret discomfort reactions ranging from postural adjustments to psychomotor agitation. The discussion reports lip-smacking during direct eye contact with a specific experimenter and notes that the behavior can also occur during anxiety or fear.PDF p.5, Fig. 1C, E and caption; PDF p.10, Fig. 5B, C and caption; PDF p.12, §4.4.1; PDF p.19, §5.3

wang-electroclinical-insulo-opercular-epilepsy-seeg-pet-2019.pdfIndependent primary study · 1 finding · 2 reported values

wang-electroclinical-insulo-opercular-epilepsy-seeg-pet-2019.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

oro-alimentary automatismsOnly one patient in the series presented oro-alimentary automatisms.PDF p.4, Results—Seizure semiology; PDF p.5, Table 1; PDF p.8, Discussion

Reported values

1 patientoro-alimentary automatismsCount · 22 patients with insulo-opercular epilepsy · ictal automatic behaviorPDF p.4, Results—Seizure semiology; PDF p.5, Table 1; PDF p.8, Discussion
no percentage reportedoro-alimentary automatismsCount · 22 patients with insulo-opercular epilepsy · ictal automatic behaviorPDF p.4, Results—Seizure semiology; PDF p.5, Table 1; PDF p.8, Discussion

wang-hypermotor-seizures-temporal-pole-lesions-2008.pdfNarrative, educational, or cited context · 1 finding

wang-hypermotor-seizures-temporal-pole-lesions-2008.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

The authors retrospectively reviewed consecutive epilepsy-surgery patients with MRI and pathology evidence of temporal pole lesions. Eight patients with intractable complex partial seizures were identified; long-term scalp-sphenoidal video-EEG was obtained, and two patients also underwent subdural-grid monitoring. MRI was performed in all patients; FDG PET was available for seven and ictal SPECT for three. The study classified recorded seizures as hypermotor or typical psychomotor under the source-described semiologic scheme.

Findings

psychomotor semiology: oroalimentary automatismsTypical temporal psychomotor semiology included oroalimentary automatisms.PDF p.4, Seizure semiology on video-EEG recording

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdfIndependent primary study · 5 findings · 1 reported value

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdf

Independent primary study · Class II · Evidence weight 4.92 · 2 × 1.5 × 1.639

This single-center retrospective case series included 19 patients with SEEG-confirmed occipital lobe seizure onset. The authors reviewed video-EEG/clinical descriptions and SEEG-anchored temporal evolution, used MRI/CT-fused electrode localization, and assigned a predominant propagation pattern through electroclinical concordance. The source’s occipital parcellation and phenotype labels are preserved without imposing a Lüders or ILAE crosswalk.

Findings

oculomotor-onset evolving motor phenotypePhenotype IV begins with eye blinking or eye pursuit without a clear visual aura, followed by oral/hand automatisms and contralateral upper-limb tonic or asymmetric posturing, sometimes progressing to GTCS.PDF p.9, Phenotype IV
orolingual and hand automatismsOrolingual/hand automatisms occurred in 10 of 19 patients (52.6%).PDF p.5, Ictal Semiology and Seizure Capture During SEEG Monitoring; PDF p.9, Figure 1
visual aura to automatism phenotypePhenotype II is characterized primarily by oropharyngeal, limb, or verbal automatisms, with or without a preceding visual aura.PDF p.9, Phenotype II
oropharyngeal automatismsTable 2 records staring followed by oropharyngeal automatisms and eye blinking in a seizure sequence.PDF p.6, Table 2 Case 1 Sz2
chewing and swallowing automatismsTable 2 records orolimentary automatisms consisting of chewing and swallowing in Case 11.PDF p.7, Table 2 Case 11

Reported values

10/19 (52.6%) orolingual/hand automatismsorolingual and hand automatismsPercentage · n/N 10/19 · 19 patients monitored with SEEG · ictal automatismsPDF p.5, Ictal Semiology and Seizure Capture During SEEG Monitoring; PDF p.9, Figure 1

22 contributing manuscripts; source-reported values remain separate and are not pooled.

Hypermotor seizures (explosive, bipedal/bimanual, thrashing, agitated)Source terms: Hypermotor seizure; Hypermotor seizuresReported: BilateralAlso reported: ContralateralAlso reported: IpsilateralAlso reported: Left hemisphereAlso reported: Right hemisphereNo single reliable side30 manuscripts · 144 findings · 101 reported values

Weighted evidence supportevidence weight 53.56 across 30 manuscripts · 3 manuscript weight pending · 5 independent primary study · 6 systematic review or meta-analysis · 3 structured design not resolved · 5 case report or observation · 11 narrative, educational, or cited context

No lateralizing direction is reported. No lateralization is reported for the behavioral-arrest phenotype. Source-reported giratory forms were predominantly ipsilateral: T+ 8.7% ipsilateral versus 4.3% contralateral, TL 3.4% ipsilateral versus 0% contralateral, and bilateral 0% in both cohorts. The source text does not provide a hemisphere direction, but the prefilled lateralization value says right. The source provides no lateralizing information for complex motor behavior with a hyperkinetic aspect. No lateralizing information is present. The case reports right orbitofrontal onset with later bilateral tonic propagation. The frontal-like hyperkinetic description provides no lateralizing information. The single reported case had left insular epilepsy with sleep-related hyperkinetic automatisms. The OFC-restricted EZN review statement reports no hemisphere or lateralization direction. The EZN-extension association provides no lateralizing information. The insular-subgroup frequency provides no lateralizing information. The hypermotor/hyperkinetic terminology statement provides no lateralizing information. No sign-specific lateralizing rule is present. The patient’s seizures had left anterior inferolateral temporal onset before frontal involvement and hypermotor behavior. The review classification of ictal feature categories reports no lateralizing direction. No hemisphere or body-side direction is reported for the clustered manifestations. The cited mechanistic network includes bilateral caudate nuclei and provides no hemisphere-specific onset direction. No lateralization information is reported. The whole-group hyperkinetic frequency provides no lateralizing information. The autonomic-hyperkinetic association coefficient provides no lateralizing information. The emotional-hyperkinetic association coefficient provides no lateralizing information. Emotional signs preceding hyperkinetic behavior provide no lateralizing information. Autonomic signs preceding hyperkinetic behavior provide no lateralizing information. No cerebral-hemisphere lateralizing direction is reported. The cited study reported bilateral hypermotor automatisms; bilateral describes motor behavior and does not identify a hemisphere. The sleep-related hypermotor phenotype record provides no lateralizing information. No resolved lateralization direction is reported. The cited anterior-versus-posterior insular comparison provides no lateralizing information. The ventral-versus-dorsal insular focus record provides no lateralizing information. Delayed hypermotor manifestation provides no lateralizing information. Right facial pain, right-ear ringing, right hemibody and foot manifestations predominated in the early sequence, while left-sided stiffening occurred in half of seizures. The table explicitly describes the hypermotor seizure pattern as non-lateralising. The hypermotor-seizure review record provides no lateralizing information. The case had right orbitofrontal onset and later bilateral tonic seizures after spread to supplementary motor area contacts. No seizure lateralization is reported. The cited emotional-expression statement reports no hemisphere or lateralization direction. left anterior/middle cingulate, central operculum, and insula on FDG-PET; hemisphere source-explicit Left-side context is not treated as a separate source-stated lateralization assertion. The review synthesis reports opposite lateralizing directions for rare body-axis rotation depending on preceding version: contralateral to the epileptogenic zone with version and ipsilateral without version. No hemisphere direction is reported. No hemisphere or body-side direction is reported. No lateralization evidence is reported. This finding provides no lateralization information. No directional head-eye side or hemisphere is reported. In one patient, a right-foot sensory aura preceded bilateral asymmetric tonic posturing and generalized tonic-clonic seizures. The hypermotor-seizure definition provides no lateralizing direction.

Source-defined result groups 35

Localization: Frontal / TemporalSource-defined values retained separatelyAll reported · whole group and other network subgroup · patients in the named network subgroup1 manuscript · 1 reported value · not pooled

Localization: ACC / cingulateSource-defined values retained separatelypatient-level frequency synthesized across eligible studies1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 50.0%All reported · typical psychomotor seizure characteristics · patients1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyTL group · TL group versus T+ group · seizures1 manuscript · 1 reported value · not pooled

Localization: InsularObserved proportion 18.2%All reported · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · scalp ictal rhythm1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 0.0%All reported · 6/61 (10%) combined · individuals1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 75.0%All reported · other hypermotor semiology features · patients1 manuscript · 1 reported value · not pooled

Localization: typical anterior cingulate lesionObserved proportion 100.0%All reported · atypical anterior group · patients1 manuscript · 1 reported value · not pooled

Localization: T+ group / TL groupSource-defined values retained separatelyT+ group · TL group versus T+ group · seizures1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 75.0%All reported · one patient with equal anterior-lateral and inferomesial involvement · patients1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 23.8%All reported · prefrontal operculum versus precentral Rolandic operculum · all included patients1 manuscript · 1 reported value · not pooled

Localization: OFC-extended EZNSource-defined values retained separatelyOFC-extended EZN group · patients with HkB1 manuscript · 1 reported value · not pooled

Localization: FrontalSource-defined values retained separatelyFrontal subgroup of OFC-extended EZN · subgroup patients with HkB1 manuscript · 1 reported value · not pooled

Localization: reviewed anterior cingulate cortex seizure casesSource-defined values retained separatelyHypermotor-complex motor behavior · pairwise symptom-occurrence comparison1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyT+ group · TL group versus T+ group · seizures1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTemporal subgroup of OFC-extended EZN · subgroup patients with HkB1 manuscript · 1 reported value · not pooled

Localization: entire OFC-involving groupSource-defined values retained separatelyEntire OFC-involving group · patients with HkB1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · Table 3 point estimate 6% · Table 3 between-report frequency range1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · other Table 3 temporo-polar sign estimates · Table 3 sign-frequency estimate1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyTL group · TL group versus T+ group · seizures1 manuscript · 1 reported value · not pooled

Localization: T+ group / TL groupSource-defined values retained separatelyTL group · TL group versus T+ group · seizures1 manuscript · 1 reported value · not pooled

Localization: Frontal / TemporalObserved proportion 100.0%All reported · seizures without hypermotor behavior · seizures1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Right hemisphereSource-defined values retained separatelyleft-sided stiffening · Early diurnal versus later nocturnal/postoperative semiology · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyTL group · TL group versus T+ group · seizures1 manuscript · 1 reported value · not pooled

Localization: Frontal / TemporalObserved proportion 100.0%All reported · seizures without hypermotor behavior · seizures1 manuscript · 1 reported value · not pooled

Localization: SMA / pre-SMASource-defined values retained separatelyAll reported · patients with the ictal symptom1 manuscript · 1 reported value · not pooled

Localization: PCE / posterior cingulate onsetObserved proportion 14.3%All reported · bilateral asymmetric tonic, dialeptic, and automotor seizures · patients1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyT+ group · TL group versus T+ group · seizures1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 9.8%All reported · 0/61 (0%) initial · individuals1 manuscript · 1 reported value · not pooled

Localization: OFC-restricted EZNObserved proportion 53.8%OFC-restricted EZN cases · patients with HkB1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 30

Alphabetical by manuscript.

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfStructured design not resolved · 8 findings · 1 reported value

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.389

Findings

typical anterior hypermotor seizuresAll six typical anterior patients had hypermotor seizures.PDF p.4, Clinical Presentation
typical anterior hypermotor feature: twisting aroundThe source lists twisting around as an example of the complex motor/hypermotor manifestations in the typical anterior group.PDF p.4, Clinical Presentation
typical anterior hypermotor feature: banging headThe source lists banging head as an example of the complex motor/hypermotor manifestations in the typical anterior group.PDF p.4, Clinical Presentation
typical anterior hypermotor feature: flailingThe source lists flailing as an example of the complex motor/hypermotor manifestations in the typical anterior group.PDF p.4, Clinical Presentation
typical anterior hypermotor feature: violent sweeping movementsThe source lists violent sweeping movements as an example of the complex motor/hypermotor manifestations in the typical anterior group.PDF p.4, Clinical Presentation
typical anterior hypermotor feature: runningThe source lists running as an example of the complex motor/hypermotor manifestations in the typical anterior group.PDF p.4, Clinical Presentation
atypical anterior hypermotor frequencyHypermotor seizures were infrequent or absent in the atypical anterior group.PDF p.5, Atypical Anterior Cingulate Epilepsy
anterior cingulate mostly nocturnal hypermotor patternAmong the 10 anterior cingulate cases, most presented with frequent, mostly nocturnal and predominantly hypermotor/hyperkinetic seizures with rare generalization, with or without fear, loud vocalization, or nonmirthful laughter.PDF p.6, Discussion

Reported values

6/6 hypermotor seizurestypical anterior hypermotor seizuresProportion · n/N 6/6 · 6 typical anterior cingulate cases · ictal semiologyPDF p.4, Clinical Presentation

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 2 findings · 12 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

giratory motor signGiratory motor signs did not differ significantly between TL and T+ groups across ipsilateral, contralateral, and bilateral forms.PDF p.6, Table 2
hypermotor behavioursHypermotor behaviours did not differ significantly between TL and T+ groups.PDF p.6, Table 2

Reported values

TL giratory 3.4%giratory motor signPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictalPDF p.6, Table 2
T+ ipsilateral 8.7%giratory motor signPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictalPDF p.6, Table 2
T+ bilateral 0%giratory motor signPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictalPDF p.6, Table 2
TL bilateral 0%giratory motor signPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictalPDF p.6, Table 2
T+ giratory 13%giratory motor signPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictalPDF p.6, Table 2
P=0.1giratory motor signP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictalPDF p.6, Table 2
T+ contralateral 4.3%giratory motor signPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictalPDF p.6, Table 2
TL ipsilateral 3.4%giratory motor signPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictalPDF p.6, Table 2
TL contralateral 0%giratory motor signPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictalPDF p.6, Table 2
T+ 43.5%hypermotor behavioursPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictalPDF p.6, Table 2
TL 30.5%hypermotor behavioursPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictalPDF p.6, Table 2
P=0.26hypermotor behavioursP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictalPDF p.6, Table 2

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfSystematic review or meta-analysis · 6 findings · 5 reported values

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

hyperkinetic behaviorHyperkinetic behavior was reported in 13% of reviewed cases.PDF p.4, Semiology and clinical features; PDF p.6, Table 3
Hyperkinetic/Agitation (Table 3)Table 3 reports hyperkinetic/agitation signs in 11 cases (13%), more during propagation.PDF p.6, Table 3
Hyperkinetic/Agitation (Table 4)In the 60 high/very-high-confidence cases, Table 4 reports hyperkinetic/agitation signs in 21 cases (35%).PDF p.7, Table 4
hyperkinetic/agitation plus gelastic behaviorThe co-occurrence analysis identified hyperkinetic/agitation with gelastic behavior in 22% of the 18-patient detailed-data set.PDF p.7, Figure 2 discussion
hypermotor bilateral automatisms (Mirandola study)Hypermotor bilateral automatisms were observed exclusively in the PIT group, in 6 patients (43%).PDF p.7, cited-study discussion
hypermotor bilateral automatisms group comparison (Mirandola study)The cited comparison of hypermotor bilateral automatisms is reported as statistically significant at p<.05.PDF p.7, cited-study discussion

Reported values

13% hyperkinetic behaviorhyperkinetic behaviorPercentage · reviewed basal temporal seizure cases · ictal propagation in Table 3PDF p.4, Semiology and clinical features; PDF p.6, Table 3
11 cases (13%)Hyperkinetic/Agitation (Table 3)Percentage · Table 3 basal temporal seizure cases · propagationPDF p.6, Table 3
21/60 (35%)Hyperkinetic/Agitation (Table 4)Percentage · n/N 21/60 · 60 basal temporal seizure cases with high or very-high EZ confidence · ictalPDF p.7, Table 4
22% co-occurrencehyperkinetic/agitation plus gelastic behaviorPercentage · 18 patients with detailed semiology data · ictal; timing not otherwise reportedPDF p.7, Figure 2 discussion
6/14 patients (43%)hypermotor bilateral automatisms (Mirandola study)Percentage · n/N 6/14 · 14 PIT-lesion patients in the cited Mirandola comparison · ictalPDF p.7, cited-study discussion

blair-temporal-lobe-epilepsy-semiology-2012.pdfNarrative, educational, or cited context · 1 finding

blair-temporal-lobe-epilepsy-semiology-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Hypermotor activityTable 1 reports hypermotor activity as rare in temporal lobe seizures and common in frontal lobe seizures.PDF p.2, Table 1

bonini-frontal-lobe-seizures-clinical-semiology-localization-2014-46edb4.pdfNarrative, educational, or cited context · 2 findings · 1 reported value

bonini-frontal-lobe-seizures-clinical-semiology-localization-2014-46edb4.pdf; bonini-frontal-lobe-seizures-clinical-semiology-localization-2014-838eb8.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Consecutive presurgical SEEG series from Timone Hospital, Marseille, February 2000-November 2010: 54 patients in whom SEEG-defined EZ was within the frontal lobe, selected from 180 SEEG explorations; patients with inconclusive intracranial recording (n=1) or a nonpredominantly frontal EZ were excluded. All patients had noninvasive presurgical assessment and video-SEEG after complete or partial antiepileptic-drug withdrawal; 374 seizures were recorded and analyzed. The cohort included 22 male and 32 female patients, mean age 24.9 +/- 9.5 years, mean epilepsy duration 16.9 +/- 8 years, and 27/54 with normal MRI. Three epileptologists independently reviewed VEEG and electrical data; 31 ictal signs and 24 brain-area variables were scored 0-1-2 per patient, with rank-based PCA, hierarchical clustering, correlation matrices, and Kendall tests at p < 0.05. The source describes sampling 20 cortical regions in one methods passage and distinguishes the SEEG-defined EZ from the source-defined early spread network.

Findings

Fearful Group 4 pattern; type 1 hypermotor seizures (HMS1)The authors state that the Group 4 electroclinical pattern resembles type 1 hypermotor seizures (HMS1), with the important difference that movements were not invariably hyperkinetic in the present study, citing Rheims et al., 2008.PDF p.11, discussion of Group 4 and fearful seizures; PDF p.13, reference list
Hyperkinetic versus normokinetic gestural behaviorHyperkinetic and normokinetic gestural motor behavior could both occur within the same patient group and in the same patient from one seizure to another; the authors therefore judged hyperkinetic character per se not to be a useful indicator of seizure localization.PDF p.10, Electroclinical subgroups; PDF p.11, Electroclinical spectrum following a rostrocaudal gradient

Reported values

Group 4 (5 patients)Fearful Group 4 pattern; type 1 hypermotor seizures (HMS1)Count · n/N 5/54 · Current Group 4 (5 patients); cited comparison population Not reported · Group 4 · IctalPDF p.11, discussion of Group 4 and fearful seizures; PDF p.13, reference list

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 2 findings · 1 reported value

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

hyperkinetic patternTable 3 lists 3 patients for the the source's own ictal symptom “hyperkinetic pattern”; its table phase label is onset.PDF p.6, Table 3
hyperkinetic patternTable 3 reports a pooled prevalence of 1% for the the source's own ictal symptom “hyperkinetic pattern”; its table phase label is onset.PDF p.6, Table 3

Reported values

1% pooled prevalencehyperkinetic patternPercentage · Patients with SMA or pre-SMA epilepsy in the selected studies · onsetPDF p.6, Table 3

chassoux-ictal-semiology-anterior-cingulate-epilepsy-systematic-review-2025.pdfSystematic review or meta-analysis · 35 findings · 31 reported values

chassoux-ictal-semiology-anterior-cingulate-epilepsy-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

emotional and autonomic manifestations; vocalization; facial expression; hypermotor behaviorThe review identifies emotional/autonomic manifestations, vocalization, facial expression changes, complex automatisms, and hypermotor behavior with preserved awareness as the main ACC clinical features.PDF p.11, Anatomical and clinical correlations; PDF p.15, Conclusion
hypermotor-complex motor behaviorThe source reports a frequency of 60% for hypermotor-complex motor behavior.PDF p.13, Table 3
hypermotor-complex motor behavior; reported frequency rangeThe source reports a frequency range of 0–100% for hypermotor-complex motor behavior.PDF p.13, Table 3
hypermotor-complex motor behavior; ACC association gradeTable 3 assigns the source's High overall association grade to hypermotor-complex motor behavior.PDF p.13, Table 3
hypermotor-complex motor behavior; Figure 4 rateFigure 4 displays a 60% rate for hypermotor-complex motor behavior.PDF p.10, Figure 4
hypermotor-complex motor behavior typicalityHypermotor-complex motor behavior met the source's typicality criterion of significantly exceeding one-third of patients.PDF p.10, Statistical analysis of ictal semiology; PDF p.11, Figure 5
hypermotor-complex motor behavior; pairwise odds-ratio significancehypermotor-complex motor behavior showed eight significant pairwise odds-ratio comparisons after Holm correction.PDF p.10, Statistical analysis of ictal semiology
pairwise OR: Hypermotor-complex motor behavior relative to Vocalization/verbalizationFigure 6 reports an odds ratio of 0.9 for Hypermotor-complex motor behavior relative to Vocalization/verbalization.PDF p.12, Figure 6
pairwise OR: Vocalization/verbalization relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of 1.1 for Vocalization/verbalization relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Affective/autonomic aura relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of 0.8 for Affective/autonomic aura relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Autonomic signs relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of 0.6 for Autonomic signs relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Facial expression change relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of 0.6 for Facial expression change relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of 0.5 for Motor (gestural) automatisms relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Loss of consciousness relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of 0.4 for Loss of consciousness relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Post-ictal confusion/behavior change disinhibition relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of 0.3 for Post-ictal confusion/behavior change disinhibition relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Chapeau de gendarme relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of 0.2 for Chapeau de gendarme relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of 0.2 for Dystonic posturing relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of 0.1 for Head-eye deviation relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Laughter relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of 0.1 for Laughter relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of <0.1 for Oro-alimentary automatisms relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Tonic-clonic relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of <0.1 for Tonic-clonic relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: F to BTC relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of <0.1 for F to BTC relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to Affective/autonomic auraFigure 6 reports an odds ratio of 1.2 for Hypermotor-complex motor behavior relative to Affective/autonomic aura.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to Autonomic signsFigure 6 reports an odds ratio of 1.6 for Hypermotor-complex motor behavior relative to Autonomic signs.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to Facial expression changeFigure 6 reports an odds ratio of 1.7 for Hypermotor-complex motor behavior relative to Facial expression change.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 2 for Hypermotor-complex motor behavior relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to Loss of consciousnessFigure 6 reports an odds ratio of 2.7 for Hypermotor-complex motor behavior relative to Loss of consciousness.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to Post-ictal confusion/behavior change disinhibitionFigure 6 reports an odds ratio of 3.4 for Hypermotor-complex motor behavior relative to Post-ictal confusion/behavior change disinhibition.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to Chapeau de gendarmeFigure 6 reports an odds ratio of 5.8 for Hypermotor-complex motor behavior relative to Chapeau de gendarme.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to Dystonic posturingFigure 6 reports an odds ratio of 6.2 for Hypermotor-complex motor behavior relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to Head-eye deviationFigure 6 reports an odds ratio of 9.1 for Hypermotor-complex motor behavior relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to LaughterFigure 6 reports an odds ratio of 13.7 for Hypermotor-complex motor behavior relative to Laughter.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 15.6 for Hypermotor-complex motor behavior relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to Tonic-clonicFigure 6 reports an odds ratio of 25.7 for Hypermotor-complex motor behavior relative to Tonic-clonic.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to F to BTCFigure 6 reports an odds ratio of 25.7 for Hypermotor-complex motor behavior relative to F to BTC.PDF p.12, Figure 6

Reported values

60% (frequency range 0–100%)hypermotor-complex motor behaviorPercentage · Reviewed ACC seizure cases with reported semiology · ictal onset and propagationPDF p.13, Table 3
60%hypermotor-complex motor behavior; Figure 4 ratePercentage · Reviewed ACC seizure cases with reported semiology · ictal onset and propagationPDF p.10, Figure 4
8 significant pairwise comparisonshypermotor-complex motor behavior; pairwise odds-ratio significanceCount · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.10, Statistical analysis of ictal semiology
OR 0.9pairwise OR: Hypermotor-complex motor behavior relative to Vocalization/verbalizationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.1pairwise OR: Vocalization/verbalization relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.8pairwise OR: Affective/autonomic aura relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.6pairwise OR: Autonomic signs relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.6pairwise OR: Facial expression change relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.5pairwise OR: Motor (gestural) automatisms relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.4pairwise OR: Loss of consciousness relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.3pairwise OR: Post-ictal confusion/behavior change disinhibition relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.2pairwise OR: Chapeau de gendarme relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.2pairwise OR: Dystonic posturing relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.1pairwise OR: Head-eye deviation relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR <0.1pairwise OR: Laughter relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR <0.1pairwise OR: Oro-alimentary automatisms relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR <0.1pairwise OR: Tonic-clonic relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR <0.1pairwise OR: F to BTC relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.2pairwise OR: Hypermotor-complex motor behavior relative to Affective/autonomic auraOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.6pairwise OR: Hypermotor-complex motor behavior relative to Autonomic signsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.7pairwise OR: Hypermotor-complex motor behavior relative to Facial expression changeOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 2pairwise OR: Hypermotor-complex motor behavior relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 2.7pairwise OR: Hypermotor-complex motor behavior relative to Loss of consciousnessOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 3.4pairwise OR: Hypermotor-complex motor behavior relative to Post-ictal confusion/behavior change disinhibitionOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 5.8pairwise OR: Hypermotor-complex motor behavior relative to Chapeau de gendarmeOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 6.2pairwise OR: Hypermotor-complex motor behavior relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 9.1pairwise OR: Hypermotor-complex motor behavior relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 13.7pairwise OR: Hypermotor-complex motor behavior relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 15.6pairwise OR: Hypermotor-complex motor behavior relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 25.7pairwise OR: Hypermotor-complex motor behavior relative to Tonic-clonicOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 25.7pairwise OR: Hypermotor-complex motor behavior relative to F to BTCOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfCase report or observation · 2 findings

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdf; chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

hyperkinetic seizure; bilateral tonic seizureIn an illustrative 24-year-old man with sleep-related hyperkinetic seizures, PET and stereo-EEG supported a right orbitofrontal source; seizures progressed to bilateral tonic seizures with loss of awareness, and the patient was seizure-free after right orbitofrontal resection.PDF p.4, Video case 2 and Figure 3 caption
hyperkinetic seizure; orbitofrontal onsetIn video case 2, a 24-year-old man had hyperkinetic seizures from sleep, right orbitofrontal PET hypometabolism, stereo-EEG onset in the right orbitofrontal region, progression to bilateral tonic seizures with loss of awareness when the seizure spread to the supplementary motor area, and seizure freedom after right orbitofrontal resection.PDF p.4, Video case 2; PDF p.5, Figure 3

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdfNarrative, educational, or cited context · 10 findings · 7 reported values

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.54 · 1 × 0.9 × 1.707

Findings

OFC group (EZN restricted to OFC); hyperkinetic behavior; verbal automatisms; sleep-related seizuresThe source characterizes seizures with an EZN restricted to the OFC as having a relatively sparse semiological profile, mainly hyperkinetic behavior and verbal automatisms, often associated with sleep.PDF p.5, Semiological profiles; PDF p.7, Conclusion
frontal and insular EZN extension; hyperkinetic behavior; mimic automatisms; gestural automatismsFrontal and insular extensions are described as more likely to show hyperkinetic behavior, mimic automatisms, and gestural automatisms.PDF p.7, Conclusion
hyperkinetic behaviorThe review states that no specific association of hyperkinetic behavior with a particular OFC sublobar region has been identified.PDF p.3, Complex motor phenomena—hyperkinetic behavior
hyperkinetic behaviorHyperkinetic behavior was reported in 14 of 26 restricted-OFC cases.PDF p.2, Semiology patterns of seizures with EZN restricted to the OFC
hyperkinetic behavior; OFC-extended EZNHyperkinetic behavior was reported in 30% of the OFC-extended group.PDF p.3, Complex motor phenomena—hyperkinetic behavior
hyperkinetic behavior; entire OFC-involving groupHyperkinetic behavior was reported in 36% of the entire group.PDF p.3, Complex motor phenomena—hyperkinetic behavior
hyperkinetic behavior; temporal OFC-extended subgroupHyperkinetic behavior was reported in 8% of the temporal subgroup.PDF p.3, Complex motor phenomena—hyperkinetic behavior
hyperkinetic behavior; insular OFC-extended subgroupHyperkinetic behavior was reported in 40% of the insular subgroup.PDF p.3, Complex motor phenomena—hyperkinetic behavior
hyperkinetic behavior; frontal OFC-extended subgroupHyperkinetic behavior was reported in 45% of the frontal subgroup.PDF p.3, Complex motor phenomena—hyperkinetic behavior
hyperkinetic behavior; Chibane cited cohortChibane et al. were reported as having 62.5% hyperkinetic behavior.PDF p.3, Complex motor phenomena—hyperkinetic behavior

Reported values

14/26 (53.8%)hyperkinetic behaviorPercentage · n/N 14/26 · OFC-restricted EZN cases · OFC-restricted EZN cases · ictalPDF p.2, Semiology patterns of seizures with EZN restricted to the OFC
30%hyperkinetic behavior; OFC-extended EZNPercentage · OFC-extended EZN group · OFC-extended EZN group · ictalPDF p.3, Complex motor phenomena—hyperkinetic behavior
36%hyperkinetic behavior; entire OFC-involving groupPercentage · Entire OFC-involving group · Entire OFC-involving group · ictalPDF p.3, Complex motor phenomena—hyperkinetic behavior
8%hyperkinetic behavior; temporal OFC-extended subgroupPercentage · Temporal subgroup of OFC-extended EZN · Temporal subgroup of OFC-extended EZN · ictalPDF p.3, Complex motor phenomena—hyperkinetic behavior
40%hyperkinetic behavior; insular OFC-extended subgroupPercentage · Insular subgroup of OFC-extended EZN · Insular subgroup of OFC-extended EZN · ictalPDF p.3, Complex motor phenomena—hyperkinetic behavior
45%hyperkinetic behavior; frontal OFC-extended subgroupPercentage · Frontal subgroup of OFC-extended EZN · Frontal subgroup of OFC-extended EZN · ictalPDF p.3, Complex motor phenomena—hyperkinetic behavior
62.5%hyperkinetic behavior; Chibane cited cohortPercentage · Chibane cited cohort · Chibane cited cohort · ictalPDF p.3, Complex motor phenomena—hyperkinetic behavior

enatsu-posterior-cingulate-epilepsy-clinical-neurophysiological-analysis-2014.pdfStructured design not resolved · 2 findings · 1 reported value

enatsu-posterior-cingulate-epilepsy-clinical-neurophysiological-analysis-2014.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.423

The study enrolled seven consecutive PCE patients; six had SEEG-identified posterior cingulate ictal onset and one had an MRI-identified postcingulate tumour. Four patients underwent CCEP. SEEG and scalp EEG were retrospectively analyzed with video-documented ictal semiology; the source used the Lüders seizure-classification scheme. The posterior cingulate was operationally defined caudal to the vertical posterior commissure line.

Findings

hypermotor seizure in PCEOne of seven PCE patients had hypermotor seizures.PDF p.1, Abstract; PDF p.5, Ictal semiology and SEEG findings
Case 1 hypermotor spreadCase 1 hypermotor seizures spread to the postcentral gyrus, ventrolateral premotor area, and orbitofrontal cortex.PDF p.5, Ictal semiology and SEEG findings; PDF p.3, Figure 1

Reported values

1/7 hypermotor seizurehypermotor seizure in PCEProportion · n/N 1/7 · 7 PCE patients · ictal semiologyPDF p.1, Abstract; PDF p.5, Ictal semiology and SEEG findings

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

hypermotor seizuresHypermotor seizures with rapid, violent proximal-limb and trunk movements originate primarily in the frontal lobe and less commonly in the temporal lobe, posterior cortex, or insula. Ventromedial frontal seizures have more hypermotor features, while dorsolateral frontal seizures more often show head/eye version and complex gestural automatisms; sexual-quality hypermotor movements and rare body-axis rotation of at least 180 degrees suggest frontal origin. Rotation is usually contralateral to the epileptogenic zone when preceded by version and usually ipsilateral when not preceded by version.PDF p.3, section 3.3 Complex motor seizures; PDF p.2, Table 1

Reported values

Body-axis rotation of at least 180 degrees in rare caseshypermotor seizuresCount · patients with focal epilepsy · ictal motor; rotation with or without preceding versionPDF p.3, section 3.3 Complex motor seizures; PDF p.2, Table 1

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdfNarrative, educational, or cited context · 1 finding

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

This source is a narrative review chapter and does not state a unified search strategy, eligibility set, enrollment cohort, or pooled analysis population. It draws on heterogeneous cited patient cohorts, seizure/event observations, imaging and EEG studies, and case reports, with emphasis on drug-resistant and presurgical temporal lobe epilepsy. Denominators, reference standards, and analysis units therefore remain study-specific; no chapter-level aggregate estimate is established.

Findings

nocturnal hyperkinetic seizures in TPENocturnal hyperkinetic seizures mimicking frontal lobe epilepsy are reported in TPE; the chapter interprets MTLE-like and FLE-like manifestations as potentially reflecting regional propagation toward mesial temporal or frontal structures.PDF p.10, Temporal pole or temporo-polar epilepsy

gibbs-clinical-features-sleep-related-hypermotor-epilepsy-2019.pdfIndependent primary study · 1 finding

gibbs-clinical-features-sleep-related-hypermotor-epilepsy-2019.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

posterior SHE primitive and less-integrated hypermotor movementsThe posterior SHE group tended to exhibit more primitive and less-integrated hypermotor movements with SMA and central cingulate semiology.PDF p.8, section 4.2

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdfSystematic review or meta-analysis · 7 findings · 3 reported values

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

elementary motor symptoms; speech dysfunction; complex motor behavior; respiratory symptoms; salivation; laughter; preserved consciousnessThe source's abstract identifies elementary motor symptoms, speech dysfunction, complex motor behavior, respiratory symptoms, salivation, and laughter as ictal signs with preserved consciousness in fronto-opercular epilepsy.PDF p.1, Abstract; PDF p.2, Key points
complex motor behavior; hyperkinetic automatismsThe source states that complex motor behaviors with a hyperkinetic aspect are not specific to opercular involvement because they are also reported in frontal, parietal, temporal, and insular epilepsies.PDF p.9, Discussion
timing; nocturnal seizure; hyperkinetic seizureThe source states that very little timing information was provided across the included studies and specifically notes one patient with nocturnal hyperkinetic seizures in the Nobili study.PDF p.9, Discussion
Complex motor behavior (hyperkinetic automatisms)Table 2 reports 5/21 (24%) for Complex motor behavior (hyperkinetic automatisms); timing is onset or propagation, and the source's overall agreement that the sign is suggestive of fronto-opercular epilepsy is graded Moderate.PDF p.7, Table 2
Complex motor behavior (hyperkinetic automatisms)Table 2 reports 3/12 patients with Complex motor behavior (hyperkinetic automatisms) in the prefrontal operculum group.PDF p.7, Table 2
Complex motor behavior (hyperkinetic automatisms)Table 2 reports 2/9 patients with Complex motor behavior (hyperkinetic automatisms) in the precentral Rolandic operculum group.PDF p.7, Table 2
Complex motor behavior (hyperkinetic automatisms)Fisher's exact comparison of Complex motor behavior (hyperkinetic automatisms) between the prefrontal and precentral Rolandic operculum groups has p=1.PDF p.7, Table 2

Reported values

5/21 (24%)Complex motor behavior (hyperkinetic automatisms)Percentage · n/N 5/21 · 21 included fronto-opercular epilepsy patients · BothPDF p.7, Table 2
3/12 patientsComplex motor behavior (hyperkinetic automatisms)Proportion · n/N 3/12 · 12 patients with EZ in the prefrontal operculum · 12 patients with EZ in the prefrontal operculum · BothPDF p.7, Table 2
2/9 patientsComplex motor behavior (hyperkinetic automatisms)Proportion · n/N 2/9 · 9 patients with EZ in the precentral Rolandic operculum · 9 patients with EZ in the precentral Rolandic operculum · BothPDF p.7, Table 2

jobst-insula-and-its-epilepsies-2019.pdfCase report or observation · 5 findings · 1 reported value

jobst-insula-and-its-epilepsies-2019.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

hypermotor behaviorHypermotor behavior is among the clinical manifestations reported with insular seizures.PDF p.2, Clinical Features
hyperkinetic behavior frontal-like symptomFrontal-like insular seizures may include hyperkinetic behavior.PDF p.2, Clinical Features
hypermotor manifestations suggesting insular focusHypermotor manifestations are among the observed signs that suggest an insular focus.PDF p.3, Video EEG
CHRNB2 and CHRNA4 mutations with sleep-related hypermotor seizuresMutations in CHRNB2 and CHRNA4 were reported in two patients with sleep-related hypermotor seizures.PDF p.3, Genetic Testing
hyperkinetic automatisms in left insular SUDEP caseThe SEEG-proven left-insular case had hyperkinetic automatisms.PDF p.8, Is SUDEP Risk Increased in Insular Epilepsy?

Reported values

2 patients with sleep-related hypermotor seizures and CHRNB2/CHRNA4 mutationsCHRNB2 and CHRNA4 mutations with sleep-related hypermotor seizuresCount · 2 patients with operculo-insular epilepsy cases · sleep-related ictal semiologyPDF p.3, Genetic Testing

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdfIndependent primary study · 1 finding · 2 reported values

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdf

Independent primary study · Class II · Evidence weight 5.11 · 2 × 1.35 × 1.893

Findings

HyperkineticHyperkinetic semiology was absent as initial semiology (0/61, 0%) and occurred in 6/61 individuals (10%) in the combined set-of-semiology.PDF p.5, Table 2

Reported values

0/61 (0%) initialHyperkineticPercentage · n/N 0/61 · 61 individuals undergoing frontal lobe epilepsy surgery · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2
6/61 (10%) combinedHyperkineticPercentage · n/N 6/61 · 61 individuals undergoing frontal lobe epilepsy surgery · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 1 finding

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Hypermotor seizure patternTable 2 associates hypermotor semiology with anterior cingulum, orbitofrontal, frontopolar, opercular-insular, and medial intermediate frontal regions and describes it as non-lateralising.PDF p.3, Table 2

luders-semiological-seizure-classification-1998.pdfNarrative, educational, or cited context · 1 finding

luders-semiological-seizure-classification-1998.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Hypermotor seizureHypermotor seizures are complex motor seizures dominated by large movements of proximal limb segments and trunk; the movements imitate normal actions but are inappropriate and usually purposeless, may be stereotypically repeated in sequences such as pedaling, and consciousness may be preserved.PDF p.4, Complex motor seizures; PDF p.5, Complex motor seizures, Hypermotor seizures; PDF p.2, Table 1

mcgonigal-frontal-lobe-seizures-overview-update-2022.pdfNarrative, educational, or cited context · 1 finding

mcgonigal-frontal-lobe-seizures-overview-update-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

This document is a review/Neurological Update and reports or synthesizes observations from multiple SEEG, intracerebral-recording, and other cited series rather than a single study population. It specifically describes a cited SEEG series of 54 patients with FLE and a cited series of 42 patients with prefrontal seizures for emotional prevalence; other cited cohort sizes, ascertainment details, reference standards, and region-specific denominators are not reported in the document. The review frames its electroclinical correlations as group-level aids for presurgical sublobar hypotheses. It states that both seizure onset and propagation contribute to semiological expression and distinguishes elementary motor signs from complex motor behavior.

Findings

sleep-related hypermotor phenotype with frontal and extra-frontal localizationsThe review states that many previously termed nocturnal frontal lobe epilepsy cases had confirmed frontal localizations on intracerebral EEG, including orbitofrontal cortex, anterior cingulate, and supplementary motor area, while similar sleep-related hypermotor seizure phenotypes may also arise from extra-frontal localizations including insula; it presents Sleep-Related Hypermotor Epilepsies as broader terminology reflecting this localization range.PDF p.5, Frontal seizures and genetics

mcgonigal-on-seizure-semiology-2021-5ba29d.pdfNarrative, educational, or cited context · 6 findings · 8 reported values

mcgonigal-on-seizure-semiology-2021-5ba29d.pdf; mcgonigal-on-seizure-semiology-2021-9127f2.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

vestibular symptoms; hyperkinetic motor behaviorThe review reports that Bartolomei et al. (2011) found seizures predominantly arising from the superior parietal lobule were often associated with vestibular symptoms, whereas hyperkinetic motor behavior was associated with inferior parietal involvement.PDF p.6, Table 2, Parietal lobe row
vestibular symptoms; hyperkinetic motor behaviorIn the summarized Bartolomei et al. study of parietal seizures, seizures predominantly arising from the superior parietal lobule were often associated with vestibular symptoms, whereas hyperkinetic motor behavior was associated with inferior parietal involvement.PDF p.6, Table 2, Bartolomei et al. 2011 row
antero-posterior rockingThe review reports that Zalta et al. (2020) associated delta-range rhythmic body rocking in a prefrontal seizure with cortical delta oscillatory activity and phase-coupled high-gamma energy.PDF p.5, Table 1, Antero-posterior rocking row
hyperkinetic seizure; automatismThe authors caution that “hyperkinetic seizure” conflates an individual semiologic feature with the description of the overall seizure and, although included in the current ILAE classification, does not correspond to a known localization, etiology, or pathophysiological correlation; they also identify “automatism” and “hyperkinetic” as terms with imprecise or nonconsensual meaning in some contexts.PDF p.12, Table 3; PDF p.13, paragraph 2
antero-posterior rocking; rhythmic body rockingIn the summarized Zalta et al. case, delta-range rhythmic body rocking in prefrontal seizures was associated with cortical delta oscillatory activity and phase-coupled high-gamma energy when compared with non-rocking seizures in the same patient.PDF p.5, Table 1 (continued), Zalta et al. 2020 row; PDF p.11, mechanism 4
hyperkinetic signs; speech modifications; viscerosensory symptoms; pain; asymmetric tonic; focal clonic; tonic symptomsIn the summarized Peltola et al. study of pure insular epilepsies, hyperkinetic signs, speech modifications, and viscerosensory symptoms were related to an anterior insular seizure-onset zone, whereas pain, asymmetric tonic, focal clonic, and tonic symptoms were more frequent in patients with a posterior insular seizure onset.PDF p.7, Table 2 (continued), Peltola et al. 2020 row

Reported values

17 subjectsvestibular symptoms; hyperkinetic motor behaviorCount · 17 subjects with parietal-lobe epilepsy and 34 seizures · Seizure organization and semiologic expressionPDF p.6, Table 2, Parietal lobe row
34 seizuresvestibular symptoms; hyperkinetic motor behaviorCount · 17 subjects with parietal-lobe epilepsy and 34 seizures · Seizure organization and semiologic expressionPDF p.6, Table 2, Parietal lobe row
34 seizuresvestibular symptoms; hyperkinetic motor behaviorCount · 17 subjects with parietal-lobe epilepsy; 34 seizures · ictalPDF p.6, Table 2, Bartolomei et al. 2011 row
17 subjectsvestibular symptoms; hyperkinetic motor behaviorCount · 17 subjects with parietal-lobe epilepsy; 34 seizures · ictalPDF p.6, Table 2, Bartolomei et al. 2011 row
n=1 subjectantero-posterior rockingCount · 1 subject with frontal-lobe epilepsy · During antero-posterior rockingPDF p.5, Table 1, Antero-posterior rocking row
Patient in intraoperative stimulation study n=1antero-posterior rocking; rhythmic body rockingCount · 1 subject with frontal-lobe epilepsy; number of seizures Not reported · ictal, during antero-posterior rockingPDF p.5, Table 1 (continued), Zalta et al. 2020 row; PDF p.11, mechanism 4
79 seizureshyperkinetic signs; speech modifications; viscerosensory symptoms; pain; asymmetric tonic; focal clonic; tonic symptomsCount · 11 subjects with pure insular epilepsy; 79 seizures · Peltola et al. study · ictal onset and semiologic expressionPDF p.7, Table 2 (continued), Peltola et al. 2020 row
11 subjectshyperkinetic signs; speech modifications; viscerosensory symptoms; pain; asymmetric tonic; focal clonic; tonic symptomsCount · 11 subjects with pure insular epilepsy; 79 seizures · Peltola et al. pure insular epilepsy study · ictal onset and semiologic expressionPDF p.7, Table 2 (continued), Peltola et al. 2020 row

misulis-sonmezturk-ess-abou-khalil-atlas-eeg-seizure-semiology-management-3e-2022.pdfNarrative, educational, or cited context · 1 finding

misulis-sonmezturk-ess-abou-khalil-atlas-eeg-seizure-semiology-management-3e-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

The complete native PDF page set 1-473 was reviewed as one source. Per-page text was read in coherent sections with targeted consolidation of repeated headers, references, medication material, and non-in-scope management content. Renderings were additionally inspected for the vision-required pages and for selected semiology diagrams, EEG traces, montages, tables, captions, and case figures where visual field, waveform evolution, or extraction uncertainty carried scientific meaning. Populations are heterogeneous and the source's own: educational descriptions, selected cited-study restatements, and distinct illustrated patient cases are kept separate below. Quantitative values are reported only when the source states them.

Findings

supplementary negative motor and frontal hypermotor seizuresSupplementary sensorimotor seizures may produce ictal paralysis or other negative motor symptoms, often with no scalp EEG because of mesial frontal dipole orientation; bizarre hypermotor seizures can arise from cingulate or orbitofrontal regions or appear after extrafrontal spread, with unilateral posturing and axial rotation favoring mesial frontal origin, severe agitation favoring orbitofrontal localization, and a longer electrical-to-hypermotor latency suggesting extrafrontal onset.PDF p.52; PDF p.53

moser-chapeau-de-gendarme-sign-focal-epilepsy-systematic-review-2025.pdfCase report or observation · 3 findings

moser-chapeau-de-gendarme-sign-focal-epilepsy-systematic-review-2025.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

The authors registered the review in PROSPERO (CRD42024519156) and report PRISMA methods. PubMed, EMBASE, and Scopus were searched through December 1, 2024. Original peer-reviewed studies with individual-level spontaneous ictal descriptions and invasive EEG, surgery/outcome, or imaging data were eligible; case reports were included. EZ confidence was graded as very high, high, moderate, or low using MRI, invasive EEG, and postsurgical outcome, and GRADE was used for overall evidence. Descriptive statistics and Pearson chi-squared tests with Holm-corrected pairwise proportion tests were reported.

Findings

affective ACC expressionStronger emotional expressions such as fear or menace, with open eyes, hypermotor, and autonomic features, were linked to the rostroventral “affective” ACC.PDF p.8, Discussion
figure 2 chapeau de gendarme caseFigure 2 describes a 16-year-old girl with sleep-related hypermotor epilepsy and the chapeau de gendarme sign.PDF p.7, Figure 2
persistence during hypermotor phaseThe chapeau de gendarme sign persisted during the hypermotor phase and correlated with extensive mesial frontal involvement in the Figure 2 case.PDF p.7, Figure 2

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 12 findings · 7 reported values

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

The review included English-language case series and selected case reports of drug-resistant temporal or frontal epilepsy with electroclinical or imaging evidence of temporo-frontal/fronto-temporal network involvement. The reviewed population is 40 articles and 109 patients; the source divides them into a temporo-frontal subgroup (temporal seizure-onset zone with frontal extension) and a fronto-temporal subgroup (frontal onset with temporal involvement). Search counts, duplicate resolution, reviewer roles, eligibility/risk-of-bias details, Table 1 per-study MRI/SEEG/surgery/outcome cells, and standalone surgery/outcome counts are retained only as compact context here. The source uses cluster analysis, Fisher exact comparisons for sign/resection associations, and random-effects prevalence meta-analysis.

Findings

automatisms; elementary motor; hyperkinetic; autonomic; emotional; grimace; cognitive; other subjectiveThe source classifies ictal features into automatisms, elementary motor, hyperkinetic, autonomic, emotional, grimace, cognitive, and other subjective categories for the cluster and prevalence analyses.PDF p.4, Statistical analysis
emotional; autonomic; cognitive; grimacing; hyperkinetic behaviorThe source identifies a main cluster containing emotional, grimacing, autonomic, cognitive, and hyperkinetic manifestations across the whole group and both subgroups.PDF p.1, Abstract; PDF p.10, Figure 3
hyperkinetic behaviorThe source defines hyperkinetic behavior as an excessive amount and speed of motor movements with an increased rate in motor sequences.PDF p.12, Discussion
hyperkinetic behavior; dorsoanterior insula; mesial frontal lobes; SMA; MCC; caudate nucleiThe source describes a reported hyperkinetic-behavior network involving coupling changes between dorsoanterior insula, mesial frontal lobes including SMA/MCC, and bilateral caudate heads.PDF p.12, Discussion
emotional; autonomic; automatisms; hyperkinetic behavior; grimaceAcross groups, the source places autonomic and emotional features at seizure onset, while automatisms, hyperkinetic behavior, and grimace are associated with propagation.PDF p.2, Key points; PDF p.9, Seizure semiology
hyperkinetic behavior; whole groupHyperkinetic behavior was reported in 39% of the whole review group.PDF p.5, All group; PDF p.9, Figure 2
hyperkinetic behavior; fronto-temporal subgroupHyperkinetic behavior was reported in 21% of the fronto-temporal subgroup (33 patients).PDF p.5, Fronto-temporal subgroup
hyperkinetic behavior; temporo-frontal subgroupHyperkinetic behavior was reported in 46% of the temporo-frontal subgroup (76 patients).PDF p.5, Temporo-frontal subgroup
association coefficient; autonomic and hyperkineticThe source reports an association coefficient of 0.606 for autonomic and hyperkinetic in the whole group.PDF p.5, All group; PDF p.10, Figure 3A
association coefficient; emotional and hyperkineticThe source reports an association coefficient of 0.879 for emotional and hyperkinetic in the fronto-temporal subgroup.PDF p.5, Fronto-temporal subgroup; PDF p.10, Figure 3B
hyperkinetic behavior preceded by emotional signsThe source states that hyperkinetic behavior could be preceded by emotional signs in 31% of cases.PDF p.12, Discussion
hyperkinetic behavior preceded by autonomic signsThe source states that hyperkinetic behavior could be preceded by autonomic signs in 38% of cases.PDF p.12, Discussion

Reported values

39%hyperkinetic behavior; whole groupPercentage · 109 review patients, whole group · ictal propagationPDF p.5, All group; PDF p.9, Figure 2
21%hyperkinetic behavior; fronto-temporal subgroupPercentage · 33 patients, fronto-temporal subgroup · ictal propagationPDF p.5, Fronto-temporal subgroup
46%hyperkinetic behavior; temporo-frontal subgroupPercentage · 76 patients, temporo-frontal subgroup · ictal propagationPDF p.5, Temporo-frontal subgroup
association coefficient 0.606association coefficient; autonomic and hyperkineticAssociation Coefficient · 109 review patients · ictal symptom co-occurrencePDF p.5, All group; PDF p.10, Figure 3A
association coefficient 0.879association coefficient; emotional and hyperkineticAssociation Coefficient · 33 fronto-temporal subgroup patients · ictal symptom co-occurrencePDF p.5, Fronto-temporal subgroup; PDF p.10, Figure 3B
31%hyperkinetic behavior preceded by emotional signsPercentage · Source-described hyperkinetic-behavior cases · ictal onset before hyperkinetic propagationPDF p.12, Discussion
38%hyperkinetic behavior preceded by autonomic signsPercentage · Source-described hyperkinetic-behavior cases · ictal onset before hyperkinetic propagationPDF p.12, Discussion

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdfCase report or observation · 3 findings · 7 reported values

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

focal nonmotor unaware seizures; hyperkinetic features; asymmetric tonic posturing; elementary facial contractionsThe source relates more ventrally located insular foci to focal nonmotor unaware seizures and more dorsally located foci to motor manifestations caused by propagation toward frontal areas, including often sleep-related hyperkinetic features, asymmetric tonic posturing, or elementary facial contractions; patients are frequently unaware of these manifestations.PDF p.5, Ictal Semiology; PDF p.16, Summary
delayed hypermotor manifestationIn hypermotor seizures, the chapter identifies a delay from seizure onset to the hypermotor manifestation, averaging 20 seconds with a reported range of 5 to 40 seconds in one study, together with previously described auras during wakefulness, as features suggesting an insular rather than primary frontal origin.PDF p.5, Ictal Semiology
Case 2 painful somatosensory, auditory-reflex, hypermotor, and autonomic/speech semiologyCase 2 was a 46-year-old right-handed man whose seizures began with lancinating right facial pain followed within 2 seconds by high-pitched right-ear ringing descending along the right hemibody to the foot, sometimes with right-foot tremor, witnessed erratic right-sided and truncal movements, and left-sided stiffening in half the seizures; he was usually conscious without postictal paresis, had 10–15-second events up to 100 times per day triggered by sounds, and could develop hypersalivation, speech difficulty, later nocturnal hypermotor seizures, and urinary incontinence.PDF p.11, Case 2; PDF p.13, continuation of Case 2

Reported values

Average delay 20 secondsdelayed hypermotor manifestationCount · Patients in one cited study of hypermotor seizures; cohort size not reported here · Ictal; interval from seizure onset to hypermotor manifestationPDF p.5, Ictal Semiology
range 5–40 secondsdelayed hypermotor manifestationCount · Patients in one cited study of hypermotor seizures; cohort size not reported here · Ictal; interval from seizure onset to hypermotor manifestationPDF p.5, Ictal Semiology
within 2 secondsCase 2 painful somatosensory, auditory-reflex, hypermotor, and autonomic/speech semiologyDuration · Individual Case 2; 46-year-old right-handed man, seizure onset age 16 · early sensory sequence · Ictal; longitudinal diurnal, nocturnal, and postoperative descriptionsPDF p.11, Case 2; PDF p.13, continuation of Case 2
10–15-second eventsCase 2 painful somatosensory, auditory-reflex, hypermotor, and autonomic/speech semiologyRange · Individual Case 2; 46-year-old right-handed man, seizure onset age 16 · habitual events · Ictal; longitudinal diurnal, nocturnal, and postoperative descriptionsPDF p.11, Case 2; PDF p.13, continuation of Case 2
2–3 per monthCase 2 painful somatosensory, auditory-reflex, hypermotor, and autonomic/speech semiologyRange · Individual Case 2; 46-year-old right-handed man, seizure onset age 16 · youth · Ictal; longitudinal diurnal, nocturnal, and postoperative descriptionsPDF p.11, Case 2; PDF p.13, continuation of Case 2
in half the seizuresCase 2 painful somatosensory, auditory-reflex, hypermotor, and autonomic/speech semiologyOther reported value · Individual Case 2; 46-year-old right-handed man, seizure onset age 16 · left-sided stiffening · Ictal; longitudinal diurnal, nocturnal, and postoperative descriptionsPDF p.11, Case 2; PDF p.13, continuation of Case 2
up to 100 times per dayCase 2 painful somatosensory, auditory-reflex, hypermotor, and autonomic/speech semiologyFrequency · Individual Case 2; 46-year-old right-handed man, seizure onset age 16 · later high-frequency period · Ictal; longitudinal diurnal, nocturnal, and postoperative descriptionsPDF p.11, Case 2; PDF p.13, continuation of Case 2

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdfSystematic review or meta-analysis · 3 findings · 2 reported values

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

hypermotor semiology; temporal pole propagation; frontal onsetThe source cautions that hypermotor semiology may arise through temporal-pole propagation rather than indicating a primary frontal onset.PDF p.6, Discussion
hypermotorTable 3 reports hypermotor semiology in 6% of the temporo-polar synthesis (evidence grade Low).PDF p.5, Table 3
hypermotorTable 3 reports a 0–50% range for hypermotor semiology across the temporo-polar reports (evidence grade Low).PDF p.5, Table 3

Reported values

6%hypermotorPercentage · Temporo-polar semiology synthesis represented in Table 3 · clinical onset or laterPDF p.5, Table 3
range 0–50%hypermotorPercentage Range · Temporo-polar semiology synthesis represented in Table 3 · clinical onset or laterPDF p.5, Table 3

suzuki-sensory-motor-networks-reflex-seizure-case-report-2017.pdfCase report or observation · 1 finding

suzuki-sensory-motor-networks-reflex-seizure-case-report-2017.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

reflex seizures; hypermotor seizures; right foot sensory auraIn this patient, the two seizure types were hypermotor seizures and a right-foot sensory aura followed by bilateral asymmetric tonic posturing and generalized tonic-clonic seizures; the latter occurred spontaneously and was also provoked by loud sounds, more commonly by somatosensory stimulation of the right foot, and reflex seizures were exaggerated by sudden unexpected stimulation.PDF p.1, Case Report; PDF p.3, Discussion

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdfNarrative, educational, or cited context · 1 finding

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

hypermotor seizuresThe review describes hypermotor seizures as complex multijoint movements involving the trunk and proximal limbs, often occurring during sleep with possible preserved consciousness. Most are stated to originate from orbital or mesial frontal regions, although temporal and insular epilepsies can also produce them; some consist of sexual-activity-like automatisms with pelvic, limb, groin, or genital movements.PDF p.4, Complex motor seizures; PDF p.5, Hypermotor seizures

wang-electroclinical-insulo-opercular-epilepsy-seeg-pet-2019.pdfIndependent primary study · 1 finding · 1 reported value

wang-electroclinical-insulo-opercular-epilepsy-seeg-pet-2019.pdf

Independent primary study · Class II · Evidence weight 5.01 · 2 × 1.5 × 1.671

Findings

hypermotor behaviorHypermotor behavior was detected in four patients.PDF p.4, Results—Seizure semiology; PDF p.10, Discussion

Reported values

4/22 (18%)hypermotor behaviorPercentage · n/N 4/22 · 22 patients with insulo-opercular epilepsy · ictal complex motor behaviorPDF p.4, Results—Seizure semiology; PDF p.10, Discussion

wang-hypermotor-seizures-temporal-pole-lesions-2008.pdfStructured design not resolved · 23 findings · 10 reported values

wang-hypermotor-seizures-temporal-pole-lesions-2008.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.452

Findings

thrashing or upper-extremity flexion-extensionAmong the four hypermotor patients, the source reports three hypermotor patients with thrashing or flexion and extension of upper extremities.PDF p.4, Seizure semiology on video-EEG recording
hypermotor and hyperkinetic terminologyThe introduction describes the pattern as “hypermotor” and notes that the 2006 ILAE Classification Core uses the term “hyperkinetic.”PDF p.2, Introduction
hypermotor feature: thrashingThe source lists thrashing among repetitive complex movements involving proximal limbs and trunk in hypermotor seizures.PDF p.2, Introduction
hypermotor feature: body rockingThe source lists body rocking among repetitive complex movements involving proximal limbs and trunk in hypermotor seizures.PDF p.2, Introduction
temporal pole lesions and hypermotor seizuresThe article investigates and concludes that hypermotor seizures occur frequently in patients with lesions involving the temporal pole.PDF p.1, Summary and Conclusion; PDF p.5, Discussion
hypermotor seizure semiologyFour of eight patients with temporal pole lesions exhibited hypermotor seizure semiology.PDF p.1, Summary; PDF p.4, Results; PDF p.5, Discussion
anterior lateral temporal scalp ictal activity in hypermotor seizuresThree of four hypermotor patients had 4–5 Hz rhythmic scalp ictal activity in the anterior lateral temporal region that later spread to the inferomesial temporal region.PDF p.4, EEG findings
orbitofrontal spread in hypermotor seizuresOne patient had rapid spread through temporal and lateral orbitofrontal areas in two complex partial seizures with hypermotor manifestation.PDF p.4, EEG findings
hypermotor behavior with orbitofrontal involvementIn both seizures described in that patient, hypermotor behavior began in conjunction with involvement of the orbitofrontal region.PDF p.4, EEG findings
absence of orbitofrontal spread without hypermotor behaviorSeizures without hypermotor behavior did not spread to the orbitofrontal region in the described comparison.PDF p.4, EEG findings
left anterior inferolateral temporal onset in 10 hypermotor seizuresIn one patient with 10 hypermotor seizures, ictal onset was from the left anterior inferolateral temporal region.PDF p.4, EEG findings; PDF p.5, Figure 2
spread to lateral temporal regionsThose seizures spread rapidly to other lateral temporal regions.PDF p.4, EEG findings
spread to basal temporal cortexThose seizures also spread to basal temporal cortex.PDF p.4, EEG findings
spread to orbitofrontal regionThose seizures also spread to the orbitofrontal region.PDF p.4, EEG findings
delayed onset of hypermotor behaviorThe onset of hypermotor behavior was delayed after the onset of frontal involvement in the described 10-seizure patient.PDF p.4, EEG findings; PDF p.5, Figure 2
hypermotor behavior with orbitofrontal delta activityHypermotor behavior usually corresponded to the end of ictal activity in lateral temporal cortex and development of prominent delta activity in the orbitofrontal region.PDF p.4, EEG findings; PDF p.5, Figure 2
hypermotor semiology in temporal lobe epilepsy cited estimateThe discussion cites studies indicating that 2–3% of patients with hippocampal or extrahippocampal temporal lobe epilepsy manifest hypermotor semiology.PDF p.5, Discussion
hypermotor neocortical versus mesial temporal estimateThe discussion cites a 6% hypermotor rate in neocortical temporal lobe epilepsy versus 1% in mesial temporal lobe epilepsy.PDF p.5, Discussion
cited hypermotor temporal lobe countThe discussion cites a study with nine hypermotor-seizure patients among 502 patients with temporal lobe epilepsy of any etiology.PDF p.5, Discussion
reported frontal structures associated with hypermotor onsetThe discussion states that earlier studies suggested origin from the medial frontal gyrus, anterior cingulate cortex, or orbitofrontal and frontal polar regions.PDF p.5, Discussion
orbitofrontal involvement with hypermotor behaviorIn both patients studied with subdural grids, orbitofrontal involvement was always present with the hypermotor behavior.PDF p.5, Discussion
temporal pole onset inferred from subdural gridsIn the two subdural-grid patients, localization of seizure onset to the temporal pole was inferred from ictal discharge at the anterior edge of the grids.PDF p.5, Discussion
temporal-pole-to-frontal spread hypothesisThe authors state that their data support the hypothesis that hypermotor manifestations associated with temporal pole lesions arise from direct spread from the pole to the frontal lobe.PDF p.6, Discussion

Reported values

3/4 thrashing or upper-extremity flexion-extensionthrashing or upper-extremity flexion-extensionProportion · n/N 3/4 · 4 patients with hypermotor seizure semiology · ictal semiologyPDF p.4, Seizure semiology on video-EEG recording
4/8 (50%) hypermotor seizure semiologyhypermotor seizure semiologyPercentage · n/N 4/8 · 8-patient temporal pole lesion cohort · ictal semiologyPDF p.1, Summary; PDF p.4, Results; PDF p.5, Discussion
4–5 Hz rhythmic scalp ictal activityanterior lateral temporal scalp ictal activity in hypermotor seizuresRate range · 4 hypermotor patients · ictal onset and spreadPDF p.4, EEG findings
3/4 hypermotor patients with anterior lateral temporal scalp ictal activityanterior lateral temporal scalp ictal activity in hypermotor seizuresProportion · n/N 3/4 · 4 hypermotor patients · ictal onset and spreadPDF p.4, EEG findings
2 seizures with rapid temporal-to-lateral-orbitofrontal spreadorbitofrontal spread in hypermotor seizuresCount · n/N 2/2 · one hypermotor patient; two recorded seizures · seizure spreadPDF p.4, EEG findings
2/2 seizures with hypermotor behavior beginning with orbitofrontal involvementhypermotor behavior with orbitofrontal involvementProportion · n/N 2/2 · two hypermotor seizures in one patient · seizure evolutionPDF p.4, EEG findings
2–3% hypermotor semiologyhypermotor semiology in temporal lobe epilepsy cited estimatePercentage Range · cited temporal lobe epilepsy populations · ictal semiologyPDF p.5, Discussion
6% neocorticalhypermotor neocortical versus mesial temporal estimatePercentage · cited neocortical temporal epilepsy population · neocortical temporal epilepsy · ictal semiologyPDF p.5, Discussion
1% mesialhypermotor neocortical versus mesial temporal estimatePercentage · cited mesial temporal epilepsy population · mesial temporal epilepsy · ictal semiologyPDF p.5, Discussion
9/502 hypermotor seizurescited hypermotor temporal lobe countProportion · n/N 9/502 · cited temporal lobe epilepsy population · ictal semiologyPDF p.5, Discussion

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdfIndependent primary study · 1 finding

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

behavioral-arrest onset phenotypePhenotype V begins with behavioral arrest and progresses to oculomotor or motor signs, including limb tonic or hypermotor activity, with a tendency to evolve into GTCS.PDF p.9, Phenotype V

30 contributing manuscripts; source-reported values remain separate and are not pooled.

Contralateral dystonic limb posturingSource terms: Dystonic limb posturingReported: BilateralAlso reported: ContralateralAlso reported: IpsilateralAlso reported: Left hemisphereAlso reported: Non-dominant hemisphereAlso reported: Right hemisphere23 manuscripts · 99 findings · 116 reported values

Weighted evidence supportevidence weight 51.89 across 23 manuscripts · 1 manuscript weight pending · 5 independent primary study · 1 structured design not resolved · 6 systematic review or meta-analysis · 10 narrative, educational, or cited context · 1 case report or observation

The discussion restates greater lateralizing value for dystonic than tonic posturing without stating the lateralizing direction. The review describes early upper-limb and orofacial elementary motor signs as mainly contralateral tonic, clonic, or dystonic manifestations. At onset, 8/21 fronto-opercular epilepsy patients had contralateral brachial tonic, clonic, or dystonic posturing. Four of 12 prefrontal-operculum patients had contralateral brachial tonic, clonic, or dystonic posturing at onset. Four of nine precentral Rolandic-operculum patients had contralateral brachial tonic, clonic, or dystonic posturing at onset. This row restates the Fisher exact test for the contralateral brachial combined-sign comparison. Table 3 reports three studies assessing contralateral dystonic posturing. Table 3 reports 45 patients assessed for contralateral dystonic posturing. Across included lateral-temporal studies, contralateral dystonic posturing ranged from 0–60%. Table 3 reports one study contributing onset timing for contralateral dystonic posturing. One lateral-temporal study reported median onset of contralateral dystonic posturing at 26 seconds. The random-effects odds of contralateral dystonic posturing occurrence in lateral TLE were 0.15. The overall odds estimate for contralateral dystonic posturing has a 95% confidence interval of 0.01–2.95. The heterogeneity test for the contralateral dystonic-posturing odds estimate is p=0.0037. Table 5 reports three studies comparing contralateral dystonic posturing across lateral and mesial TLE. Table 5 reports 45 lateral-TLE patients assessed for contralateral dystonic posturing. Table 5 reports 96 mesial-TLE patients assessed for contralateral dystonic posturing. Study-level lateral-TLE prevalence of contralateral dystonic posturing ranged from 0–60%. Study-level mesial-TLE prevalence of contralateral dystonic posturing ranged from 40–74.2%. The review restates that dystonic limb posturing reliably predicts seizure onset in the contralateral hemisphere. The educational tables label ictal dystonia as contralateral. The cited series includes delayed motor signs, including source-described contralateral dystonia, without a reported onset-side direction. The review synthesis describes early upper-extremity dystonic and clonic activity as contralateral to the temporal seizure focus. Right-sided motor manifestations accompanied a case interpreted as left mesial temporal epilepsy. The review describes automatisms with dystonia as a strong but direction-unspecified lateralisation clue and preserves the ictal/postictal distinction. The table restates dystonic posturing as contralateral. The review states that dystonic posturing tends to occur contralateral to seizure onset. The review restates that the dystonic limb is contralateral to the epileptogenic zone in more than 90% of cases. The cited review restates early facial activity and contralateral motor activity as suggestive of neocortical temporal epilepsy. The cited Chassoux series restatement includes bilateral tonic-clonic seizures alongside oro-alimentary, salivation, dystonic, and head-deviation phenomena. Dystonic posturing in the reviewed ACC cases was reported as contralateral to seizure onset and occurred later in ictal propagation. The paper restates that ictal dystonia in temporal lobe epilepsy is almost always contralateral to the hemisphere or epileptogenic focus. The review describes ictal dystonic posturing as contralateral to seizure onset and basal-ganglia hyperperfusion as contralateral to the posturing. The table reports ipsilateral, contralateral, and bilateral dystonic posturing, but it does not define what those labels are relative to. All 34 seizures with unilateral dystonia placed it contralateral to the EEG seizure-onset focus; none were ipsilateral. The review associates mesial-temporal automatisms with hand or mouth movements, ictal speech with nondominant seizures, and unilateral dystonic posturing with a contralateral seizure-onset relation. Cerebral lateralization: these signs are contralateral to seizure onset; target lobe is not differentiated by these signs alone. Table 3 reports one study assessing ipsilateral dystonic posturing. Table 3 reports 13 patients assessed for ipsilateral dystonic posturing. Ipsilateral dystonic posturing was reported in 23.1% of the lateral-temporal population represented in the table. Table 5 reports one study comparing ipsilateral dystonic posturing across lateral and mesial TLE. Table 5 reports 13 lateral-TLE patients assessed for ipsilateral dystonic posturing. Table 5 reports 45 mesial-TLE patients assessed for ipsilateral dystonic posturing. Ipsilateral dystonic posturing occurred in 23.1% of the reported lateral-TLE subgroup. Ipsilateral dystonic posturing occurred in 2.2% of the reported mesial-TLE subgroup. Unilateral dystonic posturing predicted the epileptogenic zone contralateral to the postured limb with a reported PPV of 75%. Among five patients with upper-limb dystonia, three were labeled contralateral and two ipsilateral, a slight contralateral numerical predominance. The review distinguishes right-temporal tendencies for selected automatisms or well-formed ictal language, contralateral nonmanipulative movements and dystonia, ipsilateral early head turning with dystonia, and predominantly contralateral late or versive turning. The study reports sign-specific epileptogenic-zone direction, predominantly contralateral, with ipsilateral direction for asymmetric clonic ending. The review describes head/eye deviation as suggesting an ipsilateral focus and other listed unilateral motor signs as usually indicating a contralateral focus. The review reports unilateral dystonic posturing as predominantly contralateral to the epileptogenic zone. Unilateral dystonic posturing was overwhelmingly contralateral to seizure onset in the cited series. The review reports unilateral dystonic posturing as contralateral to the epileptogenic zone in 96% of 29 affected patients, with one ipsilateral exception. The cited Dupont series is restated as predominantly ipsilateral automatisms in mesial TLE, exclusively contralateral automatisms in neocortical TLE, and contralateral dystonia plus ipsilateral automatisms only in mesial TLE. This finding provides no lateralization information. The category definition reports no lateralizing direction. The 3.4% value is composition of non-topological data and reports no lateralizing direction. The all-data panel count supplies no lateralizing direction. The non-topological panel count supplies no lateralizing direction. No lateralization axis information is reported for dystonic posturing versus affective/autonomic aura. No hemisphere or body-side direction is reported. No lateralization evidence is reported. Figure 6 reports OR 5.2 for Affective/autonomic aura relative to Dystonic posturing, with no hemisphere or lateralization direction. No lateralizing direction is reported.

Source-defined result groups 63

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelycontralateral upper limb dystonia · ipsilateral · patient1 manuscript · 1 reported value · not pooled

Localization: T+ / TLSource-defined values retained separatelyT+ · TL 30.5% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Localization: T+ / TLSource-defined values retained separatelyT+ · TL 3.4% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Localization: T+ / TLSource-defined values retained separatelyTL · T+ 17.4% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 33.3%12 patients with EZ in the prefrontal operculum · precentral Rolandic operculum group (N=9) · patients in the prefrontal operculum group1 manuscript · 1 reported value · not pooled

Localization: T+ / TLSource-defined values retained separatelyT+ · TL 0% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyasymmetric clonic ending · representative seizure with sign1 manuscript · 1 reported value · not pooled

Localization: anterior cingulate cortex/cingulate seizure casesSource-defined values retained separatelypatient-level frequency synthesized across eligible studies1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTemporal lobe epilepsy; all observed cases · seizure1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 0.0%All reported · individual1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · propagation timing · seconds from seizure onset1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · reported sign prevalence across included studies1 manuscript · 1 reported value · not pooled

Lateralization: IpsilateralSource-defined values retained separatelyLateral TLE patients assessed for Ipsilateral dystonic posturing · mesial TLE percentage shown separately · reported lateral-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · Table 3 point estimate 19% · Table 3 between-report frequency range1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 44.4%9 patients with EZ in the precentral Rolandic operculum · prefrontal operculum group (N=12) · patients in the precentral Rolandic operculum group1 manuscript · 1 reported value · not pooled

Localization: T+ / TLSource-defined values retained separatelyTL · T+ 21.7% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyLateral TLE patients assessed for Contralateral dystonic posturing · mesial TLE percentage shown separately · reported lateral-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyMesial TLE patients assessed for Contralateral dystonic posturing · lateral TLE percentage shown separately · reported mesial-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 44.4%9 patients with EZ in the precentral Rolandic operculum · prefrontal operculum group (N=12) · patients in the precentral Rolandic operculum group1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyAll reported · propagation timing · seconds from seizure onset1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyAll reported · absence of the same sign in lateral TLE · random-effects summary odds of sign occurrence1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyunilateral tonic · representative seizure with sign1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · reported sign prevalence across included studies1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 3.3%All reported · individual1 manuscript · 1 reported value · not pooled

Localization: reviewed anterior cingulate cortex seizure casesSource-defined values retained separatelyMotor (gestural) automatisms · pairwise symptom-occurrence comparison1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyunilateral clonic · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyM2e · representative seizure with sign1 manuscript · 1 reported value · not pooled

Localization: T+ / TLSource-defined values retained separatelyTL · T+ 4.3% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyMesial TLE patients assessed for Ipsilateral dystonic posturing · lateral TLE percentage shown separately · reported mesial-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyleft sphenoidal · left versus right temporal/sphenoidal recording maxima · source-defined interictal sharp-wave observations and single-case seizure observations1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyLateral TLE patients assessed for Ipsilateral dystonic posturing · mesial TLE percentage shown separately · reported lateral-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Localization: T+ / TLSource-defined values retained separatelyT+ · TL 27.1% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyFig of 4 · representative seizure with sign1 manuscript · 1 reported value · not pooled

Localization: reviewed anterior cingulate cortex seizure casesSource-defined values retained separatelyAutonomic signs · pairwise symptom-occurrence comparison1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 33.3%12 patients with EZ in the prefrontal operculum · precentral Rolandic operculum group (N=9) · patients in the prefrontal operculum group1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyAll reported · reported sign prevalence across included studies1 manuscript · 1 reported value · not pooled

Localization: FrontalSource-defined values retained separatelyfrontal localization given dystonic seizure · localizing data point1 manuscript · 1 reported value · not pooled

Localization: reviewed anterior cingulate cortex seizure casesSource-defined values retained separatelyVocalization/verbalization · pairwise symptom-occurrence comparison1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyright sphenoidal · left versus right temporal/sphenoidal recording maxima · source-defined interictal sharp-wave observations and single-case seizure observations1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 38.1%All reported · prefrontal operculum versus precentral Rolandic operculum · all included patients1 manuscript · 1 reported value · not pooled

Localization: reviewed anterior cingulate cortex seizure casesSource-defined values retained separatelyFacial expression change · pairwise symptom-occurrence comparison1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 0.0%ipsilateral to EEG focus · 34 contralateral seizures · seizures1 manuscript · 1 reported value · not pooled

Lateralization: IpsilateralSource-defined values retained separatelyAll reported · reported sign prevalence across included studies1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyleft anterior temporal · left versus right temporal/sphenoidal recording maxima · source-defined interictal sharp-wave observations and single-case seizure observations1 manuscript · 1 reported value · not pooled

Localization: reviewed anterior cingulate cortex seizure casesSource-defined values retained separatelyDystonic posturing · pairwise symptom-occurrence comparison1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyipsilateral upper limb dystonia · contralateral · patient1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelydystonia · representative seizure with sign1 manuscript · 1 reported value · not pooled

Localization: orbitofrontal cortex-restricted epileptogenic-zone networkSource-defined values retained separatelyOFC-restricted EZN cases · patients1 manuscript · 1 reported value · not pooled

Localization: T+ / TLSource-defined values retained separatelyTL · T+ 0% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 29.3%contralateral to EEG focus · 0 ipsilateral seizures · seizures1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 38.1%All reported · prefrontal operculum versus precentral Rolandic operculum · all included patients1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyMesial TLE patients assessed for Contralateral dystonic posturing · lateral TLE percentage shown separately · reported mesial-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Localization: cingulateSource-defined values retained separatelycingulate localization · localizing data point1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTemporal lobe epilepsy; all observed cases · patient1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyversion · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyLateral TLE patients assessed for Contralateral dystonic posturing · mesial TLE percentage shown separately · reported lateral-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyTodd's paralysis · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyOverall; all observed cases were temporal · sign-positive lateralization1 manuscript · 1 reported value · not pooled

Lateralization: IpsilateralSource-defined values retained separatelyMesial TLE patients assessed for Ipsilateral dystonic posturing · lateral TLE percentage shown separately · reported mesial-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 23

Alphabetical by manuscript.

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdfSystematic review or meta-analysis · 8 findings · 3 reported values

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

dystonicTable 1 defines or exemplifies the the source's own semiology category “dystonic” as Twisted posture or reported dystonia.PDF p.7, Table 1 Semiology descriptions and frequencies
dystonicDystonic semiology comprised 3.4% of non-topological data.PDF p.7, Table 1 Semiology descriptions and frequencies
dystonic; Figure 3 all-data subsetFigure 3 reports N = 634 for the all-data dystonic panel.PDF p.9, Figure 3 and caption
dystonic; Figure 3 non-topological subsetFigure 3 reports N = 120 for the non-topological dystonic panel.PDF p.9, Figure 3 and caption
dystonic; frontal lobeDystonic seizures originated mainly from the frontal lobe in 53%.PDF p.8, Seizure semiology localizing values
dystonic; frontal lobeThe 95% CI for dystonic; frontal lobe was 40%–66%.PDF p.8, Seizure semiology localizing values
dystonic; cingulatedystonic semiology was cingulate in 5%.PDF p.8, Seizure semiology localizing values
dystonic; cingulateThe 95% CI for dystonic; cingulate was 2%–9%.PDF p.8, Seizure semiology localizing values

Reported values

dystonic 3.4%dystonicPercentage · non-topological Semio2Brain dataPDF p.7, Table 1 Semiology descriptions and frequencies
dystonic; frontal lobe 53%dystonic; frontal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
dystonic; cingulate 5%dystonic; cingulatePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 1 finding · 9 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 5.65 · 2 × 1.5 × 1.882

Findings

dystonic posturingDystonic posturing did not differ significantly between TL and T+ groups across ipsilateral, contralateral, and bilateral forms.PDF p.6, Table 2

Reported values

T+ 0%dystonic posturingPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictalPDF p.6, Table 2
P=0.43dystonic posturingP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictalPDF p.6, Table 2
T+ 17.4%dystonic posturingPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictalPDF p.6, Table 2
TL 30.5%dystonic posturingPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictalPDF p.6, Table 2
TL 27.1%dystonic posturingPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictalPDF p.6, Table 2
T+ 4.3%dystonic posturingPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictalPDF p.6, Table 2
TL 3.4%dystonic posturingPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictalPDF p.6, Table 2
T+ 21.7%dystonic posturingPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictalPDF p.6, Table 2
TL 0%dystonic posturingPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictalPDF p.6, Table 2

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfNarrative, educational, or cited context · 1 finding

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

delayed motor signs (Duchowny study)The cited Duchowny series is described as having behavioral arrest and delayed motor signs including version, contralateral dystonia, clonic jerks, and automatisms.PDF p.7, cited-study discussion

blair-temporal-lobe-epilepsy-semiology-2012.pdfNarrative, educational, or cited context · 1 finding

blair-temporal-lobe-epilepsy-semiology-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Dystonic limb posturingDystonic posturing of the arms and legs is described as reliably predicting seizure onset in the contralateral hemisphere.PDF p.4, Table 2; PDF p.4, section 4; PDF p.5, dystonic-posturing paragraph

chassoux-ictal-semiology-anterior-cingulate-epilepsy-systematic-review-2025.pdfSystematic review or meta-analysis · 34 findings · 31 reported values

chassoux-ictal-semiology-anterior-cingulate-epilepsy-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

dystonic posturing; contralateral to seizure onsetDystonic posturing occurred in 19% of patients and was contralateral to seizure onset.PDF p.9, Objective symptomatology
dystonic posturing; head-eye deviation; tonic-clonic manifestationsThe review links dystonic posturing, head/eye deviation, and tonic-clonic manifestations to propagation rather than the earliest seizure phase.PDF p.11, Anatomical and clinical correlations
dystonic posturingThe source reports a frequency of 19% for dystonic posturing.PDF p.13, Table 3
dystonic posturing; reported frequency rangeThe source reports a frequency range of 0–60% for dystonic posturing.PDF p.13, Table 3
dystonic posturing; ACC association gradeTable 3 assigns the source's Moderate overall association grade to dystonic posturing.PDF p.13, Table 3
dystonic posturing; Figure 4 rateFigure 4 displays a 19.4% rate for dystonic posturing.PDF p.10, Figure 4
pairwise OR: Dystonic posturing relative to Vocalization/verbalizationFigure 6 reports an odds ratio of 0.2 for Dystonic posturing relative to Vocalization/verbalization.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of 0.2 for Dystonic posturing relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to Affective/autonomic auraFigure 6 reports an odds ratio of 0.2 for Dystonic posturing relative to Affective/autonomic aura.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to Autonomic signsFigure 6 reports an odds ratio of 0.3 for Dystonic posturing relative to Autonomic signs.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to Facial expression changeFigure 6 reports an odds ratio of 0.3 for Dystonic posturing relative to Facial expression change.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 0.3 for Dystonic posturing relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to Loss of consciousnessFigure 6 reports an odds ratio of 0.4 for Dystonic posturing relative to Loss of consciousness.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to Post-ictal confusion/behavior change disinhibitionFigure 6 reports an odds ratio of 0.5 for Dystonic posturing relative to Post-ictal confusion/behavior change disinhibition.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to Chapeau de gendarmeFigure 6 reports an odds ratio of 0.9 for Dystonic posturing relative to Chapeau de gendarme.PDF p.12, Figure 6
pairwise OR: Vocalization/verbalization relative to Dystonic posturingFigure 6 reports an odds ratio of 6.5 for Vocalization/verbalization relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to Dystonic posturingFigure 6 reports an odds ratio of 6.2 for Hypermotor-complex motor behavior relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Affective/autonomic aura relative to Dystonic posturingFigure 6 reports an odds ratio of 5.2 for Affective/autonomic aura relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Autonomic signs relative to Dystonic posturingFigure 6 reports an odds ratio of 3.9 for Autonomic signs relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Facial expression change relative to Dystonic posturingFigure 6 reports an odds ratio of 3.6 for Facial expression change relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to Dystonic posturingFigure 6 reports an odds ratio of 3.1 for Motor (gestural) automatisms relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Loss of consciousness relative to Dystonic posturingFigure 6 reports an odds ratio of 2.3 for Loss of consciousness relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Post-ictal confusion/behavior change disinhibition relative to Dystonic posturingFigure 6 reports an odds ratio of 1.8 for Post-ictal confusion/behavior change disinhibition relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Chapeau de gendarme relative to Dystonic posturingFigure 6 reports an odds ratio of 1.1 for Chapeau de gendarme relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Dystonic posturingFigure 6 reports an odds ratio of 0.7 for Head-eye deviation relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Laughter relative to Dystonic posturingFigure 6 reports an odds ratio of 0.6 for Laughter relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to Dystonic posturingFigure 6 reports an odds ratio of 0.4 for Oro-alimentary automatisms relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Tonic-clonic relative to Dystonic posturingFigure 6 reports an odds ratio of 0.4 for Tonic-clonic relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: F to BTC relative to Dystonic posturingFigure 6 reports an odds ratio of 0.2 for F to BTC relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to Head-eye deviationFigure 6 reports an odds ratio of 1.5 for Dystonic posturing relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to LaughterFigure 6 reports an odds ratio of 2.2 for Dystonic posturing relative to Laughter.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 2.5 for Dystonic posturing relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to Tonic-clonicFigure 6 reports an odds ratio of 4.2 for Dystonic posturing relative to Tonic-clonic.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to F to BTCFigure 6 reports an odds ratio of 4.2 for Dystonic posturing relative to F to BTC.PDF p.12, Figure 6

Reported values

19%dystonic posturing; contralateral to seizure onsetPercentage · Reviewed ACC seizure cases with reported semiology · Reviewed ACC seizure casesPDF p.9, Objective symptomatology
19% (frequency range 0–60%)dystonic posturingPercentage · Reviewed ACC seizure cases with reported semiology · ictal propagationPDF p.13, Table 3
19.4%dystonic posturing; Figure 4 ratePercentage · Reviewed ACC seizure cases with reported semiology · ictal propagationPDF p.10, Figure 4
OR 0.2pairwise OR: Dystonic posturing relative to Vocalization/verbalizationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.2pairwise OR: Dystonic posturing relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.2pairwise OR: Dystonic posturing relative to Affective/autonomic auraOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.3pairwise OR: Dystonic posturing relative to Autonomic signsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.3pairwise OR: Dystonic posturing relative to Facial expression changeOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.3pairwise OR: Dystonic posturing relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.4pairwise OR: Dystonic posturing relative to Loss of consciousnessOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.5pairwise OR: Dystonic posturing relative to Post-ictal confusion/behavior change disinhibitionOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.9pairwise OR: Dystonic posturing relative to Chapeau de gendarmeOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 6.5pairwise OR: Vocalization/verbalization relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 6.2pairwise OR: Hypermotor-complex motor behavior relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 5.2pairwise OR: Affective/autonomic aura relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 3.9pairwise OR: Autonomic signs relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 3.6pairwise OR: Facial expression change relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 3.1pairwise OR: Motor (gestural) automatisms relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 2.3pairwise OR: Loss of consciousness relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.8pairwise OR: Post-ictal confusion/behavior change disinhibition relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.1pairwise OR: Chapeau de gendarme relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.7pairwise OR: Head-eye deviation relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.4pairwise OR: Laughter relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.4pairwise OR: Oro-alimentary automatisms relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.2pairwise OR: Tonic-clonic relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.2pairwise OR: F to BTC relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.5pairwise OR: Dystonic posturing relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 2.2pairwise OR: Dystonic posturing relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 2.5pairwise OR: Dystonic posturing relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 4.2pairwise OR: Dystonic posturing relative to Tonic-clonicOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 4.2pairwise OR: Dystonic posturing relative to F to BTCOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 2 findings · 1 reported value

chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

mesial temporal automatisms; ictal speech; unilateral dystonic posturingMesial temporal automatisms often involve the hands or mouth; less common vocalisations and ictal speech are associated with non-dominant seizures; unilateral dystonic posturing can occur and is described as a contralateral sign.PDF p.5, Mesial temporal lobe including hippocampus
unilateral clonic movement; unilateral tonic/dystonic posturing; early head versionThe review describes unilateral clonic movements, unilateral tonic or dystonic posturing, and early forced head version as robust lateralising motor signs with positive predictive value greater than 80%, and states that these signs are contralateral to the side of seizure onset.PDF p.10, Lateralising signs

Reported values

positive predictive value >80%unilateral clonic movement; unilateral tonic/dystonic posturing; early head versionPositive predictive value · focal seizure literature · ictal onset/early ictalPDF p.10, Lateralising signs

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

dystonic elementary motor phenomenonOne restricted-OFC case had a dystonic elementary motor phenomenon.PDF p.2, Semiology patterns of seizures with EZN restricted to the OFC

Reported values

1 patientdystonic elementary motor phenomenonCount · OFC-restricted EZN cases · OFC-restricted EZN cases · ictalPDF p.2, Semiology patterns of seizures with EZN restricted to the OFC

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdfSystematic review or meta-analysis · 21 findings · 8 reported values

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

Contralateral dystonic posturingTable 3 reports 3 studies assessing Contralateral dystonic posturing.PDF p.6, Table 3
Contralateral dystonic posturingTable 3 reports 45 patients assessed for Contralateral dystonic posturing.PDF p.6, Table 3
Contralateral dystonic posturingTable 3 reports 0–60% as the percentage range or value for Contralateral dystonic posturing; the overall association grade is Low.PDF p.6, Table 3
Contralateral dystonic posturingTable 3 reports 1 study with onset timing for Contralateral dystonic posturing.PDF p.6, Table 3
Contralateral dystonic posturingTable 3 reports an onset latency of 26 s for Contralateral dystonic posturing.PDF p.6, Table 3
odds of occurrence; Contralateral dystonic posturingTable 4 reports overall odds of 0.15 for occurrence of Contralateral dystonic posturing in lateral TLE.PDF p.7, Table 4; PDF p.8, Figure 2
odds confidence interval; Contralateral dystonic posturingTable 4 reports a 95% confidence interval of 0.01–2.95 for the overall odds of Contralateral dystonic posturing.PDF p.7, Table 4; PDF p.8, Figure 2
heterogeneity test; Contralateral dystonic posturingThe heterogeneity test for the Table 4 odds estimate for Contralateral dystonic posturing has p=0.0037.PDF p.7, Table 4
Contralateral dystonic posturing; lateral versus mesial comparisonTable 5 reports 3 studies comparing Contralateral dystonic posturing in lateral and mesial TLE.PDF p.9, Table 5
Contralateral dystonic posturing; lateral TLE patient denominatorTable 5 reports 45 lateral-TLE patients assessed for Contralateral dystonic posturing.PDF p.9, Table 5
Contralateral dystonic posturing; mesial TLE patient denominatorTable 5 reports 96 mesial-TLE patients assessed for Contralateral dystonic posturing.PDF p.9, Table 5
Contralateral dystonic posturing; lateral TLE prevalenceTable 5 reports a lateral-TLE percentage of 0–60% for Contralateral dystonic posturing.PDF p.9, Table 5
Contralateral dystonic posturing; mesial TLE prevalenceTable 5 reports a mesial-TLE percentage of 40–74.2% for Contralateral dystonic posturing.PDF p.9, Table 5
Ipsilateral dystonic posturingTable 3 reports 1 studies assessing Ipsilateral dystonic posturing.PDF p.6, Table 3
Ipsilateral dystonic posturingTable 3 reports 13 patients assessed for Ipsilateral dystonic posturing.PDF p.6, Table 3
Ipsilateral dystonic posturingTable 3 reports 23.1% as the percentage range or value for Ipsilateral dystonic posturing; the overall association grade is Low.PDF p.6, Table 3
Ipsilateral dystonic posturing; lateral versus mesial comparisonTable 5 reports 1 studies comparing Ipsilateral dystonic posturing in lateral and mesial TLE.PDF p.9, Table 5
Ipsilateral dystonic posturing; lateral TLE patient denominatorTable 5 reports 13 lateral-TLE patients assessed for Ipsilateral dystonic posturing.PDF p.9, Table 5
Ipsilateral dystonic posturing; mesial TLE patient denominatorTable 5 reports 45 mesial-TLE patients assessed for Ipsilateral dystonic posturing.PDF p.9, Table 5
Ipsilateral dystonic posturing; lateral TLE prevalenceTable 5 reports a lateral-TLE percentage of 23.1% for Ipsilateral dystonic posturing.PDF p.9, Table 5
Ipsilateral dystonic posturing; mesial TLE prevalenceTable 5 reports a mesial-TLE percentage of 2.2% for Ipsilateral dystonic posturing.PDF p.9, Table 5

Reported values

0–60%Contralateral dystonic posturingPercentage Range · Lateral temporal epilepsy patients assessed for Contralateral dystonic posturing · ictalPDF p.6, Table 3
median onset latency 26 sContralateral dystonic posturingMedian · Lateral temporal epilepsy study reporting onset timing for Contralateral dystonic posturing · ictal onsetPDF p.6, Table 3
odds 0.15odds of occurrence; Contralateral dystonic posturingOdds · Lateral temporal epilepsy patients assessed for Contralateral dystonic posturing · ictalPDF p.7, Table 4; PDF p.8, Figure 2
0–60%Contralateral dystonic posturing; lateral TLE prevalencePercentage Range · Lateral TLE patients assessed for Contralateral dystonic posturing · Lateral TLE patients assessed for Contralateral dystonic posturing · ictalPDF p.9, Table 5
40–74.2%Contralateral dystonic posturing; mesial TLE prevalencePercentage Range · Mesial TLE patients assessed for Contralateral dystonic posturing · Mesial TLE patients assessed for Contralateral dystonic posturing · ictalPDF p.9, Table 5
23.1%Ipsilateral dystonic posturingPercentage · Lateral temporal epilepsy patients assessed for Ipsilateral dystonic posturing · ictalPDF p.6, Table 3
23.1%Ipsilateral dystonic posturing; lateral TLE prevalencePercentage · Lateral TLE patients assessed for Ipsilateral dystonic posturing · Lateral TLE patients assessed for Ipsilateral dystonic posturing · ictalPDF p.9, Table 5
2.2%Ipsilateral dystonic posturing; mesial TLE prevalencePercentage · Mesial TLE patients assessed for Ipsilateral dystonic posturing · Mesial TLE patients assessed for Ipsilateral dystonic posturing · ictalPDF p.9, Table 5

elwan-kotagal-lateralizing-localizing-seizure-semiology-2018.pdfIndependent primary study · 1 finding · 4 reported values

elwan-kotagal-lateralizing-localizing-seizure-semiology-2018.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

Unilateral dystonic posturingUnilateral dystonic posturing was reported as a contralateral lateralizing sign with 75% PPV and inter-observer kappa of 0.80, and was observed only in temporal lobe epilepsy.PDF p.3, Table 1; PDF p.3, §5.1

Reported values

inter-observer kappa 0.80Unilateral dystonic posturingKappa · Sign-positive occurrences included 8 seizures in 7 patients, all in temporal lobe epilepsy. · IctalPDF p.3, Table 1; PDF p.3, §5.1
8 seizures with unilateral dystonic posturingUnilateral dystonic posturingCount · Sign-positive occurrences included 8 seizures in 7 patients, all in temporal lobe epilepsy. · Temporal lobe epilepsy; all observed cases · IctalPDF p.3, Table 1; PDF p.3, §5.1
7 patients with unilateral dystonic posturingUnilateral dystonic posturingCount · Sign-positive occurrences included 8 seizures in 7 patients, all in temporal lobe epilepsy. · Temporal lobe epilepsy; all observed cases · IctalPDF p.3, Table 1; PDF p.3, §5.1
PPV 75% (contralateral)Unilateral dystonic posturingPositive predictive value · Sign-positive occurrences included 8 seizures in 7 patients, all in temporal lobe epilepsy. · Overall; all observed cases were temporal · IctalPDF p.3, Table 1; PDF p.3, §5.1

epilepsy-fellowship-handbook-semiologyreferences.pdfNarrative, educational, or cited context · 1 finding

epilepsy-fellowship-handbook-semiologyreferences.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Not reported. The excerpt is an educational handbook table and reports no study design, setting, cohort, analysis population, ascertainment method, comparator, reference standard, sample size, or statistical analysis.

Findings

Ictal dystoniaBoth tables list Ictal dystonia as Contralateral.PDF p.2, Lateralizing signs/Localization table row "Ictal dystonia" (printed p.7); PDF p.3, Lateralizing signs/Localization table row "Ictal dystonia" (printed p.5)

foldvary-focal-epilepsy-surgical-evaluation-comprehensive-clinical-neurophysiology-2000.pdfCase report or observation · 2 findings · 3 reported values

foldvary-focal-epilepsy-surgical-evaluation-comprehensive-clinical-neurophysiology-2000.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

This is an educational chapter rather than a single primary cohort. The general text synthesizes source-cited series involving focal epilepsy, temporal/mesial temporal epilepsy, and frontal, parietal, or occipital epilepsy, and separately presents three illustrative case observations. The source uses patients, cases, seizures, and source-defined observations as analysis units; no common cohort, eligibility rule, comparator, reference standard, or chapter-wide denominator is reported. The report retains the source's unit and missingness for each finding and does not infer denominators from percentages.

Findings

contralateral upper-extremity dystonic and clonic activityIn a series comparing mesial and neocortical temporal seizure semiology, automatisms and dystonic posturing of the contralateral upper extremity early in the seizure were more common in mesial temporal epilepsy, whereas early clonic activity of the contralateral upper extremity or facial grimacing suggested neocortical temporal origin.PDF p.4, temporal seizure semiology paragraph beginning "In series comparing mesial"
Case Study 1 olfactory aura, dystonic posturing, and left temporal findingsIn Case Study 1, a right-handed woman had recurrent unusual-odor auras without initial loss of consciousness, later seizures with loss of awareness, oral/manual automatisms, unintelligible speech, left-hand automatisms, right-arm dystonic posturing, and head version to the right. Interictal sharp waves were maximal at the left sphenoidal electrode in 90% of the source-defined observations versus 5% at the left anterior temporal and 5% at the right sphenoidal electrode, and ictal rhythmic delta followed by repetitive spiking was maximal in the left temporal region; the chapter's discussion interpreted the combined history and testing as left mesial temporal lobe epilepsy.PDF p.12, Case Study 1, history and seizure description; PDF p.12, Case Study 1, interictal and ictal EEG paragraph; PDF p.12, Case Study 1, Discussion

Reported values

5% right sphenoidalCase Study 1 olfactory aura, dystonic posturing, and left temporal findingsPercentage · Single illustrative case, 31-year-old right-handed woman with poorly controlled seizures · right sphenoidal · aura, ictal, and interictalPDF p.12, Case Study 1, history and seizure description; PDF p.12, Case Study 1, interictal and ictal EEG paragraph; PDF p.12, Case Study 1, Discussion
90% left sphenoidalCase Study 1 olfactory aura, dystonic posturing, and left temporal findingsPercentage · Single illustrative case, 31-year-old right-handed woman with poorly controlled seizures · left sphenoidal · aura, ictal, and interictalPDF p.12, Case Study 1, history and seizure description; PDF p.12, Case Study 1, interictal and ictal EEG paragraph; PDF p.12, Case Study 1, Discussion
5% left anterior temporalCase Study 1 olfactory aura, dystonic posturing, and left temporal findingsPercentage · Single illustrative case, 31-year-old right-handed woman with poorly controlled seizures · left anterior temporal · aura, ictal, and interictalPDF p.12, Case Study 1, history and seizure description; PDF p.12, Case Study 1, interictal and ictal EEG paragraph; PDF p.12, Case Study 1, Discussion

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 2 findings · 5 reported values

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

dystonic limb posturingDystonic limb posturing is more common in TLE than EXTLE, typically follows bilateral manual automatisms or occurs with automatisms in the other upper limb, and is contralateral to the epileptogenic zone in more than 90% of cases. When accompanied by manual automatisms and ipsilateral head turning, it is highly suggestive of MTLE.PDF p.4, section 4 Lateralizing motor signs in complex motor seizures; PDF p.5, Table 2
early dystonia, oral automatisms, and early facial or contralateral motor activity in NTLE versus MTLEDystonic limb posturing within 20 seconds of seizure onset was reported more often in MTLE than NTLE, 52% versus 26%, and oral automatisms were reported 69% versus 11%, respectively. Early facial grimacing or twitching and contralateral motor activity were suggestive of NTLE.PDF p.6, section 8.1 Neocortical temporal lobe epilepsy

Reported values

More than 90% contralateral to EZdystonic limb posturingPercentage · patients with focal epilepsy, including TLE and EXTLE · ictal motor, following or accompanying automatismsPDF p.4, section 4 Lateralizing motor signs in complex motor seizures; PDF p.5, Table 2
Oral automatisms in MTLE 69%early dystonia, oral automatisms, and early facial or contralateral motor activity in NTLE versus MTLEPercentage · patients with NTLE and MTLE · MTLE · within 20 seconds of seizure onset; early ictalPDF p.6, section 8.1 Neocortical temporal lobe epilepsy
Early dystonic posturing in NTLE 26%early dystonia, oral automatisms, and early facial or contralateral motor activity in NTLE versus MTLEPercentage · patients with NTLE and MTLE · NTLE · within 20 seconds of seizure onset; early ictalPDF p.6, section 8.1 Neocortical temporal lobe epilepsy
Early dystonic posturing in MTLE 52%early dystonia, oral automatisms, and early facial or contralateral motor activity in NTLE versus MTLEPercentage · patients with NTLE and MTLE · MTLE · within 20 seconds of seizure onset; early ictalPDF p.6, section 8.1 Neocortical temporal lobe epilepsy
Oral automatisms in NTLE 11%early dystonia, oral automatisms, and early facial or contralateral motor activity in NTLE versus MTLEPercentage · patients with NTLE and MTLE · NTLE · within 20 seconds of seizure onset; early ictalPDF p.6, section 8.1 Neocortical temporal lobe epilepsy

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdfNarrative, educational, or cited context · 2 findings

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

ictal SPECT, dystonic posturing, focal aware seizures, and network propagationIctal contralateral dystonic posturing is associated with hyperperfused basal ganglia in the hemisphere contralateral to the posturing, whereas ictal SPECT has lower sensitivity for temporal focal aware seizures; SPECT can show early propagation through network connectivity but is not routinely used for MTLE-HS when video-EEG and structural MRI already provide the needed localizing information and is mainly helpful for restricting areas for SEEG in MRI-normal cases.PDF p.20, Ictal SPECT in TLE; PDF p.21, Ictal SPECT in TLE
unilateral dystonic posturing, head/eye deviation, clonic or tonic movements, and hypokinesiaSecondary motor signs related to propagation outside the temporal lobe may lateralize the seizure-onset zone: unilateral dystonic posturing is usually contralateral to the focus, head or eye deviation suggests an ipsilateral focus, and other unilateral clonic or tonic movements or limb immobility usually indicate a contralateral focus.PDF p.8, Focal impaired awareness seizures

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdfSystematic review or meta-analysis · 5 findings · 3 reported values

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

elementary motor symptoms; orofacial; brachial; tonic; clonic; dystonicElementary motor symptoms were described as early, mainly involving the orofacial regions and/or arms; arm manifestations were mainly contralateral tonic, clonic, or dystonic seizures or postures.PDF p.6, Anatomical and clinical correlations; PDF p.8, Discussion
Brachial contralateral (tonic and/or clonic or dystonic posture)Table 2 reports 8/21 (38%) for Brachial contralateral (tonic and/or clonic or dystonic posture); timing is onset, and the source's overall agreement that the sign is suggestive of fronto-opercular epilepsy is graded Moderate.PDF p.7, Table 2
Brachial contralateral (tonic and/or clonic or dystonic posture)Table 2 reports 4/12 patients with Brachial contralateral (tonic and/or clonic or dystonic posture) in the prefrontal operculum group.PDF p.7, Table 2
Brachial contralateral (tonic and/or clonic or dystonic posture)Table 2 reports 4/9 patients with Brachial contralateral (tonic and/or clonic or dystonic posture) in the precentral Rolandic operculum group.PDF p.7, Table 2
Brachial contralateral (tonic and/or clonic or dystonic posture)Fisher's exact comparison of Brachial contralateral (tonic and/or clonic or dystonic posture) between the prefrontal and precentral Rolandic operculum groups has p=0.673.PDF p.7, Table 2

Reported values

8/21 (38%)Brachial contralateral (tonic and/or clonic or dystonic posture)Percentage · n/N 8/21 · 21 included fronto-opercular epilepsy patients · OnsetPDF p.7, Table 2
4/12 patientsBrachial contralateral (tonic and/or clonic or dystonic posture)Proportion · n/N 4/12 · 12 patients with EZ in the prefrontal operculum · 12 patients with EZ in the prefrontal operculum · OnsetPDF p.7, Table 2
4/9 patientsBrachial contralateral (tonic and/or clonic or dystonic posture)Proportion · n/N 4/9 · 9 patients with EZ in the precentral Rolandic operculum · 9 patients with EZ in the precentral Rolandic operculum · OnsetPDF p.7, Table 2

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdfIndependent primary study · 1 finding · 2 reported values

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdf

Independent primary study · Class II · Evidence weight 5.11 · 2 × 1.35 × 1.893

Findings

Focal motor (dystonic)Focal motor (dystonic) semiology was absent as initial semiology (0/61, 0%) and occurred in 2/61 individuals (3%) in the combined set-of-semiology.PDF p.5, Table 2

Reported values

Initial 0/61 (0%)Focal motor (dystonic)Percentage · n/N 0/61 · 61 individuals undergoing frontal lobe epilepsy surgery · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2
Combined 2/61 (3%)Focal motor (dystonic)Percentage · n/N 2/61 · 61 individuals undergoing frontal lobe epilepsy surgery · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 2 findings

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Automatisms with dystoniaThe review states that automatisms may be ictal or postictal and provide strong lateralisation clues when associated with dystonia; manipulative automatisms may be more common postictally, and EEG can help distinguish ictal from postictal automatisms.PDF p.4, section 1.6
Dystonic posturingTable 3 associates dystonic posturing with basal ganglia involvement and contralateral lateralisation.PDF p.4, Table 3

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdfNarrative, educational, or cited context · 4 findings · 12 reported values

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

unilateral dystonic posturingUnilateral dystonic posturing in temporal lobe epilepsy lateralizes predominantly to the contralateral epileptogenic zone.PDF p.6, section 3.8; PDF p.12, Table 1
unilateral dystonic posturingIn Kotagal et al., unilateral dystonic posturing was always contralateral to seizure onset.PDF p.6, section 3.8
unilateral dystonic posturingYen et al. found unilateral dystonic posturing contralateral in 96%, with one ipsilateral exception.PDF p.6, section 3.8; PDF p.12, Table 1
unilateral motor automatisms with dystonic posturingDupont et al. reported predominantly ipsilateral automatisms in mesial TLE, exclusively contralateral automatisms in neocortical TLE, and the combination of contralateral dystonia with ipsilateral automatisms only in mesial TLE.PDF p.6, section 3.9

Reported values

Unilateral dystonic posturing contralateral in 100%unilateral dystonic posturingPercentage · patients with temporal lobe epilepsy and unilateral dystonic posturing · Selected table evidence · ictalPDF p.6, section 3.8; PDF p.12, Table 1
Reported ipsilateral exception n=1unilateral dystonic posturingCount · patients with temporal lobe epilepsy and unilateral dystonic posturing · Yen report · ictalPDF p.6, section 3.8; PDF p.12, Table 1
Unilateral dystonic posturing in 43.9% of TLEunilateral dystonic posturingPercentage · patients with temporal lobe epilepsy and unilateral dystonic posturing · Temporal lobe epilepsy · ictalPDF p.6, section 3.8; PDF p.12, Table 1
100% contralateralunilateral dystonic posturingPercentage · 31 consecutive patients seizure free after temporal lobectomy plus 10 patients evaluated by video/EEG; 118 seizures reviewed · unilateral dystonic posturing · ictalPDF p.6, section 3.8
41 seizuresunilateral dystonic posturingCount · n/N 41/118 · 31 consecutive patients seizure free after temporal lobectomy plus 10 patients evaluated by video/EEG; 118 seizures reviewed · reviewed seizures · ictalPDF p.6, section 3.8
118 seizuresunilateral dystonic posturingCount · 31 consecutive patients seizure free after temporal lobectomy plus 10 patients evaluated by video/EEG; 118 seizures reviewed · reviewed seizures · ictalPDF p.6, section 3.8
18 patientsunilateral dystonic posturingCount · 31 consecutive patients seizure free after temporal lobectomy plus 10 patients evaluated by video/EEG; 118 seizures reviewed · patients with unilateral dystonic posturing · ictalPDF p.6, section 3.8
31 consecutive patientsunilateral dystonic posturingCount · 31 consecutive patients seizure free after temporal lobectomy plus 10 patients evaluated by video/EEG; 118 seizures reviewed · seizure-free after temporal lobectomy · ictalPDF p.6, section 3.8
96% contralateralunilateral dystonic posturingPercentage · 83 patients seizure free after temporal lobectomy, including 29 with dystonic posturing · patients with dystonic posturing · ictalPDF p.6, section 3.8; PDF p.12, Table 1
29/83 had dystonic posturingunilateral dystonic posturingPercentage · n/N 29/83 · 83 patients seizure free after temporal lobectomy, including 29 with dystonic posturing · unilateral dystonic posturing · ictalPDF p.6, section 3.8; PDF p.12, Table 1
1 of 29 ipsilateralunilateral dystonic posturingPercentage · n/N 1/29 · 83 patients seizure free after temporal lobectomy, including 29 with dystonic posturing · ipsilateral exception · ictalPDF p.6, section 3.8; PDF p.12, Table 1
26/60 had unilateral motor automatismsunilateral motor automatisms with dystonic posturingCount · n/N 26/60 · 60 patients with temporal lobe epilepsy, including 26 with unilateral motor automatisms · ictalPDF p.6, section 3.9

marashly-ictal-motor-sequences-lateralization-localization-values-2016.pdfIndependent primary study · 2 findings · 24 reported values

marashly-ictal-motor-sequences-lateralization-localization-values-2016.pdf

Independent primary study · Class II · Evidence weight 4.22 · 2 × 1.15 × 1.836

The authors screened 1,970 patients admitted to adult and pediatric epilepsy monitoring units at University Hospitals of Case Medical Center, Cleveland, Ohio, from 2009 through 2014; 236 had a documented secondarily generalized motor seizure. Inclusion required focal epilepsy, a video-captured seizure manifesting at least two defined motor signs, and evolution to a generalized motor seizure. Exclusions were more than one or an ill-defined EZ, focal motor signs in generalized epilepsy, or no secondary generalization during EMU monitoring. The final cohort was 47 patients: 26 with temporal lobe epilepsy, 13 with frontal lobe epilepsy, and 8 with other epilepsy types (1 parietal, 2 parieto-occipital, 3 hemispheric, 1 fronto-temporal, and 1 central). One representative seizure per patient was selected from the available video and history to reflect the patient's habitual seizure components; the face, trunk, and all limbs were visible in the selected recordings. Three investigators independently reviewed the videos while blinded to all clinical and electrographic data; a motor component was accepted when at least two readers agreed, and Fleiss Kappa quantified inter-observer agreement. The study's sign and sequence analyses therefore use one representative seizure per patient, although the manuscript alternates “patients” and “seizures” for some subset descriptions. EZ localization and lateralization were based on extensive presurgical evaluation including surface and/or invasive EEG, available MRI, PET, and SPECT, followed by presentation at a weekly patient-management conference where an expert panel agreed on each EZ using concordance across modalities; the authors call this their gold standard. The analysis was restricted to simple motor seizures and excluded complex motor seizures such as automatisms. Sequence analysis retained signs meeting the source's “reliable” PPV criterion and required at least two reliable signs; the source uses both PPV ≥80% and PPV >80% wording, documented below without resolving the discrepancy.

Findings

ictal dystoniaThe current paper reports that ictal dystonia, as described in the cited literature, almost always lateralizes to the contralateral hemisphere in temporal lobe epilepsy, and that Rusu et al. described the earliest and/or most marked dystonic posturing as contralateral to the epileptogenic focus, mainly involving the hand.PDF p.8, cited dystonia value and study definition; PDF p.12, discussion of cited duration and lateralization; PDF p.13, discussion of the cited Rusu result
version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisIn the 47 representative seizures, Table 1 reports the following prevalence counts, PPVs, and Fleiss Kappa indices: version 36, 97%, 0.6961; unilateral tonic 24, 96%, 0.2594; M2e 21, 100%, 0.7364; unilateral clonic 10, 90%, 0.3643; Fig of 4 23, 74%, 0.4873; dystonia 6, 67%, 0.2620; asymmetric clonic ending 28, 89%, 0.6761; Todd's paralysis 6, 83%, 0.4360.PDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability

Reported values

0.262version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · dystonia · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
28/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 28/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · asymmetric clonic ending · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
89%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · asymmetric clonic ending · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
67%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · dystonia · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
96%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral tonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
10/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 10/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral clonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
23/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 23/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Fig of 4 · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
36/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 36/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · version · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.2594version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral tonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.3643version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral clonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
90%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral clonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
21/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 21/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · M2e · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
83%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Todd's paralysis · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
6/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 6/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Todd's paralysis · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.6961version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · version · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
100%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · M2e · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
97%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · version · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
6/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 6/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · dystonia · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
74%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Fig of 4 · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.6761version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · asymmetric clonic ending · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.7364version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · M2e · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.4873version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Fig of 4 · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
24/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 24/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral tonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.436version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Todd's paralysis · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability

misulis-sonmezturk-ess-abou-khalil-atlas-eeg-seizure-semiology-management-3e-2022.pdfNarrative, educational, or cited context · 1 finding

misulis-sonmezturk-ess-abou-khalil-atlas-eeg-seizure-semiology-management-3e-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

temporal automatisms, dystonic posturing, and head turningOroalimentary automatisms suggest temporal involvement but are not specific; spitting, drinking, and preserved responsiveness during automatisms favor right temporal localization; manipulative automatisms alone do not lateralize, whereas nonmanipulative distal or proximal movements tend to be contralateral and may precede contralateral dystonic posturing; dystonic posturing is usually contralateral, early head turning with dystonia tends ipsilateral, late head turning is more often contralateral, and versive head turning is almost always contralateral.PDF p.50; PDF p.51

roh-lateralizing-value-ictal-behaviors-temporal-lobe-epilepsy-1996.pdfStructured design not resolved · 2 findings · 4 reported values

roh-lateralizing-value-ictal-behaviors-temporal-lobe-epilepsy-1996.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 2

The study included 19 patients with unilateral TLE who underwent anterior temporal lobectomy with amygdalohippocampectomy. Long-term video/EEG monitoring used scalp and sphenoidal electrodes; hippocampal depth electrodes were used in five patients. The epileptogenic zone was determined from ictal EEG, MRI findings including mesial temporal sclerosis, ictal SPECT, regional temporal PET, and surgical outcome; Wada-test results were used for dominant versus nondominant hemisphere classification. Two to ten seizures per patient were reviewed (mean 6.1); the cohort included 10 females and 9 males, mean age 28.7 years (range 12-43). Sixty-five seizures were classified as nondominant-hemisphere onset and 51 as dominant-hemisphere onset; 85 seizures arose from the right temporal lobe and 31 from the left. Chi-square testing was used for statistical analysis.

Findings

dystonic versus tonic posturingThe discussion distinguishes tonic from dystonic posturing, states that dystonia has greater lateralizing value, and reports that Kotagal et al. (1989) observed unilateral dystonia in 15% of patients with TLE.PDF p.5, Discussion
unilateral dystoniaIn the unilateral TLE cohort, unilateral dystonia occurred only on the side contralateral to the EEG seizure focus.PDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1

Reported values

15% of patients with TLE, as reported for Kotagal et al. (1989)dystonic versus tonic posturingPercentage · Cited TLE study as described by the current source; not independently reviewed · ictal motor posturingPDF p.5, Discussion
0 ipsilateral seizuresunilateral dystoniaCount · n/N 0/116 · 19 patients with unilateral TLE; dystonia occurred in 12 patients · ipsilateral to EEG focus · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1
34 contralateral seizures (30% of all 116 seizures)unilateral dystoniaPercentage · n/N 34/116 · 19 patients with unilateral TLE; dystonia occurred in 12 patients · contralateral to EEG focus · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1
12 patientsunilateral dystoniaCount · n/N 12/19 · 19 patients with unilateral TLE; dystonia occurred in 12 patients · patients with unilateral dystonia · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdfSystematic review or meta-analysis · 3 findings · 2 reported values

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

Chassoux cohort; oro-alimentary automatisms; salivation; dystonic signs; head deviation; bilateral tonic-clonic seizuresThe review restates that Chassoux et al. described 33 patients with oro-alimentary automatisms, salivation, motor signs including dystonia and head deviation, and bilateral tonic-clonic seizures in the medio-lateral context.PDF p.4, Medio-lateral temporal origin
dystonicTable 3 reports dystonic signs in 19% of the temporo-polar synthesis (evidence grade Low).PDF p.5, Table 3
dystonicTable 3 reports a 0–100% range for dystonic signs across the temporo-polar reports (evidence grade Low).PDF p.5, Table 3

Reported values

19%dystonicPercentage · Temporo-polar semiology synthesis represented in Table 3 · later after propagation to symptomatogenic areasPDF p.5, Table 3
range 0–100%dystonicPercentage Range · Temporo-polar semiology synthesis represented in Table 3 · later after propagation to symptomatogenic areasPDF p.5, Table 3

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

dystonic posturingThe review defines dystonic posturing as sustained, longer-than-10-second, forced, unnatural positioning of one upper extremity with a clear rotational component and states that, in temporal lobe epilepsy, it reliably lateralizes to the contralateral hemisphere; it can also occur in extratemporal epilepsy. The review relates it to basal-ganglia activation through spread and cites ictal SPECT evidence of basal-ganglia involvement.PDF p.5, Additional lateralizing signs/Dystonic posturing; PDF p.6, Dystonic posturing (continued)

Reported values

Sustained >10 secdystonic posturingCount · Patients with temporal lobe and extratemporal epilepsy; no cohort reported · Ictal, sustained >10 secPDF p.5, Additional lateralizing signs/Dystonic posturing; PDF p.6, Dystonic posturing (continued)

wang-electroclinical-insulo-opercular-epilepsy-seeg-pet-2019.pdfIndependent primary study · 1 finding · 3 reported values

wang-electroclinical-insulo-opercular-epilepsy-seeg-pet-2019.pdf

Independent primary study · Class II · Evidence weight 5.01 · 2 × 1.5 × 1.671

Findings

upper limb dystoniaUpper limb dystonia occurred in five patients; it was contralateral in three and ipsilateral in two, and could involve the whole arm or be limited to the hand.PDF p.3, Results—Seizure semiology; PDF p.5, Table 1

Reported values

five patients (23%)upper limb dystoniaPercentage · n/N 5/22 · 22 patients with insulo-opercular epilepsy · all upper limb dystonia · ictal motor semiologyPDF p.3, Results—Seizure semiology; PDF p.5, Table 1
three patientsupper limb dystoniaCount · 22 patients with insulo-opercular epilepsy · contralateral upper limb dystonia · ictal motor semiologyPDF p.3, Results—Seizure semiology; PDF p.5, Table 1
two patientsupper limb dystoniaCount · 22 patients with insulo-opercular epilepsy · ipsilateral upper limb dystonia · ictal motor semiologyPDF p.3, Results—Seizure semiology; PDF p.5, Table 1

23 contributing manuscripts; source-reported values remain separate and are not pooled.

Vertiginous aura / ictal vestibular sensationSource terms: Vertiginous auraReported: IpsilateralAlso reported: Right hemisphere20 manuscripts · 42 findings · 42 reported values

Weighted evidence supportevidence weight 49.49 across 20 manuscripts · 1 manuscript weight pending · 7 independent primary study · 7 narrative, educational, or cited context · 5 systematic review or meta-analysis · 1 structured design not resolved

The temporal-plus description preserves contraversive eye/head and ipsilateral tonic-motor relations without assigning a left/right cerebral hemisphere. The cited table describes vertiginous aura as not-lateralising but often right. No lateralizing direction is reported. No hemisphere or body-side direction is reported. Gustatory aura was associated with the TS subgroup and vestibular aura with the TPO subgroup; no lateralization is reported. No seizure lateralization is reported. The cited vertigo observations do not report a hemisphere or lateralizing direction. No cerebral direction or body-side result is reported. No lateralization relationship is reported. The primary table's dizziness/cephalic-aura result reports no hemisphere or lateralization direction. The primary odds result for Dizziness/cephalic aura reports no hemisphere or lateralization direction. The primary lateral-TLE percentage range for Dizziness/cephalic aura reports no hemisphere or lateralization direction. The primary mesial-TLE percentage range for Dizziness/cephalic aura reports no hemisphere or lateralization direction. No lateralization axis information is reported for the nine vertiginous-sensation patients. No lateralization axis information is reported for the 11 vertiginous-sensation entries. No lateralizing direction is reported for the dizzy aura reproduced at electrode 8. The educational stimulation statement contains no lateralization evidence. No lateralization axis information is reported for the review's vertigo frequency. The review table reports vertigo in seven basal-temporal cases (8%) with no hemisphere or lateralizing direction. The review reports vertigo in 4/60 high- or very-high-confidence basal-temporal EZ cases (7%) with no hemisphere or lateralizing direction. No lateralization axis information is reported for stimulation-evoked vestibular sensations. This record provides no seizure lateralization. No lateralization axis information is reported for the typical anterior freezing/lightheadedness aura. No lateralizing direction is reported for the posterior-cingulate falling aura. The patient-level falling, gustatory, and abdominal aura entry gives no body-side or hemisphere information. The primary result reports no lateralization; vertigo frequencies did not differ significantly across the M, ML, and L temporal-onset groups. The primary comparison reports no hemisphere-level lateralization; it compares M, ML, and L temporal-onset subtypes. The review places fear, auditory or gustatory hallucinations, sensory hallucinations, and vertigo between lateral and medial temporal patterns.

Source-defined result groups 25

Localization: Insular / ParietalObserved proportion 100.0%pain at seizure onset · other SOZ · patient1 manuscript · 1 reported value · not pooled

Localization: ParietalSource-defined values retained separatelyAll reported · no vertiginous sensation · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 8.3%M · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTL · T+ · seizures1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyT+ · seizures1 manuscript · 1 reported value · not pooled

Localization: InsularObserved proportion 7.5%All reported · other insular stimulation sites and vestibular description categories · evoked vestibular response1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyT+ · seizures1 manuscript · 1 reported value · not pooled

Localization: Insular / ParietalObserved proportion 100.0%choking sensation · other SOZ · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · reported sign prevalence across included studies1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyMesial TLE patients assessed for Dizziness/cephalic aura · lateral TLE percentage shown separately · reported mesial-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 12.5%M · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: falling aura / posterior cingulate lesionObserved proportion 25.0%All reported · other posterior aura terms · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyLateral TLE patients assessed for Dizziness/cephalic aura · mesial TLE percentage shown separately · reported lateral-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTL · T+ · seizures1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 11.1%ML · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 33.3%ML · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 84.6%L · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyVestibular-response contacts · other insular stimulation sites and vestibular description categories · stimulation contact1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 15.4%L · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: Insular / ParietalObserved proportion 100.0%vertigo or falling sensation · other SOZ · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTL · T+ · seizures1 manuscript · 1 reported value · not pooled

Localization: ParietalSource-defined values retained separatelyAll reported · other aura categories · aura entries1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 20

Alphabetical by manuscript.

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfStructured design not resolved · 3 findings · 2 reported values

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.301

Findings

typical anterior freezing/lightheadedness auraOne typical anterior patient had a subjective sensation of freezing with or without lightheadedness.PDF p.3, Clinical Presentation
posterior cingulate falling auraThe source reports 1 posterior cingulate patient with falling aura.PDF p.5, Clinical Presentation
patient 12 falling/gustatory/abdominal auraFalling, gustatory, and abdominal aura terms were listed for patient 12.PDF p.4, Figure 3

Reported values

1/6 subjective freezing aura with or without lightheadednesstypical anterior freezing/lightheadedness auraProportion · n/N 1/6 · 6 typical anterior cingulate cases · auraPDF p.3, Clinical Presentation
1/4 falling auraposterior cingulate falling auraProportion · n/N 1/4 · 4 posterior cingulate cases · auraPDF p.5, Clinical Presentation

asadollahi-drug-resistant-parietal-lobe-epilepsy-clinical-manifestations-surgery-outcome-2017.pdfIndependent primary study · 1 finding · 1 reported value

asadollahi-drug-resistant-parietal-lobe-epilepsy-clinical-manifestations-surgery-outcome-2017.pdf

Independent primary study · Class II · Evidence weight 3.91 · 2 × 1.2 × 1.628

Findings

dizzinessTwo patients reported dizziness.PDF p.2, Results

Reported values

2/18 (11%) dizzinessdizzinessPercentage · n/N 2/18 · 18-patient drug-resistant parietal lobe epilepsy cohort · auraPDF p.2, Results

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 4 findings · 8 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

vestibular auraVestibular auras were more frequent in T+ than TL seizures, driven in the table by rotatory rather than non-rotatory symptoms.PDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Auras
T+ subgroup associations for gustatory and vestibular aurasAmong T+ cases, gustatory auras were significantly associated with the TS subgroup and vestibular auras with the TPO subgroup.PDF p.5, Seizure clinical semiology; PDF p.7, Auras
gustatory, vestibular, and auditory symptomsThe source states that the localizing significance of gustatory, vestibular, and auditory symptoms remains uncertain in the cited literature.PDF p.7, Auras
rotatory vestibular symptomThe source states that a cited case report described epileptic rotatory vertigo arising from the temporo-parieto-occipital junction and that a cortical electrical stimulation study identified a lateral temporoparietal area from which rotatory sensations were easily elicited.PDF p.7, Auras

Reported values

TL 1.7%vestibular auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Auras
T+ 13%vestibular auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Auras
TL 0%vestibular auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Auras
T+ 8.7%vestibular auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Auras
T+ 4.3%vestibular auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Auras
TL 1.7%vestibular auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Auras
P=0.02T+ subgroup associations for gustatory and vestibular aurasP value · T+ subgroup patients and their one analyzed typical seizure; TS n=7 and TPO n=6 · TPO subgroup · ictal onsetPDF p.5, Seizure clinical semiology; PDF p.7, Auras
P=0.009T+ subgroup associations for gustatory and vestibular aurasP value · T+ subgroup patients and their one analyzed typical seizure; TS n=7 and TPO n=6 · TS subgroup · ictal onsetPDF p.5, Seizure clinical semiology; PDF p.7, Auras

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfSystematic review or meta-analysis · 3 findings · 3 reported values

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

vertigoVertigo accounted for 8% of the sensory manifestations in the narrative summary.PDF p.4, Semiology and clinical features; PDF p.6, Table 3
Vertigo (Table 3)Table 3 reports vertigo in 7 cases (8%), more at seizure onset.PDF p.6, Table 3
Vertigo (Table 4)In the 60 high/very-high-confidence cases, Table 4 reports vertigo in 4 cases (7%).PDF p.7, Table 4

Reported values

8% vertigovertigoPercentage · reviewed basal temporal seizure cases · ictal onsetPDF p.4, Semiology and clinical features; PDF p.6, Table 3
7 cases (8%)Vertigo (Table 3)Percentage · Table 3 basal temporal seizure cases · onsetPDF p.6, Table 3
4/60 (7%)Vertigo (Table 4)Percentage · n/N 4/60 · 60 basal temporal seizure cases with high or very-high EZ confidence · ictalPDF p.7, Table 4

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 1 finding

chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

gustatory; olfactory; vestibular; autonomic auraTable 3 maps gustatory aura to insula or mesiotemporal regions, olfactory aura to insula, mesiotemporal, or orbitofrontal regions, vestibular aura to posterior temporal or parietal regions, and autonomic aura to insula, amygdala, or cingulate regions.PDF p.10, Table 3; PDF p.3, Figure 1

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdfSystematic review or meta-analysis · 11 findings · 4 reported values

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

Dizziness/cephalic auraTable 3 reports 3 studies assessing Dizziness/cephalic aura.PDF p.6, Table 3
Dizziness/cephalic auraTable 3 reports 47 patients assessed for Dizziness/cephalic aura.PDF p.6, Table 3
Dizziness/cephalic auraTable 3 reports 11.8–50% as the percentage range or value for Dizziness/cephalic aura; the overall association grade is Low.PDF p.6, Table 3
odds of occurrence; Dizziness/cephalic auraTable 4 reports overall odds of 0.31 for occurrence of Dizziness/cephalic aura in lateral TLE.PDF p.7, Table 4; PDF p.8, Figure 2
odds confidence interval; Dizziness/cephalic auraTable 4 reports a 95% confidence interval of 0.10–0.93 for the overall odds of Dizziness/cephalic aura.PDF p.7, Table 4; PDF p.8, Figure 2
heterogeneity test; Dizziness/cephalic auraThe heterogeneity test for the Table 4 odds estimate for Dizziness/cephalic aura has p=0.1134.PDF p.7, Table 4
Dizziness/cephalic aura; lateral versus mesial comparisonTable 5 reports 2 studies comparing Dizziness/cephalic aura in lateral and mesial TLE.PDF p.9, Table 5
Dizziness/cephalic aura; lateral TLE patient denominatorTable 5 reports 25 lateral-TLE patients assessed for Dizziness/cephalic aura.PDF p.9, Table 5
Dizziness/cephalic aura; mesial TLE patient denominatorTable 5 reports 40 mesial-TLE patients assessed for Dizziness/cephalic aura.PDF p.9, Table 5
Dizziness/cephalic aura; lateral TLE prevalenceTable 5 reports a lateral-TLE percentage of 11.8–50% for Dizziness/cephalic aura.PDF p.9, Table 5
Dizziness/cephalic aura; mesial TLE prevalenceTable 5 reports a mesial-TLE percentage of 0–40% for Dizziness/cephalic aura.PDF p.9, Table 5

Reported values

11.8–50%Dizziness/cephalic auraPercentage Range · Lateral temporal epilepsy patients assessed for Dizziness/cephalic aura · ictalPDF p.6, Table 3
odds 0.31odds of occurrence; Dizziness/cephalic auraOdds · Lateral temporal epilepsy patients assessed for Dizziness/cephalic aura · ictalPDF p.7, Table 4; PDF p.8, Figure 2
11.8–50%Dizziness/cephalic aura; lateral TLE prevalencePercentage Range · Lateral TLE patients assessed for Dizziness/cephalic aura · Lateral TLE patients assessed for Dizziness/cephalic aura · ictalPDF p.9, Table 5
0–40%Dizziness/cephalic aura; mesial TLE prevalencePercentage Range · Mesial TLE patients assessed for Dizziness/cephalic aura · Mesial TLE patients assessed for Dizziness/cephalic aura · ictalPDF p.9, Table 5

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 1 finding

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

vertiginous aurasVertiginous auras with sensations of rotation or movement are usually associated with visual or auditory symptoms and a symptomatogenic zone near the visual and auditory association areas at the temporoparietal junction. Electrical stimulation readily elicits vestibular or rotatory sensations from a lateral temporoparietal region spanning the Sylvian fissure, including the parietal operculum and middle and posterior superior and middle temporal gyri.PDF p.2, section 3.1 Auras; PDF p.2, Table 1

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdfNarrative, educational, or cited context · 1 finding

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

visual and vestibular illusions, including vertigoVisual and vestibular illusions, especially vertigo, are reported particularly in posterior LTLE, but the chapter states that they probably rely on propagation of ictal activity to occipital or parietal regions.PDF p.9, Focal aware seizures

gibbs-clinical-features-sleep-related-hypermotor-epilepsy-2019.pdfIndependent primary study · 1 finding · 3 reported values

gibbs-clinical-features-sleep-related-hypermotor-epilepsy-2019.pdf

Independent primary study · Class II · Evidence weight 3.90 · 2 × 1.5 × 1.301

Findings

pain, choking sensation, vertigo, and falling sensationAll four patients with pain at seizure onset and all three patients with a choking sensation had an insular SOZ, while all three patients with either vertigo or a falling sensation had a parietal SOZ.PDF p.6, section 3.3

Reported values

all four patientspain, choking sensation, vertigo, and falling sensationPercentage · n/N 4/4 · SHE patients with the specified sensory manifestations; source reports four pain cases, three choking cases, and three vertigo/falling cases · pain at seizure onset · at the beginning of the seizure/early sensory onsetPDF p.6, section 3.3
all three patientspain, choking sensation, vertigo, and falling sensationPercentage · n/N 3/3 · SHE patients with the specified sensory manifestations; source reports four pain cases, three choking cases, and three vertigo/falling cases · vertigo or falling sensation · at the beginning of the seizure/early sensory onsetPDF p.6, section 3.3
all three patientspain, choking sensation, vertigo, and falling sensationPercentage · n/N 3/3 · SHE patients with the specified sensory manifestations; source reports four pain cases, three choking cases, and three vertigo/falling cases · choking sensation · at the beginning of the seizure/early sensory onsetPDF p.6, section 3.3

jobst-insula-and-its-epilepsies-2019.pdfNarrative, educational, or cited context · 1 finding

jobst-insula-and-its-epilepsies-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

vestibular body-motion sensationLess common vestibular responses were described as a feeling of body motion.PDF p.5, Other Insular Responses

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdfIndependent primary study · 1 finding · 2 reported values

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdf

Independent primary study · Class II · Evidence weight 5.11 · 2 × 1.35 × 1.893

Findings

Focal sensory (vestibular)Focal sensory (vestibular) semiology occurred in 1/61 individuals (2%) both as initial semiology and in the combined set-of-semiology.PDF p.5, Table 2

Reported values

Combined 1/61 (2%)Focal sensory (vestibular)Percentage · n/N 1/61 · 61 individuals undergoing frontal lobe epilepsy surgery · combined set-of-semiology · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2
Initial 1/61 (2%)Focal sensory (vestibular)Percentage · n/N 1/61 · 61 individuals undergoing frontal lobe epilepsy surgery · initial semiology · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 1 finding

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Vertiginous auraTable 2 associates vertiginous aura with the temporo-parieto-occipital junction, including superior temporal and inferior parietal regions, and describes it as not-lateralising, often right.PDF p.3, Table 2

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdfIndependent primary study · 2 findings · 7 reported values

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdf

Independent primary study · Class II · Evidence weight 5.07 · 2 × 1.5 × 1.69

Findings

vertigoVertigo frequencies did not differ significantly across M, ML, and L groups.PDF p.5, Table 2; PDF p.8, Initial sensory illusions and hallucinations
sensory hallucination or illusion (visual, auditory, vestibular)The combined category of visual, auditory, or vestibular sensory hallucination or illusion was more frequent in L than M or ML patients.PDF p.5, Table 2; PDF p.5, Semiologic analysis; PDF p.8, Sensory illusions and hallucinations

Reported values

p=0.86vertigoP value · 55 patients with unilateral TLE; M=24, ML=18, L=13 · initial ictal subjective symptomPDF p.5, Table 2; PDF p.8, Initial sensory illusions and hallucinations
L=2/13 (15.4%)vertigoPercentage · n/N 2/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · initial ictal subjective symptomPDF p.5, Table 2; PDF p.8, Initial sensory illusions and hallucinations
M=2/24 (8.3%)vertigoPercentage · n/N 2/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · initial ictal subjective symptomPDF p.5, Table 2; PDF p.8, Initial sensory illusions and hallucinations
ML=2/18 (11.1%)vertigoPercentage · n/N 2/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · initial ictal subjective symptomPDF p.5, Table 2; PDF p.8, Initial sensory illusions and hallucinations
6/18 (33.3%)sensory hallucination or illusion (visual, auditory, vestibular)Percentage · n/N 6/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · initial ictal subjective symptomPDF p.5, Table 2; PDF p.5, Semiologic analysis; PDF p.8, Sensory illusions and hallucinations
3/24 (12.5%)sensory hallucination or illusion (visual, auditory, vestibular)Percentage · n/N 3/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · initial ictal subjective symptomPDF p.5, Table 2; PDF p.5, Semiologic analysis; PDF p.8, Sensory illusions and hallucinations
11/13 (84.6%)sensory hallucination or illusion (visual, auditory, vestibular)Percentage · n/N 11/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · initial ictal subjective symptomPDF p.5, Table 2; PDF p.5, Semiologic analysis; PDF p.8, Sensory illusions and hallucinations

mazzola-electrical-stimulation-human-insula-ictal-semiology-2017.pdfNarrative, educational, or cited context · 1 finding · 5 reported values

mazzola-electrical-stimulation-human-insula-ictal-semiology-2017.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.80 · 1 × 0.9 × 2

Findings

vestibular sensationsVestibular sensations occurred in 41 of 550 clinically eloquent stimulations (7.5%), were mainly localized to the medium and posterior-superior insula, and were described as body motion in 39/41 responses or movement of the visual environment in 2/41.PDF p.3, Results and Table 1; PDF p.5, Other Types of Evoked Sensations and Fig. 5B

Reported values

z-coordinate OR=0.84vestibular sensationsOdds ratio · 41 vestibular responses in the 550-response series · Vestibular-response contacts · stimulation-evoked vestibular responsePDF p.3, Results and Table 1; PDF p.5, Other Types of Evoked Sensations and Fig. 5B
Visual environment moving 2/41 (4.9%)vestibular sensationsPercentage · n/N 2/41 · 41 vestibular responses in the 550-response series · Vestibular responses · stimulation-evoked vestibular responsePDF p.3, Results and Table 1; PDF p.5, Other Types of Evoked Sensations and Fig. 5B
Vestibular responses 41/550 (7.5%)vestibular sensationsPercentage · n/N 41/550 · 41 vestibular responses in the 550-response series · stimulation-evoked vestibular responsePDF p.3, Results and Table 1; PDF p.5, Other Types of Evoked Sensations and Fig. 5B
y-coordinate OR=0.9vestibular sensationsOdds ratio · 41 vestibular responses in the 550-response series · Vestibular-response contacts · stimulation-evoked vestibular responsePDF p.3, Results and Table 1; PDF p.5, Other Types of Evoked Sensations and Fig. 5B
Body motion 39/41 (95.1%)vestibular sensationsPercentage · n/N 39/41 · 41 vestibular responses in the 550-response series · Vestibular responses · stimulation-evoked vestibular responsePDF p.3, Results and Table 1; PDF p.5, Other Types of Evoked Sensations and Fig. 5B

mcgonigal-on-seizure-semiology-2021-5ba29d.pdfNarrative, educational, or cited context · 2 findings · 4 reported values

mcgonigal-on-seizure-semiology-2021-5ba29d.pdf; mcgonigal-on-seizure-semiology-2021-9127f2.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

vestibular symptoms; hyperkinetic motor behaviorThe review reports that Bartolomei et al. (2011) found seizures predominantly arising from the superior parietal lobule were often associated with vestibular symptoms, whereas hyperkinetic motor behavior was associated with inferior parietal involvement.PDF p.6, Table 2, Parietal lobe row
vestibular symptoms; hyperkinetic motor behaviorIn the summarized Bartolomei et al. study of parietal seizures, seizures predominantly arising from the superior parietal lobule were often associated with vestibular symptoms, whereas hyperkinetic motor behavior was associated with inferior parietal involvement.PDF p.6, Table 2, Bartolomei et al. 2011 row

Reported values

17 subjectsvestibular symptoms; hyperkinetic motor behaviorCount · 17 subjects with parietal-lobe epilepsy and 34 seizures · Seizure organization and semiologic expressionPDF p.6, Table 2, Parietal lobe row
34 seizuresvestibular symptoms; hyperkinetic motor behaviorCount · 17 subjects with parietal-lobe epilepsy and 34 seizures · Seizure organization and semiologic expressionPDF p.6, Table 2, Parietal lobe row
34 seizuresvestibular symptoms; hyperkinetic motor behaviorCount · 17 subjects with parietal-lobe epilepsy; 34 seizures · ictalPDF p.6, Table 2, Bartolomei et al. 2011 row
17 subjectsvestibular symptoms; hyperkinetic motor behaviorCount · 17 subjects with parietal-lobe epilepsy; 34 seizures · ictalPDF p.6, Table 2, Bartolomei et al. 2011 row

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 1 finding

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

temporal plus epilepsy; gustatory; vestibular; auditory; contraversive eyes/head; piloerection; ipsilateral tonic motor; postictal dysphoriaThe source describes temporal-plus semiology as more often including gustatory, vestibular, or auditory symptoms, contraversive eye or head manifestations, piloerection, ipsilateral tonic motor signs, and a more dysphoric postictal phase.PDF p.2, Introduction

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdfNarrative, educational, or cited context · 1 finding

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

stimulation-evoked somatosensory, auditory, vestibular, olfactory, gustatory, and viscerosensory symptomsThe chapter reports that electrical stimulation studies evoked somatosensory symptoms, including pain, from the posterior two-thirds of the insula; auditory and vestibular symptoms from the posterior insula; and olfactory, gustatory, and viscerosensory symptoms, including laryngeal constriction, from the midinsula, whereas stimulation of the most anterior portion rarely evoked symptoms unless a larger network seizure was elicited.PDF p.3, insular functional differentiation and electrical cortical stimulation

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdfIndependent primary study · 4 findings · 3 reported values

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdf

Independent primary study · Class II · Evidence weight 2.70 · 2 × 1.35 × 1

Findings

vertiginous sensationVertiginous sensations were reported by nine patients in the narrative results.PDF p.3, Results, Aurae
vertiginous sensation entries in Table 1Table 1 lists 11 vertiginous-sensation aura entries.PDF p.4, Table 1
dizzy aura reproduced at electrode 8In Figure 2, stimulation of electrode 8 reproduced a dizzy aura that the patient described as feeling like swaying rather than things going round.PDF p.7, Fig. 2
vertigo at temporo-parietal borderThe source states that vertiginous aurae are elicited predominantly from the temporo-parietal border in cited stimulation work.PDF p.9, Discussion

Reported values

9 patientsvertiginous sensationCount · 82-patient parietal epilepsy series · aura or seizure onsetPDF p.3, Results, Aurae
11 source-reported aura entriesvertiginous sensation entries in Table 1Count · 82-patient parietal epilepsy series · aura or seizure onsetPDF p.4, Table 1
1 casedizzy aura reproduced at electrode 8Count · n/N 1/1 · patient 49 (M.Mc.) · stimulation responsePDF p.7, Fig. 2

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdfSystematic review or meta-analysis · 1 finding

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

fear; auditory hallucinations; gustatory hallucinations; sensory hallucinations; vertigoThe source describes fear, auditory or gustatory hallucinations, sensory hallucinations, and vertigo as intermediate features between lateral and medial temporal patterns.PDF p.5, Discussion

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdfIndependent primary study · 1 finding

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

dizziness with or without colored lightsTable 2 records dizziness with or without colored lights as an aura in Case 13.PDF p.7, Table 2 Case 13

20 contributing manuscripts; source-reported values remain separate and are not pooled.

Ictal head versionReported: BilateralAlso reported: ContralateralAlso reported: IpsilateralAlso reported: Right hemisphereNo single reliable side21 manuscripts · 98 findings · 125 reported values

Weighted evidence supportevidence weight 48.16 across 21 manuscripts · 2 manuscript weight pending · 6 independent primary study · 7 narrative, educational, or cited context · 2 structured design not resolved · 5 systematic review or meta-analysis · 1 case report or observation

Source reports contralateral limb posturing in a sequential occipital-onset phenotype. The source describes visual aura followed by head-eye deviation and contralateral tonic posturing as activity propagates through dorsal parietal nodes toward premotor areas. The seizure contains a leftward head/eye deviation, preserved as a body-side observation without cerebral lateralization inference. Table 2 records rightward head, eye, and body deviation in a case with source-reported right occipital onset. MCC stimulation elicited ipsilateral rightward head turning within a composite experience whose table distribution was labeled bilateral. In the unilateral TLE cohort, head version occurred only contralateral to the EEG seizure focus. Head turning occurred in both directions relative to the EEG seizure-onset focus: 15 ipsilateral and 17 contralateral seizures; the card also reports 5 ipsilateral-turning and 6 contralateral-turning patients. The temporal-plus description preserves contraversive eye/head and ipsilateral tonic-motor relations without assigning a left/right cerebral hemisphere. Two recorded bilateral tonic-clonic seizures began with left head deviation despite generalized bifrontally predominant EEG activity; an earlier event reportedly turned right, so head direction was not proof of focal epilepsy. The reproduced table lists head turning with ipsilateral lateralization while also retaining contralateral-space neglect and propagation-to-basal-ganglia contexts. The reproduced table associates head version with a contralateral direction. The current paper restates that version has high positive predictive value for the side of ictal onset without specifying a left/right or ipsi/contra direction. Cited evidence is conflicting: some reports found no lateralizing value, whereas Wyllie et al. reported contralateral onset when deviation was forced, involuntary, and sustained. The cited Chassoux series restatement includes bilateral tonic-clonic seizures alongside oro-alimentary, salivation, dystonic, and head-deviation phenomena. The source reports head and eye deviation in 14% of patients and describes it as contralateral to seizure onset. Cited reports found ipsiversion in 50% and 48% of seizures with head/eye turning and concluded that forced turning at onset had no localizing or lateralizing value. The cited study reports 4/16 ipsiversion in a selected series; no cerebral reference frame is resolved. The cited series reported ipsiversion incidence of 3% in a larger series and 4/16 (25%) in a selected series. The cited series reports contraversive head and eye movements in 29% of 55 patients without a resolved cerebral reference frame. The review synthesis states that the ictal focus was contralateral to the direction of head turning in reviewed occipital-lobe epilepsy reports. The Figure 2 tracing shows rightward head deviation during the illustrated depth-recorded seizure. The primary result reports contralateral head deviation relative to the focus in 21/42 patients (50%). Both depth-studied patients had contralateral head and eye deviation. One patient had ipsilateral head deviation relative to the focus. The review restates that late forced head and eye version can be ipsilateral when initial contraversion ends during generalization, but can remain contralateral when initial contraversion persists. In the cited Wyllie series, late deviation was contralateral when initial contraversion persisted and ipsilateral when initial contraversion ended. The cited series reports late ipsiversion after an initial contraversive movement in 6 of 38 selected patients, always ipsilateral to the epilepsy focus. No lateralizing direction is reported for the visual-aura sequence. No hemisphere or body-side direction is reported. No lateralization axis information is reported for temporal psychomotor head turning. No lateralization axis information is reported for the head-turning study count. No lateralization axis information is reported for the 15-patient head-turning denominator. No lateralization axis information is reported for the 14-second head-turning onset value. No lateralization axis information is reported for the head-turning study comparison. No lateralization axis information is reported for the 15 lateral-TLE head-turning patients. No lateralization axis information is reported for the 31 mesial-TLE head-turning patients. No lateralization axis information is reported for the 41% head-and-eye-deviation frequency. The educational definition of head version gives no hemisphere or lateralizing direction. No lateralization axis information is reported for the 4.3% head-version frequency. The all-data head-version panel sample size N=597 provides no lateralization result. The non-topological head-version panel sample size N=151 provides no lateralization result. No lateralization axis information is reported for head version with temporal-lobe localization. No lateralization axis information is reported for head version with frontal-lobe localization. No lateralization axis information is reported for the conditional frontal head-version probability. No lateralization axis information is reported for the conditional temporal head-version probability. No lateralization axis information is reported for the frontal head-version odds interval. No lateralization axis information is reported for the temporal head-version odds interval. No cerebral lateralization axis information is reported for head version or orientation. No cerebral lateralization axis information is reported for the 25 head-orientation cases. No cerebral lateralization axis information is reported for the 15/60 head-orientation cases. The primary comparison reports no lateralization; head and/or eye deviation over the whole seizure course did not differ significantly across M, ML, and L temporal-onset groups. The primary result reports no lateralization; late head and/or eye deviation did not differ significantly across M, ML, and L temporal-onset groups. This finding provides no lateralization information. Frequency only; no lateralization is reported. No lateralization axis information is reported for the 0–50% head-eye-deviation range. No lateralization axis information is reported for the moderate head-eye-deviation association grade. No lateralization is reported. No seizure lateralization is reported. No directional head-eye side or hemisphere is reported. No lateralization axis information is reported for head-eye deviation versus affective/autonomic aura. No lateralization axis information is reported for head-eye deviation versus autonomic signs. This record provides no seizure lateralization. No lateralization evidence is reported. Figure 6 reports OR 7.7 for Affective/autonomic aura relative to Head-eye deviation, with no hemisphere or lateralization direction. Figure 6 reports OR 5.7 for Autonomic signs relative to Head-eye deviation, with no hemisphere or lateralization direction. No lateralizing direction is reported. No lateralizing semiology is reported for the tonic-clonic versus head-eye-deviation odds comparison. No lateralizing semiology is reported for the reciprocal head-eye-deviation versus tonic-clonic odds comparison. No independent lateralization axis record is present; the card concerns the timing of contraversive movement relative to onset region.

Source-defined result groups 29

Localization: TemporalObserved proportion 33.3%M · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelytemporal localization relative to EUD-Loc · localizing data point1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 37.5%M · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelycontralateral · ipsilateral versus contralateral head turning relative to EEG focus · seizure, with patient count in parentheses1 manuscript · 1 reported value · not pooled

Localization: OccipitalObserved proportion 100.0%All reported · seizure spread beyond occipital lobe · cases1 manuscript · 1 reported value · not pooled

Localization: FrontalSource-defined values retained separatelyfrontal localization relative to EUD-Loc · localizing data point1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralObserved proportion range 12.9–46.9% (median 29.9%)ipsilateral · ipsilateral versus contralateral head turning relative to EEG focus · seizure, with patient count in parentheses1 manuscript · 2 reported values · not pooled

Localization: Frontal / Occipital / Parietal / TemporalObserved proportion 86.5%frontal · onset regions and preceding ictal event categories · seizure; patient counts in parentheses in Table 21 manuscript · 1 reported value · not pooled

Localization: Frontal / Occipital / Parietal / TemporalObserved proportion 57.4%total · onset regions and preceding ictal event categories · seizure; patient counts in parentheses in Table 21 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyMesial TLE patients assessed for Head turning · lateral TLE percentage shown separately · reported mesial-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Localization: ACC/cingulate localization / reviewed anterior cingulate cortex seizure casesSource-defined values retained separatelyHead-eye deviation · pairwise symptom-occurrence comparison1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · reported sign prevalence across included studies1 manuscript · 1 reported value · not pooled

Localization: ACC/cingulate localization / reviewed anterior cingulate cortex seizure casesSource-defined values retained separatelyLaughter · pairwise symptom-occurrence comparison1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelytemporal localization given head version · localizing data point1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyipsilateral · ipsilateral versus contralateral head turning relative to EEG focus · seizure, with patient count in parentheses1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 33.3%ML · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 23.1%L · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: FrontalSource-defined values retained separatelyfrontal localization given head version · localizing data point1 manuscript · 1 reported value · not pooled

Localization: reviewed anterior cingulate cortex seizure casesSource-defined values retained separatelyHead-eye deviation · pairwise symptom-occurrence comparison1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralObserved proportion range 14.7–53.1% (median 33.9%)contralateral · ipsilateral versus contralateral head turning relative to EEG focus · seizure, with patient count in parentheses1 manuscript · 2 reported values · not pooled

Localization: TemporalObserved proportion 50.0%ML · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: ACC/cingulate localization / reviewed anterior cingulate cortex seizure casesSource-defined values retained separatelyMotor (gestural) automatisms · pairwise symptom-occurrence comparison1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 50.0%All reported · no contralateral head deviation · patients1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 100.0%All reported · seizure spread beyond occipital lobe · cases1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 38.5%L · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: FrontalSource-defined values retained separatelyFacial expression change · pairwise symptom-occurrence comparison1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyLateral TLE patients assessed for Head turning · mesial TLE percentage shown separately · reported lateral-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 21

Alphabetical by manuscript.

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdfSystematic review or meta-analysis · 16 findings · 7 reported values

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

head versionTable 1 defines or exemplifies the the source's own semiology category “head version” as Forced head deviation over the shoulder or extreme head turn.PDF p.7, Table 1 Semiology descriptions and frequencies
head versionHead version comprised 4.3% of non-topological data.PDF p.7, Table 1 Semiology descriptions and frequencies
head version; Figure 3 all-data subsetFigure 3 reports N = 597 for the all-data head version panel.PDF p.9, Figure 3 and caption
head version; Figure 3 non-topological subsetFigure 3 reports N = 151 for the non-topological head version panel.PDF p.9, Figure 3 and caption
head version; temporal lobeHead version implicated the temporal lobe in 46%.PDF p.8, Seizure semiology localizing values
head version; temporal lobeThe 95% CI for head version; temporal lobe was 36%–57%.PDF p.8, Seizure semiology localizing values
head version; frontal lobeHead version implicated the frontal lobe in 33%.PDF p.8, Seizure semiology localizing values
head version; frontal lobeThe 95% CI for head version; frontal lobe was 24%–41%.PDF p.8, Seizure semiology localizing values
head version; frontal lobeHead version had a probability of 0.33 for frontal localization in the non-topological estimate.PDF p.8, Relative localizing values
head version; frontal lobeThe interval for the head-version frontal localization given head version probability was 0.24–0.41.PDF p.8, Relative localizing values
head version; temporal lobeHead version had a probability of 0.46 for temporal localization in the non-topological estimate.PDF p.8, Relative localizing values
head version; temporal lobeThe interval for the head-version temporal localization given head version probability was 0.36–0.57.PDF p.8, Relative localizing values
head version; frontal lobeHead version had an OR of 0.9 for frontal localization relative to the EUD-Loc prior.PDF p.8, Relative localizing values of semiologies
head version; frontal lobeThe 95% CI for head version; frontal lobe was 0.7–1.2.PDF p.8, Relative localizing values of semiologies
head version; temporal lobeHead version had an OR of 1.21 for temporal localization relative to the EUD-Loc prior.PDF p.8, Relative localizing values of semiologies
head version; temporal lobeThe 95% CI for head version; temporal lobe was 0.9–1.6.PDF p.8, Relative localizing values of semiologies

Reported values

head version 4.3%head versionPercentage · non-topological Semio2Brain dataPDF p.7, Table 1 Semiology descriptions and frequencies
head version; temporal lobe 46%head version; temporal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
head version; frontal lobe 33%head version; frontal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
probability 0.33head version; frontal lobeProbability · non-topological localizing data pointsPDF p.8, Relative localizing values
probability 0.46head version; temporal lobeProbability · non-topological localizing data pointsPDF p.8, Relative localizing values
OR 0.9head version; frontal lobeOdds ratio · non-topological Semio2Brain data unless otherwise statedPDF p.8, Relative localizing values of semiologies
OR 1.21head version; temporal lobeOdds ratio · non-topological Semio2Brain data unless otherwise statedPDF p.8, Relative localizing values of semiologies

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfNarrative, educational, or cited context · 1 finding

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

head version and ictal SPECT hyperperfusionThe source reports an ictal SPECT study in which head version was related to multiple hyperperfusion areas in frontal, temporal, and basal ganglia regions.PDF p.8, Motor signs

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfSystematic review or meta-analysis · 3 findings · 3 reported values

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

head version or orientationHead version or orientation was reported in 30% of reviewed cases.PDF p.4, Semiology and clinical features; PDF p.6, Table 3
Head orientation (Table 3)Table 3 reports head orientation in 25 cases (30%), more during propagation.PDF p.6, Table 3
Head orientation (Table 4)In the 60 high/very-high-confidence cases, Table 4 reports head orientation in 15 cases (25%).PDF p.7, Table 4

Reported values

30% head orientationhead version or orientationPercentage · reviewed basal temporal seizure cases · ictal propagation in Table 3PDF p.4, Semiology and clinical features; PDF p.6, Table 3
25 cases (30%)Head orientation (Table 3)Percentage · Table 3 basal temporal seizure cases · propagationPDF p.6, Table 3
15/60 (25%)Head orientation (Table 4)Percentage · n/N 15/60 · 60 basal temporal seizure cases with high or very-high EZ confidence · ictalPDF p.7, Table 4

chassoux-ictal-semiology-anterior-cingulate-epilepsy-systematic-review-2025.pdfSystematic review or meta-analysis · 34 findings · 31 reported values

chassoux-ictal-semiology-anterior-cingulate-epilepsy-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

head-eye deviation; contralateral to seizure onsetHead and eye deviation occurred in 14% of patients and was contralateral to seizure onset.PDF p.9, Objective symptomatology
dystonic posturing; head-eye deviation; tonic-clonic manifestationsThe review links dystonic posturing, head/eye deviation, and tonic-clonic manifestations to propagation rather than the earliest seizure phase.PDF p.11, Anatomical and clinical correlations
head-eye deviationThe source reports a frequency of 14% for head-eye deviation.PDF p.13, Table 3
head-eye deviation; reported frequency rangeThe source reports a frequency range of 0–50% for head-eye deviation.PDF p.13, Table 3
head-eye deviation; ACC association gradeTable 3 assigns the source's Moderate overall association grade to head-eye deviation.PDF p.13, Table 3
head-eye deviation; Figure 4 rateFigure 4 displays a 14% rate for head-eye deviation.PDF p.10, Figure 4
pairwise OR: Head-eye deviation relative to Vocalization/verbalizationFigure 6 reports an odds ratio of 0.1 for Head-eye deviation relative to Vocalization/verbalization.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of 0.1 for Head-eye deviation relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Affective/autonomic auraFigure 6 reports an odds ratio of 0.1 for Head-eye deviation relative to Affective/autonomic aura.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Autonomic signsFigure 6 reports an odds ratio of 0.2 for Head-eye deviation relative to Autonomic signs.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Facial expression changeFigure 6 reports an odds ratio of 0.2 for Head-eye deviation relative to Facial expression change.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 0.2 for Head-eye deviation relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Loss of consciousnessFigure 6 reports an odds ratio of 0.3 for Head-eye deviation relative to Loss of consciousness.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Post-ictal confusion/behavior change disinhibitionFigure 6 reports an odds ratio of 0.4 for Head-eye deviation relative to Post-ictal confusion/behavior change disinhibition.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Chapeau de gendarmeFigure 6 reports an odds ratio of 0.6 for Head-eye deviation relative to Chapeau de gendarme.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Dystonic posturingFigure 6 reports an odds ratio of 0.7 for Head-eye deviation relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Vocalization/verbalization relative to Head-eye deviationFigure 6 reports an odds ratio of 9.6 for Vocalization/verbalization relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to Head-eye deviationFigure 6 reports an odds ratio of 9.1 for Hypermotor-complex motor behavior relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Affective/autonomic aura relative to Head-eye deviationFigure 6 reports an odds ratio of 7.7 for Affective/autonomic aura relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Autonomic signs relative to Head-eye deviationFigure 6 reports an odds ratio of 5.7 for Autonomic signs relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Facial expression change relative to Head-eye deviationFigure 6 reports an odds ratio of 5.2 for Facial expression change relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to Head-eye deviationFigure 6 reports an odds ratio of 4.6 for Motor (gestural) automatisms relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Loss of consciousness relative to Head-eye deviationFigure 6 reports an odds ratio of 3.4 for Loss of consciousness relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Post-ictal confusion/behavior change disinhibition relative to Head-eye deviationFigure 6 reports an odds ratio of 2.7 for Post-ictal confusion/behavior change disinhibition relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Chapeau de gendarme relative to Head-eye deviationFigure 6 reports an odds ratio of 1.6 for Chapeau de gendarme relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to Head-eye deviationFigure 6 reports an odds ratio of 1.5 for Dystonic posturing relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Laughter relative to Head-eye deviationFigure 6 reports an odds ratio of 0.9 for Laughter relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to Head-eye deviationFigure 6 reports an odds ratio of 0.6 for Oro-alimentary automatisms relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Tonic-clonic relative to Head-eye deviationFigure 6 reports an odds ratio of 0.6 for Tonic-clonic relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: F to BTC relative to Head-eye deviationFigure 6 reports an odds ratio of 0.4 for F to BTC relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to LaughterFigure 6 reports an odds ratio of 1.5 for Head-eye deviation relative to Laughter.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 1.7 for Head-eye deviation relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Tonic-clonicFigure 6 reports an odds ratio of 2.8 for Head-eye deviation relative to Tonic-clonic.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to F to BTCFigure 6 reports an odds ratio of 2.8 for Head-eye deviation relative to F to BTC.PDF p.12, Figure 6

Reported values

14%head-eye deviation; contralateral to seizure onsetPercentage · Reviewed ACC seizure cases with reported semiology · Reviewed ACC seizure casesPDF p.9, Objective symptomatology
14% (frequency range 0–50%)head-eye deviationPercentage · Reviewed ACC seizure cases with reported semiology · ictal propagationPDF p.13, Table 3
14%head-eye deviation; Figure 4 ratePercentage · Reviewed ACC seizure cases with reported semiology · ictal propagationPDF p.10, Figure 4
OR 0.1pairwise OR: Head-eye deviation relative to Vocalization/verbalizationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.1pairwise OR: Head-eye deviation relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.1pairwise OR: Head-eye deviation relative to Affective/autonomic auraOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.2pairwise OR: Head-eye deviation relative to Autonomic signsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.2pairwise OR: Head-eye deviation relative to Facial expression changeOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.2pairwise OR: Head-eye deviation relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.3pairwise OR: Head-eye deviation relative to Loss of consciousnessOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.4pairwise OR: Head-eye deviation relative to Post-ictal confusion/behavior change disinhibitionOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.6pairwise OR: Head-eye deviation relative to Chapeau de gendarmeOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.7pairwise OR: Head-eye deviation relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 9.6pairwise OR: Vocalization/verbalization relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 9.1pairwise OR: Hypermotor-complex motor behavior relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 7.7pairwise OR: Affective/autonomic aura relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 5.7pairwise OR: Autonomic signs relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 5.2pairwise OR: Facial expression change relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 4.6pairwise OR: Motor (gestural) automatisms relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 3.4pairwise OR: Loss of consciousness relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 2.7pairwise OR: Post-ictal confusion/behavior change disinhibition relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.6pairwise OR: Chapeau de gendarme relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.5pairwise OR: Dystonic posturing relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.7pairwise OR: Laughter relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.6pairwise OR: Oro-alimentary automatisms relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.4pairwise OR: Tonic-clonic relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.4pairwise OR: F to BTC relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.5pairwise OR: Head-eye deviation relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.7pairwise OR: Head-eye deviation relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 2.8pairwise OR: Head-eye deviation relative to Tonic-clonicOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 2.8pairwise OR: Head-eye deviation relative to F to BTCOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdfSystematic review or meta-analysis · 10 findings · 4 reported values

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

Head turningTable 3 reports 1 studies assessing Head turning.PDF p.6, Table 3
Head turningTable 3 reports 15 patients assessed for Head turning.PDF p.6, Table 3
Head turningTable 3 reports 60% as the percentage range or value for Head turning; the overall association grade is Low.PDF p.6, Table 3
Head turningTable 3 reports 1 study with onset timing for Head turning.PDF p.6, Table 3
Head turningTable 3 reports an onset latency of 14 s for Head turning.PDF p.6, Table 3
Head turning; lateral versus mesial comparisonTable 5 reports 1 studies comparing Head turning in lateral and mesial TLE.PDF p.9, Table 5
Head turning; lateral TLE patient denominatorTable 5 reports 15 lateral-TLE patients assessed for Head turning.PDF p.9, Table 5
Head turning; mesial TLE patient denominatorTable 5 reports 31 mesial-TLE patients assessed for Head turning.PDF p.9, Table 5
Head turning; lateral TLE prevalenceTable 5 reports a lateral-TLE percentage of 60% for Head turning.PDF p.9, Table 5
Head turning; mesial TLE prevalenceTable 5 reports a mesial-TLE percentage of 64.5% for Head turning.PDF p.9, Table 5

Reported values

60%Head turningPercentage · Lateral temporal epilepsy patients assessed for Head turning · ictalPDF p.6, Table 3
median onset latency 14 sHead turningMedian · Lateral temporal epilepsy study reporting onset timing for Head turning · ictal onsetPDF p.6, Table 3
60%Head turning; lateral TLE prevalencePercentage · Lateral TLE patients assessed for Head turning · Lateral TLE patients assessed for Head turning · ictalPDF p.9, Table 5
64.5%Head turning; mesial TLE prevalencePercentage · Mesial TLE patients assessed for Head turning · Mesial TLE patients assessed for Head turning · ictalPDF p.9, Table 5

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdfNarrative, educational, or cited context · 1 finding

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Ictal head deviation in cited studiesThe current paper reports conflicting cited evidence on ictal head deviation: Robillard et al. (1983) and Ochs et al. (1984) indicated no lateralizing value, whereas Wyllie et al. (1986) found seizure onset lateralized to the contralateral hemisphere when head and eye deviation was defined as unquestionably forced, involuntary, and sustained.PDF p.6, Discussion, tonic-head-deviation paragraph

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdfIndependent primary study · 2 findings · 4 reported values

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdf

Independent primary study · Class II · Evidence weight 5.11 · 2 × 1.35 × 1.893

Findings

Head/Body turnHead/Body turn semiology occurred in 3/61 individuals (5%) as initial semiology and 6/61 (10%) in the combined set-of-semiology.PDF p.5, Table 2
Head versionHead-version semiology occurred in 1/61 individuals (2%) as initial semiology and 12/61 (20%) in the combined set-of-semiology.PDF p.5, Table 2

Reported values

Combined 6/61 (10%)Head/Body turnPercentage · n/N 6/61 · 61 individuals undergoing frontal lobe epilepsy surgery · combined set-of-semiology · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2
Initial 3/61 (5%)Head/Body turnPercentage · n/N 3/61 · 61 individuals undergoing frontal lobe epilepsy surgery · initial semiology · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2
Initial 1/61 (2%)Head versionPercentage · n/N 1/61 · 61 individuals undergoing frontal lobe epilepsy surgery · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2
Combined 12/61 (20%)Head versionPercentage · n/N 12/61 · 61 individuals undergoing frontal lobe epilepsy surgery · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 2 findings

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Head turningTable 3 associates head turning with exhaustion of the epileptogenic hemisphere, propagation to basal ganglia, or neglect of contralateral space and lists ipsilateral lateralisation.PDF p.4, Table 3
Head versionTable 3 associates head version during secondary generalized tonic-clonic seizures with premotor area (BA 6 and 8) and contralateral lateralisation.PDF p.4, Table 3

kotagal-asymmetric-tonic-limb-posturing-secondarily-generalized.pdfNarrative, educational, or cited context · 1 finding

kotagal-asymmetric-tonic-limb-posturing-secondarily-generalized.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Group I comprised 54 patients with partial epilepsy successfully treated by temporal-lobe resection (n=34) or extratemporal resection (n=20: 14 frontal, 3 parietal, 3 occipital); 238 seizures were recorded, including 59 secondarily generalized seizures from 31 patients. Surgical success was complete seizure freedom or >90% seizure reduction at 1 year. Group II comprised 28 prospectively collected patients with 70 GTC or generalized clonic seizures over 7 months; 6 seizures and 2 patients were excluded for inadequate video visualization of both upper limbs, leaving 64 seizures from 26 patients, including 23 with focal epilepsy and 3 with symptomatic generalized epilepsy. Three observers reviewed seizures independently while blinded to ictal EEG side and other clinical data. Version was defined as forced, sustained, unnatural eye and/or head deviation to one side; ATLP was assessed against version using interobserver kappa, and Wilcoxon rank-sum tests compared ATLP timing and duration between temporal-lobe epilepsy (TLE) and extratemporal epilepsy (XTLE).

Findings

head/eye versionThe methods section characterizes version as a well-recognized lateralizing sign with good interobserver agreement and high positive predictive value for the side of ictal onset.PDF p.2, Methods—definition and comparison of version

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdfNarrative, educational, or cited context · 3 findings · 6 reported values

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Late ipsiversionThe review identifies ipsilateral forced head and eye version at the end of a generalized tonic-clonic seizure as a distinct lateralizing sign, especially when an initial contraversion ends during the generalized phase; if initial contraversion persists, late version can remain contralateral.PDF p.4, section 3.2 Late ipsiversion at the end of a generalized seizure
Late ipsiversionIn Wyllie et al., a study of 61 seizures in 27 patients with version, 9 patients had a late versive movement; when initial contraversion persisted, late deviation was contralateral in 3 patients, and when initial contraversion ended, late version was ipsilateral in 6 patients.PDF p.4, section 3.2 Late ipsiversion at the end of a generalized seizure
Late ipsiversionChee et al. found late ipsiversion after an initial contraversive movement before generalization in 6 of 38 selected patients, always ipsilateral to the epilepsy focus as determined by ictal EEG.PDF p.4, section 3.2 Late ipsiversion at the end of a generalized seizure

Reported values

6 patients had ipsilateral late versionLate ipsiversionCount · 27 patients with 61 seizures and version; 9 patients with late versive movement · initial contraversion ended · End of generalized tonic-clonic seizurePDF p.4, section 3.2 Late ipsiversion at the end of a generalized seizure
3 patients had contralateral late deviationLate ipsiversionCount · 27 patients with 61 seizures and version; 9 patients with late versive movement · initial contraversion persisted · End of generalized tonic-clonic seizurePDF p.4, section 3.2 Late ipsiversion at the end of a generalized seizure
61 seizuresLate ipsiversionCount · 27 patients with 61 seizures and version; 9 patients with late versive movement · End of generalized tonic-clonic seizurePDF p.4, section 3.2 Late ipsiversion at the end of a generalized seizure
9/27 patients had late movementLate ipsiversionPercentage · n/N 9/27 · 27 patients with 61 seizures and version; 9 patients with late versive movement · late versive movement · End of generalized tonic-clonic seizurePDF p.4, section 3.2 Late ipsiversion at the end of a generalized seizure
Late ipsiversion in 6/38 patientsLate ipsiversionPercentage · n/N 6/38 · 38 selected patients with frontal and temporal lobe epilepsy; 6 with late ipsiversion · Before or at the end of generalizationPDF p.4, section 3.2 Late ipsiversion at the end of a generalized seizure
Late ipsiversion ipsilateral to epilepsy focus 6/6Late ipsiversionPercentage · n/N 6/6 · 38 selected patients with frontal and temporal lobe epilepsy; 6 with late ipsiversion · Patients with late ipsiversion · Before or at the end of generalizationPDF p.4, section 3.2 Late ipsiversion at the end of a generalized seizure

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdfIndependent primary study · 2 findings · 7 reported values

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdf

Independent primary study · Class II · Evidence weight 5.07 · 2 × 1.5 × 1.69

Findings

head and/or eyes deviationHead and/or eyes deviation over the whole seizure course did not differ significantly across M, ML, and L groups.PDF p.6, Table 3; PDF p.9, Nondifferentiating ictal characteristics
late head and/or eyes deviationLate head and/or eyes deviation did not differ significantly across M, ML, and L groups.PDF p.7, Table 5; PDF p.7, Later features; PDF p.9, Nondifferentiating ictal characteristics

Reported values

ML=9/18 (50%)head and/or eyes deviationPercentage · n/N 9/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · ictal course, early or late combinedPDF p.6, Table 3; PDF p.9, Nondifferentiating ictal characteristics
L=5/13 (38.5%)head and/or eyes deviationPercentage · n/N 5/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · ictal course, early or late combinedPDF p.6, Table 3; PDF p.9, Nondifferentiating ictal characteristics
M=9/24 (37.5%)head and/or eyes deviationPercentage · n/N 9/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · ictal course, early or late combinedPDF p.6, Table 3; PDF p.9, Nondifferentiating ictal characteristics
p=0.69head and/or eyes deviationP value · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ictal course, early or late combinedPDF p.6, Table 3; PDF p.9, Nondifferentiating ictal characteristics
6/18 (33.3%)late head and/or eyes deviationPercentage · n/N 6/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · late ictal, second half of seizurePDF p.7, Table 5; PDF p.7, Later features; PDF p.9, Nondifferentiating ictal characteristics
8/24 (33.3%)late head and/or eyes deviationPercentage · n/N 8/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · late ictal, second half of seizurePDF p.7, Table 5; PDF p.7, Later features; PDF p.9, Nondifferentiating ictal characteristics
3/13 (23.1%)late head and/or eyes deviationPercentage · n/N 3/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · late ictal, second half of seizurePDF p.7, Table 5; PDF p.7, Later features; PDF p.9, Nondifferentiating ictal characteristics

misulis-sonmezturk-ess-abou-khalil-atlas-eeg-seizure-semiology-management-3e-2022.pdfCase report or observation · 1 finding · 4 reported values

misulis-sonmezturk-ess-abou-khalil-atlas-eeg-seizure-semiology-management-3e-2022.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

generalized epilepsy with ictal head deviationIn the illustrated adult case, two recorded bilateral tonic-clonic seizures began with head deviation to the left, but the EEG began with generalized bifrontally predominant rhythmic 12 Hz activity and 4-4.5 Hz spike-and-wave activity; an earlier witnessed event reportedly turned to the right, and the case was diagnosed as adult-onset idiopathic generalized epilepsy, illustrating that head direction at onset is not by itself proof of focal epilepsy.PDF p.380; PDF p.381; PDF p.386

Reported values

4–4.5 Hz spike-and-wave activitygeneralized epilepsy with ictal head deviationRange · 36-year-old right-handed woman with two recorded bilateral tonic-clonic seizures and prior witnessed events · ictal onset and transition to bilateral tonic-clonic activityPDF p.380; PDF p.381; PDF p.386
two recorded bilateral tonic-clonic seizuresgeneralized epilepsy with ictal head deviationCount · 36-year-old right-handed woman with two recorded bilateral tonic-clonic seizures and prior witnessed events · illustrated adult case · ictal onset and transition to bilateral tonic-clonic activityPDF p.380; PDF p.381; PDF p.386
up to 60% of primary generalized seizures may have head deviationgeneralized epilepsy with ictal head deviationPercentage · 36-year-old right-handed woman with two recorded bilateral tonic-clonic seizures and prior witnessed events · primary generalized seizures · ictal onset and transition to bilateral tonic-clonic activityPDF p.380; PDF p.381; PDF p.386
generalized bifrontally predominant rhythmic 12 Hz activitygeneralized epilepsy with ictal head deviationFrequency · 36-year-old right-handed woman with two recorded bilateral tonic-clonic seizures and prior witnessed events · ictal onset and transition to bilateral tonic-clonic activityPDF p.380; PDF p.381; PDF p.386

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 1 finding

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

temporal plus epilepsy; gustatory; vestibular; auditory; contraversive eyes/head; piloerection; ipsilateral tonic motor; postictal dysphoriaThe source describes temporal-plus semiology as more often including gustatory, vestibular, or auditory symptoms, contraversive eye or head manifestations, piloerection, ipsilateral tonic motor signs, and a more dysphoric postictal phase.PDF p.2, Introduction

popa-illusory-own-body-perceptions-cingulate-cortex-intracranial-stimulation-2019.pdfIndependent primary study · 1 finding

popa-illusory-own-body-perceptions-cingulate-cortex-intracranial-stimulation-2019.pdf

Independent primary study · Class II · Evidence weight 1.80 · 2 × 0.9 × 1

Patients underwent phase-two invasive presurgical evaluation at the University Emergency Hospital Bucharest or Strasbourg University Hospital between 2000 and 2017. The source reviewed 110 patients whose cingulate cortex was sampled and functionally mapped and included 12 right-handed patients with body-perception changes: 8 from Bucharest and 4 from Strasbourg. All had focal drug-resistant epilepsy; the epileptogenic zone was frontal in 9 patients, temporo-basal in 1, insular-opercular in 1, and insular in 1. Patients were selected when at least one electrode sampled cingulate cortex outside the epileptogenic zone; cognitive or psychiatric comorbidity judged likely to interfere with reliable interaction was excluded. Structures and stimulation sites were selected for clinical presurgical purposes, not for this study. The source reports no visible MRI lesion in the included patients and states that the stimulated locations did not overlap the delineated epileptogenic zone in the two patients who did not undergo surgery. Functional mapping used bipolar high-frequency stimulation at 50 Hz for 5 s through adjacent contacts with biphasic 1 ms pulses; current was gradually increased from 0.1 to 3 mA until a clinical or electrical response. Patients reported psychological or physical changes during or after stimulation. Body-representation changes were analyzed at the lowest intensity that evoked a symptom (SYM target group) and compared with typically half-intensity stimulations without a symptom (NS control group); after-discharges, auras, and seizures were excluded. Repeated trials, including 0 mA sham trials, were used for response consistency and psychogenic-event control. The separate connectivity analysis used h2 values from nonstimulated contacts in 10-s PRESTIM and 5-s POSTSTIM epochs; those network measurements are kept distinct from the semiologic findings below. No independent reference standard was reported for the subjective stimulation responses.

Findings

head turns to the right, detaches from the neck, and sees himself from outsideMCC stimulation S12 in Patient 7 elicited a composite body-perception experience in which the head turned to the right, was felt likely to detach from the neck after a sensation that it would explode, and was followed by a visual hallucination of seeing himself from outside from all angles without a secondary body.PDF p.5, Section 3.1 Clinical effects; PDF p.6, continuation of Section 3.1; PDF p.7, Table 2

roh-lateralizing-value-ictal-behaviors-temporal-lobe-epilepsy-1996.pdfStructured design not resolved · 2 findings · 9 reported values

roh-lateralizing-value-ictal-behaviors-temporal-lobe-epilepsy-1996.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 2

Findings

head versionIn the unilateral TLE cohort, head version occurred only on the side contralateral to the EEG seizure focus.PDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1
head turningHead turning occurred in both directions relative to the EEG seizure focus, with 15 seizures ipsilateral and 17 contralateral.PDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1; PDF p.5, Discussion

Reported values

6 patientshead versionCount · n/N 6/19 · 19 patients with unilateral TLE; head version occurred in 6 patients · patients with head version · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1
0 ipsilateral seizureshead versionCount · n/N 0/116 · 19 patients with unilateral TLE; head version occurred in 6 patients · ipsilateral to EEG focus · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1
14 contralateral seizures (12% of all 116 seizures)head versionPercentage · n/N 14/116 · 19 patients with unilateral TLE; head version occurred in 6 patients · contralateral to EEG focus · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1
17 contralateral seizures (53.1% of 32 head-turning seizures)head turningPercentage · n/N 17/32 · 19 patients with unilateral TLE; head turning occurred in 11 patients according to Table 1 patient counts · contralateral · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1; PDF p.5, Discussion
17 contralateral seizures (15% of all 116)head turningPercentage · n/N 17/116 · 19 patients with unilateral TLE; head turning occurred in 11 patients according to Table 1 patient counts · contralateral · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1; PDF p.5, Discussion
5 patients with ipsilateral head turninghead turningCount · 19 patients with unilateral TLE; head turning occurred in 11 patients according to Table 1 patient counts · ipsilateral · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1; PDF p.5, Discussion
15 ipsilateral seizures (46.9% of 32 head-turning seizures)head turningPercentage · n/N 15/32 · 19 patients with unilateral TLE; head turning occurred in 11 patients according to Table 1 patient counts · ipsilateral · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1; PDF p.5, Discussion
6 patients with contralateral head turninghead turningCount · 19 patients with unilateral TLE; head turning occurred in 11 patients according to Table 1 patient counts · contralateral · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1; PDF p.5, Discussion
15 ipsilateral seizures (13% of all 116)head turningPercentage · n/N 15/116 · 19 patients with unilateral TLE; head turning occurred in 11 patients according to Table 1 patient counts · ipsilateral · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1; PDF p.5, Discussion

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdfIndependent primary study · 6 findings · 4 reported values

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdf

Independent primary study · Class II · Evidence weight 4.89 · 2 × 1.35 × 1.812

Findings

contraversive head and eye movement in Ludwig and Ajmone-MarsanThe source reports contraversive head and eye movements in 29% of 55 patients in the cited Ludwig and Ajmone-Marsan series.PDF p.20, Discussion
focus contralateral to direction of head turningThe source states that reviewed reports of occipital lobe epilepsy found the ictal focus contralateral to the direction of head turning.PDF p.20, Discussion
head deviation in Fig. 2The Figure 2 tracing labels head deviation to the right during the illustrated depth-recorded seizure.PDF p.14, Fig. 2
contralateral head deviationContralateral head deviation occurred in 21 of 42 patients.PDF p.6, Results, Non-visual manifestations
contralateral head and eye deviation with occipital-localized seizureTwo depth-studied patients had contralateral head and eye deviation while the seizure remained localized to the occipital lobe.PDF p.6, Results, Non-visual manifestations
ipsilateral head deviationOne patient had ipsilateral head deviation.PDF p.6, Results, Non-visual manifestations

Reported values

29% of 55 patientscontraversive head and eye movement in Ludwig and Ajmone-MarsanPercentage · cited Ludwig and Ajmone-Marsan occipital epilepsy series · ictal manifestationPDF p.20, Discussion
21/42 (50%) patientscontralateral head deviationPercentage · n/N 21/42 · 42 medically refractory patients with source-defined occipital lobe epilepsy · ictal manifestationPDF p.6, Results, Non-visual manifestations
2 casescontralateral head and eye deviation with occipital-localized seizureCount · n/N 2/2 · two depth-studied cohort patients · ictal onset and early evolutionPDF p.6, Results, Non-visual manifestations
1 patientipsilateral head deviationCount · n/N 1/42 · 42 medically refractory patients with source-defined occipital lobe epilepsy · ictal manifestationPDF p.6, Results, Non-visual manifestations

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdfIndependent primary study · 1 finding · 1 reported value

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdf

Independent primary study · Class II · Evidence weight 5.28 · 2 × 1.35 × 1.957

Findings

head and eye deviationHead and eye deviation occurred in 41% of patients.PDF p.4, Results, Other seizure characteristics

Reported values

41%head and eye deviationPercentage · 82-patient parietal epilepsy series · ictal motor or oculomotor phasePDF p.4, Results, Other seizure characteristics

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdfNarrative, educational, or cited context · 1 finding

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Chassoux cohort; oro-alimentary automatisms; salivation; dystonic signs; head deviation; bilateral tonic-clonic seizuresThe review restates that Chassoux et al. described 33 patients with oro-alimentary automatisms, salivation, motor signs including dystonia and head deviation, and bilateral tonic-clonic seizures in the medio-lateral context.PDF p.4, Medio-lateral temporal origin

wang-hypermotor-seizures-temporal-pole-lesions-2008.pdfNarrative, educational, or cited context · 1 finding

wang-hypermotor-seizures-temporal-pole-lesions-2008.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

psychomotor semiology: head turningTypical temporal psychomotor semiology included head turning.PDF p.4, Seizure semiology on video-EEG recording

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdfIndependent primary study · 5 findings

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

visual aura to oculomotor to evolving motor phenotypePhenotype III progresses from visual aura to head-eye deviation or eye pursuit, then to contralateral limb tonic or asymmetric tonic posturing, with some seizures evolving to GTCS.PDF p.9, Phenotype III
dorsal parietal to premotor motor evolutionThe authors link rapid motor evolution after visual aura to propagation to dorsal parietal nodes and then premotor areas.PDF p.13, Phenotype III discussion
head and eye deviation to the leftTable 2 records head and eye deviation to the left in a seizure that followed left-upper-limb tonic posturing.PDF p.6, Table 2 Case 1 Sz1
head-eye-body deviation to the rightTable 2 records head, eye, and body deviation to the right in Case 5.PDF p.6, Table 2 Case 5
visual aura to head-eye deviation or pursuitIn Phenotype III, a visual aura rapidly progresses to head-eye deviation or eye pursuit.PDF p.9, Phenotype III; PDF p.13, Phenotype III discussion

wyllie1986.pdfStructured design not resolved · 4 findings · 45 reported values

wyllie1986.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1

Thirty-nine patients aged 1-48 years (mean 22) were selected for lateral head and eye movement during seizures; 2 were excluded because electromyographic artifact obscured electroencephalographic seizure onset. The analyzed sample was 37 patients with 74 spontaneous seizures: 20 patients were studied for complex partial seizures with or without secondary generalization and 17 for partial motor seizures with or without altered consciousness or secondary generalization. All seizures occurred spontaneously in the EEG laboratory, were recorded from onset, and had high-quality synchronized audio-video and EEG recordings; scalp, nasopharyngeal or sphenoidal electrodes were used, and 8 patients also had chronic subdural electrode arrays. Video and EEG were analyzed independently, and movement classification was performed without knowledge of EEG or clinical data. Ictal EEG seizure-onset location was used for all seizures except 3 with generalized ictal EEG onset, which were assigned to the location of the interictal focus because of other lateralizing EEG data. Table 1 onset totals were frontal 39 (12 patients), temporal 31 (22), parietal 2 (2), and occipital 2 (1); table values are seizures with patient counts in parentheses.

Findings

ipsiversion in Ochs and Robillard seriesThe current paper reports that Ochs et al. and Robillard et al. found ipsiversion in 50% and 48%, respectively, of seizures with head and eye turning and concluded that forced head turning at clinical seizure onset had no localizing or lateralizing value.PDF p.3, discussion paragraph comparing Ochs and Robillard; PDF p.5, references 31-32
ipsiversion in Ajmone Marsan and Abraham seriesThe current paper reports that Ajmone Marsan and Abraham found ipsiversion in 4 of 16 pentylenetetrazol-induced seizures with version and lateralized ictal EEG, but cautions that the seizures were selected to illustrate other electroclinical features and the 25% incidence may not have been representative.PDF p.4, paragraph beginning “Ajmone Marsan and Abraham”; PDF p.6, reference 39
ipsiversion in Ajmone Marsan and Ralston seriesThe current paper reports a 3% incidence of ipsiversion in a larger series of pentylenetetrazol-induced seizures by Ajmone Marsan and Ralston and suggests that this may have been a more accurate assessment than the 25% incidence in the selected Ajmone Marsan and Abraham series.PDF p.4, paragraph comparing the 3% and 25% incidences; PDF p.6, reference 38
ictal events preceding contraversive head and eye movementThirty-five of 61 versive seizures (57%) began with the versive movement; these were predominantly frontal-onset (91%) and none was temporal-onset, whereas the other versive seizures were preceded by quiet staring or staring with automatisms as detailed in Table 2.PDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion

Reported values

50%ipsiversion in Ochs and Robillard seriesPercentage · Seizures with head and eye turning in the cited Ochs report; cohort details not reported here · Ochs et al. · Head turning at clinical seizure onsetPDF p.3, discussion paragraph comparing Ochs and Robillard; PDF p.5, references 31-32
48%ipsiversion in Ochs and Robillard seriesPercentage · Seizures with head and eye turning in the cited Robillard report; cohort details not reported here · Robillard et al. · Head turning at clinical seizure onsetPDF p.3, discussion paragraph comparing Ochs and Robillard; PDF p.5, references 31-32
Ipsiversion 4 of 16 seizures (25%)ipsiversion in Ajmone Marsan and Abraham seriesPercentage · n/N 4/16 · Pentylenetetrazol-induced seizures selected to illustrate other electroclinical features in the cited series · Ictal head and eye turningPDF p.4, paragraph beginning “Ajmone Marsan and Abraham”; PDF p.6, reference 39
Ipsiversion incidence 3% in larger cited seriesipsiversion in Ajmone Marsan and Ralston seriesPercentage · Larger pentylenetetrazol-induced seizure series cited by the current paper · Larger Ajmone Marsan and Ralston series · Ictal head and eye turningPDF p.4, paragraph comparing the 3% and 25% incidences; PDF p.6, reference 38
Ipsiversion incidence 4/16 (25%) in selected cited seriesipsiversion in Ajmone Marsan and Ralston seriesPercentage · n/N 4/16 · Larger pentylenetetrazol-induced seizure series cited by the current paper · Selected Ajmone Marsan and Abraham series · Ictal head and eye turningPDF p.4, paragraph comparing the 3% and 25% incidences; PDF p.6, reference 38
frontal all versive seizures: 37 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · frontal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
frontal preceded by staring with automatisms: 0 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · frontal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
total preceded by staring with automatisms: 14 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · total · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
frontal all versive seizures: 10 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · frontal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
frontal preceded by quiet staring: 5 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · frontal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
temporal preceded by quiet staring: 2 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · temporal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
parietal preceded by quiet staring: 1 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · parietal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
temporal preceded by quiet staring: 2 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · temporal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
occipital preceded by quiet staring: 0 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · occipital · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
occipital preceded by staring with automatisms: 0 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · occipital · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
total all versive seizures: 27 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · total · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
occipital preceded by staring with automatisms: 0 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · occipital · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
total all versive seizures: 61 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · total · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
total version at onset 35/61 (57%)ictal events preceding contraversive head and eye movementPercentage · n/N 35/61 · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · total · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
parietal no preceding ictal event; version at onset: 1 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · parietal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
temporal no preceding ictal event; version at onset: 0 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · temporal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
total no preceding ictal event; version at onset: 12 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · total · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
total preceded by quiet staring: 8 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · total · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
parietal preceded by staring with automatisms: 0 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · parietal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
total preceded by quiet staring: 8 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · total · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
occipital preceded by quiet staring: 0 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · occipital · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
parietal preceded by quiet staring: 1 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · parietal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
frontal no preceding ictal event; version at onset: 10 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · frontal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
frontal preceded by quiet staring: 5 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · frontal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
occipital no preceding ictal event; version at onset: 1 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · occipital · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
parietal no preceding ictal event; version at onset: 1 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · parietal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
total preceded by staring with automatisms: 18 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · total · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
temporal all versive seizures: 20 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · temporal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
parietal all versive seizures: 2 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · parietal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
parietal preceded by staring with automatisms: 0 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · parietal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
occipital all versive seizures: 1 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · occipital · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
occipital no preceding ictal event; version at onset: 2 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · occipital · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
parietal all versive seizures: 2 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · parietal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
temporal all versive seizures: 14 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · temporal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
frontal version at onset 32/37 (91%)ictal events preceding contraversive head and eye movementPercentage · n/N 32/37 · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · frontal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
temporal no preceding ictal event; version at onset: 0 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · temporal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
temporal preceded by staring with automatisms: 18 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · temporal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
frontal preceded by staring with automatisms: 0 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · frontal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
temporal preceded by staring with automatisms: 14 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · temporal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
occipital all versive seizures: 2 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · occipital · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion

21 contributing manuscripts; source-reported values remain separate and are not pooled.

clonic jerking (rhythmic, somatotopic distribution)Source terms: Focal clonic jerkingReported: BilateralAlso reported: ContralateralAlso reported: IpsilateralAlso reported: Left hemisphereAlso reported: Right hemisphere23 manuscripts · 41 findings · 94 reported values

Weighted evidence supportevidence weight 44.62 across 23 manuscripts · 2 manuscript weight pending · 6 independent primary study · 2 structured design not resolved · 3 systematic review or meta-analysis · 12 narrative, educational, or cited context

Case 17 had right mouth, face, neck, and upper-limb clonic movements with a source-described left LG/FuG/PCu/SPL pathway. Ipsilateral, contralateral, and bilateral clonic motor forms occurred in both TL and T+ groups, without significant between-group differences. All 24 seizures with clonic jerking were contralateral to the EEG seizure-onset focus; no ipsilateral events were reported. The review describes early upper-limb and orofacial elementary motor signs as mainly contralateral tonic, clonic, or dystonic manifestations. At onset, 8/21 fronto-opercular epilepsy patients had contralateral brachial tonic, clonic, or dystonic posturing. Four of 12 prefrontal-operculum patients had contralateral brachial tonic, clonic, or dystonic posturing at onset. Four of nine precentral Rolandic-operculum patients had contralateral brachial tonic, clonic, or dystonic posturing at onset. This row restates the Fisher exact test for the contralateral brachial combined-sign comparison. The review states that focal clonic activity may have lateralizing value without specifying a direction. Cerebral lateralization: these signs are contralateral to seizure onset; target lobe is not differentiated by these signs alone. Unilateral clonic activity was contralateral to the epileptogenic zone with reported PPV 100% and kappa 0.81. The last clonic jerk was predominantly ipsilateral to the epileptogenic zone, with 86% overall PPV and kappa 0.85. The review table lists focal clonic jerking contralateral to a perirolandic focus. Focal motor clonic activity occurred contralateral to the epileptogenic zone in 57% of the parietal-epilepsy cohort. The cited series includes delayed motor signs, including source-described contralateral dystonia, without a reported onset-side direction. The review synthesis describes early upper-extremity dystonic and clonic activity as contralateral to the temporal seizure focus. The cited table lists clonic semiology as contralateral. The review describes unilateral clonic seizures as highly contralateralizing, while separately noting possible ipsilateral terminal paradoxical clonus. Longer terminal clonus in a secondarily generalized tonic-clonic seizure is described as ipsilateral to the epileptogenic focus. In this case, right head version and right-arm extension were contralateral to left onset, while the left last clonic jerk was ipsilateral to left onset. The review describes SSMA seizures as usually involving bilateral clonic activity with tonic posturing. Late focal jerking was contralateral to seizure onset and occurred more often in left temporal seizures (22/73) than right temporal seizures (6/54), p=0.02. The co-occurring progression pattern was described as more frequent in left temporal seizures. The study reports sign-specific epileptogenic-zone direction, predominantly contralateral, with ipsilateral direction for asymmetric clonic ending. The review describes head/eye deviation as suggesting an ipsilateral focus and other listed unilateral motor signs as usually indicating a contralateral focus. Unilateral clonic activity usually points contralaterally to the seizure focus, with ipsilateral exceptions; a cited frontal cohort estimate gave 83% contralateral direction. In a cited seizure-free frontal-lobe surgical cohort, unilateral clonic activity was contralateral in 10 patients and ipsilateral in 2. The review describes the last clonic jerk at an asymmetric generalized-seizure ending as usually ipsilateral to the seizure-onset hemisphere. Among 30 patients with asymmetric ending, the last jerk was ipsilateral to onset in 25, with PPV 83.3%. The focal clonic head jerks have no reported movement direction; bilateral applies only to the recorded pathway. No lateralizing information is supplied. No lateralization information is reported. No lateralizing direction is reported for the tonic-to-clonic propagation description. The cited anterior-versus-posterior insular comparison provides no lateralizing information.

Source-defined result groups 44

Localization: TemporalSource-defined values retained separatelyT+ · seizures1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyasymmetric clonic ending · representative seizure with sign1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTL · T+ · seizures1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyAll reported · no focal motor clonic activity · patients1 manuscript · 1 reported value · not pooled

Lateralization: IpsilateralSource-defined values retained separatelyparietal · other lobar subgroups · sign-positive occurrence1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTL · T+ · seizures1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyT+ · seizures1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyunilateral tonic · representative seizure with sign1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTL · T+ · seizures1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyIpsilateral to EEG seizure focus · Contralateral to EEG seizure focus · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyT+ · seizures1 manuscript · 1 reported value · not pooled

Lateralization: IpsilateralSource-defined values retained separatelyoverall · incorrect direction · sign-positive occurrence1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyunilateral clonic · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / Left hemisphereObserved proportion 30.1%LTL · RTL versus LTL · seizure1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTL · T+ · seizures1 manuscript · 1 reported value · not pooled

Lateralization: IpsilateralSource-defined values retained separatelytemporal · other lobar subgroups · sign-positive occurrence1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyM2e · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyTL · T+ · seizures1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyT+ · seizures1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyTL · T+ · seizures1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyT+ · seizures1 manuscript · 1 reported value · not pooled

Lateralization: IpsilateralSource-defined values retained separatelyfrontal · other lobar subgroups · sign-positive occurrence1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyFig of 4 · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / Left hemisphereObserved proportion 11.1%RTL · RTL versus LTL · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyTL · T+ · seizures1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyT+ · seizures1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 20.7%Contralateral to EEG seizure focus · seizure1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 55.6%9 patients with EZ in the precentral Rolandic operculum · prefrontal operculum group (N=12) · patients in the precentral Rolandic operculum group1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyT+ · seizures1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelydystonia · representative seizure with sign1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 38.1%All reported · prefrontal operculum versus precentral Rolandic operculum · all included patients1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyAll reported · sign-positive lateralization1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 42.9%All reported · prefrontal operculum versus precentral Rolandic operculum · all included patients1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyTL · T+ · seizures1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyT+ · seizures1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyversion · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyTodd's paralysis · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 36.8%Contralateral to EEG seizure focus · Ipsilateral to EEG seizure focus · patient1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 23

Alphabetical by manuscript.

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 1 finding · 8 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

clonic motor signsClonic motor signs did not differ significantly between TL and T+ groups across ipsilateral, contralateral, and bilateral forms.PDF p.6, Table 2

Reported values

TL 25.4%clonic motor signsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictalPDF p.6, Table 2
TL 18.6%clonic motor signsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictalPDF p.6, Table 2
T+ 13%clonic motor signsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictalPDF p.6, Table 2
T+ 13%clonic motor signsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictalPDF p.6, Table 2
TL 33.9%clonic motor signsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictalPDF p.6, Table 2
T+ 21.7%clonic motor signsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictalPDF p.6, Table 2
T+ 21.7%clonic motor signsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictalPDF p.6, Table 2
TL 20.3%clonic motor signsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictalPDF p.6, Table 2

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfNarrative, educational, or cited context · 1 finding

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

delayed motor signs (Duchowny study)The cited Duchowny series is described as having behavioral arrest and delayed motor signs including version, contralateral dystonia, clonic jerks, and automatisms.PDF p.7, cited-study discussion

blair-temporal-lobe-epilepsy-semiology-2012.pdfNarrative, educational, or cited context · 1 finding

blair-temporal-lobe-epilepsy-semiology-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Focal clonic jerkingFocal clonic jerking is listed as localizing to a contralateral perirolandic focus.PDF p.4, Table 2

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 1 finding

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

tonic posturing; clonic jerksThe source describes clonic jerks following focal tonic manifestations as likely reflecting propagation from the SMA to the primary motor area.PDF p.7, Discussion

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 2 findings · 1 reported value

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdf; chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

unilateral clonic movement; unilateral tonic/dystonic posturing; early head versionThe review describes unilateral clonic movements, unilateral tonic or dystonic posturing, and early forced head version as robust lateralising motor signs with positive predictive value greater than 80%, and states that these signs are contralateral to the side of seizure onset.PDF p.10, Lateralising signs
head version; figure-of-4 sign; last clonic jerkIn video case 7, a 33-year-old man with left temporal hypometabolism had head version to the right followed by right-arm extension in a figure-of-4 posture, indicating left hemispheric onset; in one seizure the last clonic jerk was on the left, also pointing to left onset, while ictal EEG was non-localisable in one seizure and lateralised left in another.PDF p.10, Video case 7

Reported values

positive predictive value >80%unilateral clonic movement; unilateral tonic/dystonic posturing; early head versionPositive predictive value · focal seizure literature · ictal onset/early ictalPDF p.10, Lateralising signs

elwan-kotagal-lateralizing-localizing-seizure-semiology-2018.pdfIndependent primary study · 2 findings · 27 reported values

elwan-kotagal-lateralizing-localizing-seizure-semiology-2018.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

Unilateral clonicIn the surgical cohort, unilateral clonic activity was reported as a contralateral lateralizing sign with 100% PPV and inter-observer kappa of 0.81.PDF p.3, Table 1; PDF p.3, §5.1
Last clonic jerkThe last clonic jerk was reported as an ipsilateral lateralizing sign with 86% PPV and inter-observer kappa of 0.85 overall.PDF p.3, Table 1; PDF p.3, §5.1

Reported values

inter-observer kappa 0.81Unilateral clonicKappa · Sign-positive occurrences included 17 seizures in 12 patients overall; temporal 2 seizures/2 patients, frontal 7/5, parietal 2/2, and occipital 6/3. · IctalPDF p.3, Table 1; PDF p.3, §5.1
3 patients in Occipital lobe epilepsyUnilateral clonicCount · Sign-positive occurrences included 17 seizures in 12 patients overall; temporal 2 seizures/2 patients, frontal 7/5, parietal 2/2, and occipital 6/3. · Occipital lobe epilepsy · IctalPDF p.3, Table 1; PDF p.3, §5.1
12 patients overallUnilateral clonicCount · Sign-positive occurrences included 17 seizures in 12 patients overall; temporal 2 seizures/2 patients, frontal 7/5, parietal 2/2, and occipital 6/3. · Overall · IctalPDF p.3, Table 1; PDF p.3, §5.1
17 seizures overallUnilateral clonicCount · Sign-positive occurrences included 17 seizures in 12 patients overall; temporal 2 seizures/2 patients, frontal 7/5, parietal 2/2, and occipital 6/3. · Overall · IctalPDF p.3, Table 1; PDF p.3, §5.1
6 seizures in Occipital lobe epilepsyUnilateral clonicCount · Sign-positive occurrences included 17 seizures in 12 patients overall; temporal 2 seizures/2 patients, frontal 7/5, parietal 2/2, and occipital 6/3. · Occipital lobe epilepsy · IctalPDF p.3, Table 1; PDF p.3, §5.1
2 patients in Temporal lobe epilepsyUnilateral clonicCount · Sign-positive occurrences included 17 seizures in 12 patients overall; temporal 2 seizures/2 patients, frontal 7/5, parietal 2/2, and occipital 6/3. · Temporal lobe epilepsy · IctalPDF p.3, Table 1; PDF p.3, §5.1
2 seizures in Temporal lobe epilepsyUnilateral clonicCount · Sign-positive occurrences included 17 seizures in 12 patients overall; temporal 2 seizures/2 patients, frontal 7/5, parietal 2/2, and occipital 6/3. · Temporal lobe epilepsy · IctalPDF p.3, Table 1; PDF p.3, §5.1
2 seizures in Parietal lobe epilepsyUnilateral clonicCount · Sign-positive occurrences included 17 seizures in 12 patients overall; temporal 2 seizures/2 patients, frontal 7/5, parietal 2/2, and occipital 6/3. · Parietal lobe epilepsy · IctalPDF p.3, Table 1; PDF p.3, §5.1
PPV 100% (contralateral)Unilateral clonicPositive predictive value · Sign-positive occurrences included 17 seizures in 12 patients overall; temporal 2 seizures/2 patients, frontal 7/5, parietal 2/2, and occipital 6/3. · IctalPDF p.3, Table 1; PDF p.3, §5.1
2 patients in Parietal lobe epilepsyUnilateral clonicCount · Sign-positive occurrences included 17 seizures in 12 patients overall; temporal 2 seizures/2 patients, frontal 7/5, parietal 2/2, and occipital 6/3. · Parietal lobe epilepsy · IctalPDF p.3, Table 1; PDF p.3, §5.1
5 patients in Frontal lobe epilepsyUnilateral clonicCount · Sign-positive occurrences included 17 seizures in 12 patients overall; temporal 2 seizures/2 patients, frontal 7/5, parietal 2/2, and occipital 6/3. · Frontal lobe epilepsy · IctalPDF p.3, Table 1; PDF p.3, §5.1
7 seizures in Frontal lobe epilepsyUnilateral clonicCount · Sign-positive occurrences included 17 seizures in 12 patients overall; temporal 2 seizures/2 patients, frontal 7/5, parietal 2/2, and occipital 6/3. · Frontal lobe epilepsy · IctalPDF p.3, Table 1; PDF p.3, §5.1
2 patientsLast clonic jerkCount · Sign-positive occurrences included 7 seizures in 7 patients overall; temporal 2/2, frontal 3/3, parietal 2/2, and occipital 0/0. · temporal · Ictal or terminal ictal motor phase.PDF p.3, Table 1; PDF p.3, §5.1
3 seizuresLast clonic jerkCount · Sign-positive occurrences included 7 seizures in 7 patients overall; temporal 2/2, frontal 3/3, parietal 2/2, and occipital 0/0. · frontal · Ictal or terminal ictal motor phase.PDF p.3, Table 1; PDF p.3, §5.1
0 seizuresLast clonic jerkCount · Sign-positive occurrences included 7 seizures in 7 patients overall; temporal 2/2, frontal 3/3, parietal 2/2, and occipital 0/0. · occipital · Ictal or terminal ictal motor phase.PDF p.3, Table 1; PDF p.3, §5.1
2 seizuresLast clonic jerkCount · Sign-positive occurrences included 7 seizures in 7 patients overall; temporal 2/2, frontal 3/3, parietal 2/2, and occipital 0/0. · temporal · Ictal or terminal ictal motor phase.PDF p.3, Table 1; PDF p.3, §5.1
86% overall PPVLast clonic jerkPositive predictive value · Sign-positive occurrences included 7 seizures in 7 patients overall; temporal 2/2, frontal 3/3, parietal 2/2, and occipital 0/0. · overall · Ictal or terminal ictal motor phase.PDF p.3, Table 1; PDF p.3, §5.1
2 patientsLast clonic jerkCount · Sign-positive occurrences included 7 seizures in 7 patients overall; temporal 2/2, frontal 3/3, parietal 2/2, and occipital 0/0. · parietal · Ictal or terminal ictal motor phase.PDF p.3, Table 1; PDF p.3, §5.1
7 patientsLast clonic jerkCount · Sign-positive occurrences included 7 seizures in 7 patients overall; temporal 2/2, frontal 3/3, parietal 2/2, and occipital 0/0. · overall sign-positive occurrences · Ictal or terminal ictal motor phase.PDF p.3, Table 1; PDF p.3, §5.1
2 seizuresLast clonic jerkCount · Sign-positive occurrences included 7 seizures in 7 patients overall; temporal 2/2, frontal 3/3, parietal 2/2, and occipital 0/0. · parietal · Ictal or terminal ictal motor phase.PDF p.3, Table 1; PDF p.3, §5.1
7 seizuresLast clonic jerkCount · Sign-positive occurrences included 7 seizures in 7 patients overall; temporal 2/2, frontal 3/3, parietal 2/2, and occipital 0/0. · overall sign-positive occurrences · Ictal or terminal ictal motor phase.PDF p.3, Table 1; PDF p.3, §5.1
0 patientsLast clonic jerkCount · Sign-positive occurrences included 7 seizures in 7 patients overall; temporal 2/2, frontal 3/3, parietal 2/2, and occipital 0/0. · occipital · Ictal or terminal ictal motor phase.PDF p.3, Table 1; PDF p.3, §5.1
67% PPVLast clonic jerkPositive predictive value · Sign-positive occurrences included 7 seizures in 7 patients overall; temporal 2/2, frontal 3/3, parietal 2/2, and occipital 0/0. · frontal · Ictal or terminal ictal motor phase.PDF p.3, Table 1; PDF p.3, §5.1
100% PPVLast clonic jerkPositive predictive value · Sign-positive occurrences included 7 seizures in 7 patients overall; temporal 2/2, frontal 3/3, parietal 2/2, and occipital 0/0. · temporal · Ictal or terminal ictal motor phase.PDF p.3, Table 1; PDF p.3, §5.1
kappa 0.85Last clonic jerkKappa · Sign-positive occurrences included 7 seizures in 7 patients overall; temporal 2/2, frontal 3/3, parietal 2/2, and occipital 0/0. · overall · Ictal or terminal ictal motor phase.PDF p.3, Table 1; PDF p.3, §5.1
3 patientsLast clonic jerkCount · Sign-positive occurrences included 7 seizures in 7 patients overall; temporal 2/2, frontal 3/3, parietal 2/2, and occipital 0/0. · frontal · Ictal or terminal ictal motor phase.PDF p.3, Table 1; PDF p.3, §5.1
100% PPVLast clonic jerkPositive predictive value · Sign-positive occurrences included 7 seizures in 7 patients overall; temporal 2/2, frontal 3/3, parietal 2/2, and occipital 0/0. · parietal · Ictal or terminal ictal motor phase.PDF p.3, Table 1; PDF p.3, §5.1

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdfStructured design not resolved · 2 findings · 3 reported values

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.932

Findings

Contralateral focal jerkingLate contralateral focal jerking was more common in LTL than RTL seizures.PDF p.1, Summary; PDF p.4, numbered clinical-feature results; PDF p.4, Table 5
Co-occurrence of tonic head deviation, focal jerking, and secondary generalizationThe authors state that tonic head deviation, focal jerking, and secondarily generalized seizures often occurred together and probably represented further spread of the seizure discharge.PDF p.6, Discussion

Reported values

p=0.02Contralateral focal jerkingP value · RTL seizure group, n=54, versus LTL seizure group, n=73 · Late ictal phasePDF p.1, Summary; PDF p.4, numbered clinical-feature results; PDF p.4, Table 5
RTL 6/54 seizures (11%)Contralateral focal jerkingPercentage · n/N 6/54 · RTL seizure group, n=54, versus LTL seizure group, n=73 · RTL · Late ictal phasePDF p.1, Summary; PDF p.4, numbered clinical-feature results; PDF p.4, Table 5
LTL 22/73 seizures (30%)Contralateral focal jerkingPercentage · n/N 22/73 · RTL seizure group, n=54, versus LTL seizure group, n=73 · LTL · Late ictal phasePDF p.1, Summary; PDF p.4, numbered clinical-feature results; PDF p.4, Table 5

foldvary-focal-epilepsy-surgical-evaluation-comprehensive-clinical-neurophysiology-2000.pdfNarrative, educational, or cited context · 1 finding

foldvary-focal-epilepsy-surgical-evaluation-comprehensive-clinical-neurophysiology-2000.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

contralateral upper-extremity dystonic and clonic activityIn a series comparing mesial and neocortical temporal seizure semiology, automatisms and dystonic posturing of the contralateral upper extremity early in the seizure were more common in mesial temporal epilepsy, whereas early clonic activity of the contralateral upper extremity or facial grimacing suggested neocortical temporal origin.PDF p.4, temporal seizure semiology paragraph beginning "In series comparing mesial"

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

clonic seizuresClonic activity reflects propagation over the motor cortex when it spreads from distal to proximal regions. In FLE it tends to occur early with consciousness preserved; in TLE it usually involves the face or upper extremity after an automotor phase; parietal-origin seizures are typically preceded by somatosensory disturbance, occipital-origin seizures by visual auras or versive head/eye movements, and SSMA seizures by bilateral clonic activity with tonic posturing.PDF p.3, section 3.2 Simple motor seizures; PDF p.2, Table 1

Reported values

Clonic contractions recur at 0.2–5 per secondclonic seizuresCount · patients with focal epilepsy and focal epilepsy subgroups · ictal sequencePDF p.3, section 3.2 Simple motor seizures; PDF p.2, Table 1

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdfNarrative, educational, or cited context · 1 finding

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

unilateral dystonic posturing, head/eye deviation, clonic or tonic movements, and hypokinesiaSecondary motor signs related to propagation outside the temporal lobe may lateralize the seizure-onset zone: unilateral dystonic posturing is usually contralateral to the focus, head or eye deviation suggests an ipsilateral focus, and other unilateral clonic or tonic movements or limb immobility usually indicate a contralateral focus.PDF p.8, Focal impaired awareness seizures

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdfSystematic review or meta-analysis · 9 findings · 6 reported values

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

elementary motor symptoms; orofacial; brachial; tonic; clonic; dystonicElementary motor symptoms were described as early, mainly involving the orofacial regions and/or arms; arm manifestations were mainly contralateral tonic, clonic, or dystonic seizures or postures.PDF p.6, Anatomical and clinical correlations; PDF p.8, Discussion
Brachial contralateral (tonic and/or clonic or dystonic posture)Table 2 reports 8/21 (38%) for Brachial contralateral (tonic and/or clonic or dystonic posture); timing is onset, and the source's overall agreement that the sign is suggestive of fronto-opercular epilepsy is graded Moderate.PDF p.7, Table 2
Brachial contralateral (tonic and/or clonic or dystonic posture)Table 2 reports 4/12 patients with Brachial contralateral (tonic and/or clonic or dystonic posture) in the prefrontal operculum group.PDF p.7, Table 2
Brachial contralateral (tonic and/or clonic or dystonic posture)Table 2 reports 4/9 patients with Brachial contralateral (tonic and/or clonic or dystonic posture) in the precentral Rolandic operculum group.PDF p.7, Table 2
Brachial contralateral (tonic and/or clonic or dystonic posture)Fisher's exact comparison of Brachial contralateral (tonic and/or clonic or dystonic posture) between the prefrontal and precentral Rolandic operculum groups has p=0.673.PDF p.7, Table 2
Elementary motor: orofacial (tonic and/or clonic, grimace)Table 2 reports 9/21 (43%) for Elementary motor: orofacial (tonic and/or clonic, grimace); timing is onset, and the source's overall agreement that the sign is suggestive of fronto-opercular epilepsy is graded High.PDF p.7, Table 2
Elementary motor: orofacial (tonic and/or clonic, grimace)Table 2 reports 4/12 patients with Elementary motor: orofacial (tonic and/or clonic, grimace) in the prefrontal operculum group.PDF p.7, Table 2
Elementary motor: orofacial (tonic and/or clonic, grimace)Table 2 reports 5/9 patients with Elementary motor: orofacial (tonic and/or clonic, grimace) in the precentral Rolandic operculum group.PDF p.7, Table 2
Elementary motor: orofacial (tonic and/or clonic, grimace)Fisher's exact comparison of Elementary motor: orofacial (tonic and/or clonic, grimace) between the prefrontal and precentral Rolandic operculum groups has p=0.396.PDF p.7, Table 2

Reported values

8/21 (38%)Brachial contralateral (tonic and/or clonic or dystonic posture)Percentage · n/N 8/21 · 21 included fronto-opercular epilepsy patients · OnsetPDF p.7, Table 2
4/12 patientsBrachial contralateral (tonic and/or clonic or dystonic posture)Proportion · n/N 4/12 · 12 patients with EZ in the prefrontal operculum · 12 patients with EZ in the prefrontal operculum · OnsetPDF p.7, Table 2
4/9 patientsBrachial contralateral (tonic and/or clonic or dystonic posture)Proportion · n/N 4/9 · 9 patients with EZ in the precentral Rolandic operculum · 9 patients with EZ in the precentral Rolandic operculum · OnsetPDF p.7, Table 2
9/21 (43%)Elementary motor: orofacial (tonic and/or clonic, grimace)Percentage · n/N 9/21 · 21 included fronto-opercular epilepsy patients · OnsetPDF p.7, Table 2
4/12 patientsElementary motor: orofacial (tonic and/or clonic, grimace)Proportion · n/N 4/12 · 12 patients with EZ in the prefrontal operculum · 12 patients with EZ in the prefrontal operculum · OnsetPDF p.7, Table 2
5/9 patientsElementary motor: orofacial (tonic and/or clonic, grimace)Proportion · n/N 5/9 · 9 patients with EZ in the precentral Rolandic operculum · 9 patients with EZ in the precentral Rolandic operculum · OnsetPDF p.7, Table 2

jobst-insula-and-its-epilepsies-2019.pdfNarrative, educational, or cited context · 1 finding

jobst-insula-and-its-epilepsies-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

clonic motor manifestationClonic motor manifestations are among the clinical manifestations reported with insular seizures.PDF p.2, Clinical Features

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdfIndependent primary study · 2 findings · 2 reported values

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdf

Independent primary study · Class II · Evidence weight 5.11 · 2 × 1.35 × 1.893

Findings

focal clonic activityThe authors state that focal clonic activity can be characteristic of frontal-lobe involvement and may have lateralising value, but does not always localise to a specific frontal-lobe region.PDF p.5, Discussion
Focal motor (clonic)Focal motor (clonic) semiology occurred in 2/61 individuals (3%) as initial semiology and 7/61 (11%) in the combined set-of-semiology.PDF p.5, Table 2

Reported values

Initial 2/61 (3%)Focal motor (clonic)Percentage · n/N 2/61 · 61 individuals undergoing frontal lobe epilepsy surgery · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2
Combined 7/61 (11%)Focal motor (clonic)Percentage · n/N 7/61 · 61 individuals undergoing frontal lobe epilepsy surgery · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 1 finding

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Clonic seizure patternTable 2 associates clonic semiology with primary motor cortex, premotor cortex, and SSMA and lists contralateral lateralisation.PDF p.3, Table 2

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdfNarrative, educational, or cited context · 4 findings · 13 reported values

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Unilateral clonic activityThe review presents unilateral clonic activity as a frequent lateralizing sign that usually points contralaterally to the seizure focus, while noting that ipsilateral jerking can occur, in part through the last-clonic-jerk phenomenon.PDF p.4, section 3.3 Unilateral clonic activity; PDF p.5, section 3.3.1 Mechanism; PDF p.12, Table 1
Unilateral clonic activityJanszky et al. found unilateral clonic activity in 33% of patients with frontal lobe epilepsy rendered seizure free after surgery; clonic activity was ipsilateral to the seizure focus in 2 and contralateral in 10 patients.PDF p.4, section 3.3 Unilateral clonic activity
Last clonic jerk and asymmetric endingThe review describes asymmetric ending of a generalized tonic-clonic seizure, particularly a last clonic jerk ipsilateral to the hemisphere of seizure onset, as a lateralizing sign with high reported observer agreement in the cited series.PDF p.5, section 3.4 Significance of last clonic jerk
Last clonic jerkLeutmezer et al. investigated 70 patients with mesial temporal lobe epilepsy due to hippocampal sclerosis and Engel class I or II outcome after 1 year; asymmetric ending occurred in 30 of 43 patients with secondary generalized tonic-clonic seizures, and the last jerk was ipsilateral to seizure onset in 25 of 30, with a positive predictive value of 83.3%.PDF p.5, section 3.4 Significance of last clonic jerk

Reported values

44.4%Unilateral clonic activityPercentage · Patients with focal or frontal lobe epilepsy · frontal lobe epilepsy · Ictal clonic phasePDF p.12, Table 1
56%Unilateral clonic activityPercentage · Patients with focal or frontal lobe epilepsy · epileptic seizures · Ictal clonic phasePDF p.4, section 3.3 Unilateral clonic activity; PDF p.5, section 3.3.1 Mechanism; PDF p.12, Table 1
83%Unilateral clonic activityPercentage · Patients with focal or frontal lobe epilepsy · frontal lobe epilepsy patients with unilateral clonic activity · Ictal clonic phasePDF p.12, Table 1
33% of patients had unilateral clonic activityUnilateral clonic activityPercentage · Patients with frontal lobe epilepsy rendered seizure free after epilepsy surgery · frontal-lobe epilepsy seizure-free surgical cohort · Ictal clonic phasePDF p.4, section 3.3 Unilateral clonic activity
2 patients ipsilateralUnilateral clonic activityCount · Patients with frontal lobe epilepsy rendered seizure free after epilepsy surgery · ipsilateral · Ictal clonic phasePDF p.4, section 3.3 Unilateral clonic activity
10 patients contralateralUnilateral clonic activityCount · Patients with frontal lobe epilepsy rendered seizure free after epilepsy surgery · contralateral · Ictal clonic phasePDF p.4, section 3.3 Unilateral clonic activity
Table 1 does not list this signLast clonic jerk and asymmetric endingCount · n/N 25/30 · Patients with mesial or temporal lobe epilepsy and generalized tonic-clonic seizures · End of generalized tonic-clonic seizurePDF p.5, section 3.4 Significance of last clonic jerk
specific series are reported in F012 and F013Last clonic jerk and asymmetric endingCount · n/N 25/30 · Patients with mesial or temporal lobe epilepsy and generalized tonic-clonic seizures · End of generalized tonic-clonic seizurePDF p.5, section 3.4 Significance of last clonic jerk
43 patientsLast clonic jerkCount · n/N 43/70 · 70 patients with mesial temporal lobe epilepsy due to hippocampal sclerosis and Engel class I or II outcome after 1 year; 43 with secondary generalized tonic-clonic seizures · secondary generalized tonic-clonic seizures · End of secondary generalized tonic-clonic seizurePDF p.5, section 3.4 Significance of last clonic jerk
25 of 30Last clonic jerkCount · n/N 25/30 · 70 patients with mesial temporal lobe epilepsy due to hippocampal sclerosis and Engel class I or II outcome after 1 year; 43 with secondary generalized tonic-clonic seizures · asymmetric ending · End of secondary generalized tonic-clonic seizurePDF p.5, section 3.4 Significance of last clonic jerk
83.3%Last clonic jerkPositive predictive value · n/N 25/30 · 70 patients with mesial temporal lobe epilepsy due to hippocampal sclerosis and Engel class I or II outcome after 1 year; 43 with secondary generalized tonic-clonic seizures · asymmetric ending · End of secondary generalized tonic-clonic seizurePDF p.5, section 3.4 Significance of last clonic jerk
96.7%Last clonic jerkOther reported value · 70 patients with mesial temporal lobe epilepsy due to hippocampal sclerosis and Engel class I or II outcome after 1 year; 43 with secondary generalized tonic-clonic seizures · last-clonic-jerk assessment · End of secondary generalized tonic-clonic seizurePDF p.5, section 3.4 Significance of last clonic jerk
30 of 43Last clonic jerkCount · n/N 30/43 · 70 patients with mesial temporal lobe epilepsy due to hippocampal sclerosis and Engel class I or II outcome after 1 year; 43 with secondary generalized tonic-clonic seizures · asymmetric ending · End of secondary generalized tonic-clonic seizurePDF p.5, section 3.4 Significance of last clonic jerk

luders-semiological-seizure-classification-1998.pdfNarrative, educational, or cited context · 2 findings · 2 reported values

luders-semiological-seizure-classification-1998.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

This is a classification/methods article rather than a cohort study. The proposed classification is based on semiology reported by the patient or observers or observed during video monitoring; the article gives definitions, examples, and clinical-application rationale. No study cohort, eligibility criteria, analysis population, reference standard, diagnostic accuracy analysis, or comparative denominator is reported. The authors state that the system had been tested in selected epilepsy centers for more than 10 years, without presenting a validation cohort or performance estimates in this report.

Findings

clonic seizureThe source defines clonic seizures as a series of myoclonic contractions that recur regularly at a rate of 0.2–5 per second.PDF p.4, Simple motor seizures
Clonic seizureClonic seizures are a series of myoclonic contractions that recur regularly at a rate of 0.2 to 5 per second.PDF p.4, Simple motor seizures, Clonic seizures; PDF p.2, Table 1

Reported values

recurrent contraction rate 0.2–5/sclonic seizureRate range · ictalPDF p.4, Simple motor seizures
0.2-5/s recurrence rateClonic seizureCount · IctalPDF p.4, Simple motor seizures, Clonic seizures; PDF p.2, Table 1

marashly-ictal-motor-sequences-lateralization-localization-values-2016.pdfIndependent primary study · 1 finding · 24 reported values

marashly-ictal-motor-sequences-lateralization-localization-values-2016.pdf

Independent primary study · Class II · Evidence weight 4.22 · 2 × 1.15 × 1.836

Findings

version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisIn the 47 representative seizures, Table 1 reports the following prevalence counts, PPVs, and Fleiss Kappa indices: version 36, 97%, 0.6961; unilateral tonic 24, 96%, 0.2594; M2e 21, 100%, 0.7364; unilateral clonic 10, 90%, 0.3643; Fig of 4 23, 74%, 0.4873; dystonia 6, 67%, 0.2620; asymmetric clonic ending 28, 89%, 0.6761; Todd's paralysis 6, 83%, 0.4360.PDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability

Reported values

0.262version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · dystonia · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
28/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 28/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · asymmetric clonic ending · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
89%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · asymmetric clonic ending · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
67%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · dystonia · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
96%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral tonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
10/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 10/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral clonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
23/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 23/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Fig of 4 · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
36/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 36/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · version · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.2594version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral tonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.3643version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral clonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
90%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral clonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
21/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 21/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · M2e · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
83%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Todd's paralysis · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
6/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 6/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Todd's paralysis · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.6961version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · version · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
100%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · M2e · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
97%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · version · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
6/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 6/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · dystonia · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
74%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Fig of 4 · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.6761version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · asymmetric clonic ending · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.7364version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · M2e · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.4873version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Fig of 4 · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
24/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 24/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral tonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.436version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Todd's paralysis · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability

mcgonigal-on-seizure-semiology-2021-5ba29d.pdfNarrative, educational, or cited context · 1 finding · 2 reported values

mcgonigal-on-seizure-semiology-2021-9127f2.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

hyperkinetic signs; speech modifications; viscerosensory symptoms; pain; asymmetric tonic; focal clonic; tonic symptomsIn the summarized Peltola et al. study of pure insular epilepsies, hyperkinetic signs, speech modifications, and viscerosensory symptoms were related to an anterior insular seizure-onset zone, whereas pain, asymmetric tonic, focal clonic, and tonic symptoms were more frequent in patients with a posterior insular seizure onset.PDF p.7, Table 2 (continued), Peltola et al. 2020 row

Reported values

79 seizureshyperkinetic signs; speech modifications; viscerosensory symptoms; pain; asymmetric tonic; focal clonic; tonic symptomsCount · 11 subjects with pure insular epilepsy; 79 seizures · Peltola et al. study · ictal onset and semiologic expressionPDF p.7, Table 2 (continued), Peltola et al. 2020 row
11 subjectshyperkinetic signs; speech modifications; viscerosensory symptoms; pain; asymmetric tonic; focal clonic; tonic symptomsCount · 11 subjects with pure insular epilepsy; 79 seizures · Peltola et al. pure insular epilepsy study · ictal onset and semiologic expressionPDF p.7, Table 2 (continued), Peltola et al. 2020 row

roh-lateralizing-value-ictal-behaviors-temporal-lobe-epilepsy-1996.pdfStructured design not resolved · 1 finding · 3 reported values

roh-lateralizing-value-ictal-behaviors-temporal-lobe-epilepsy-1996.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 2

Findings

clonic jerkingIn the unilateral TLE cohort, clonic jerking occurred only on the side contralateral to the EEG seizure focus.PDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1

Reported values

24/116 contralateral seizures (21%)clonic jerkingPercentage · n/N 24/116 · 19 patients with unilateral TLE; clonic jerking occurred in 7 patients · Contralateral to EEG seizure focus · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1
0 ipsilateral seizuresclonic jerkingCount · 19 patients with unilateral TLE; clonic jerking occurred in 7 patients · Ipsilateral to EEG seizure focus · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1
7 patients with contralateral clonic jerkingclonic jerkingCount · n/N 7/19 · 19 patients with unilateral TLE; clonic jerking occurred in 7 patients · Contralateral to EEG seizure focus · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdfIndependent primary study · 1 finding · 1 reported value

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdf

Independent primary study · Class II · Evidence weight 5.28 · 2 × 1.35 × 1.957

Findings

focal motor clonic activityFocal motor clonic activity occurred in 57% of patients and was contralateral to the epileptogenic zone in the source description.PDF p.4, Results, Other seizure characteristics

Reported values

57%focal motor clonic activityPercentage · 82-patient parietal epilepsy series · ictal motor phasePDF p.4, Results, Other seizure characteristics

trebuchon-drane-electrical-stimulation-functional-mapping-seeg-2025.pdfNarrative, educational, or cited context · 1 finding

trebuchon-drane-electrical-stimulation-functional-mapping-seeg-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

focal clonic movement; negative motor responses; tonic posturing; palilaliaThe source reports that central-region pulse or short-train stimulation is used to induce focal clonic movement, that negative motor responses are seen in the pre-SMA region, and that SMA-proper stimulation induces positive motor behaviors such as tonic posturing or palilalia.PDF p.13, Motor Behaviors

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdfNarrative, educational, or cited context · 2 findings · 1 reported value

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

clonic seizuresThe review states that clonic contractions recur at 0.2-5 per second and that the symptomatogenic zone is usually the primary motor strip. In temporal lobe epilepsy, the face, frontal eye field, and hand areas tend to be affected earlier than the legs; when clonus without altered consciousness is the first seizure sign, the epileptogenic zone is usually at or near the primary motor strip. Unilateral clonic seizures have high lateralizing value toward the contralateral hemisphere.PDF p.4, Clonic seizures
end of seizure paradoxical clonusIn secondarily generalized tonic-clonic seizures, the review states that clonic activity may persist longer on the side ipsilateral to the epileptogenic focus; it calls this “end of seizure paradoxical clonus” a highly reliable lateralizing sign and states that asymmetric seizure termination is relatively unusual in generalized epilepsy.PDF p.4, Clonic seizures

Reported values

Regular recurrence rate 0.2-5 per secondclonic seizuresCount · Patients with focal epilepsy, including temporal lobe epilepsy; no cohort reported · Ictal; first sign and early propagation emphasizedPDF p.4, Clonic seizures

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdfIndependent primary study · 2 findings

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

right-sided clonic mouth-face-neck-upper-limb movementsTable 2 records right-sided clonic movements involving the mouth, face, neck, and upper limb in Case 17.PDF p.8, Table 2 Case 17
focal clonic head jerksTable 2 records evolution to focal clonic jerks of the head in Case 19.PDF p.8, Table 2 Case 19

23 contributing manuscripts; source-reported values remain separate and are not pooled.

Ictal aphasia / speech arrest during seizureSource terms: Ictal aphasia / speech arrestReported: ContralateralAlso reported: Dominant hemisphereAlso reported: Left hemisphereAlso reported: Non-dominant hemisphereAlso reported: Right hemisphereNo single reliable side25 manuscripts · 74 findings · 76 reported values

Weighted evidence supportevidence weight 43.31 across 25 manuscripts · 2 manuscript weight pending · 2 structured design not resolved · 4 systematic review or meta-analysis · 4 independent primary study · 11 narrative, educational, or cited context · 4 case report or observation

Speech arrest occurred with equal frequency in the dominant- and nondominant-hemisphere seizure-onset groups. Dysphasia was reported in 4 DHS seizures from 3 patients versus 1 NHS seizure/patient, with p=0.002, supporting a dominant-hemisphere tendency in the study's classified ictal-language result. The discussion restates nondominant temporal onset for ictal normal speech and dominant-hemisphere onset for dysphasia. The review states that anarthria alone is insufficient for hemispheric lateralization. The educational statement says dominant-hemisphere seizures can produce the same phonatory symptoms as non-dominant seizures, with dysphasia additionally possible in dominant-hemisphere seizures. The review links early ictal dysphasia to dominant-hemisphere involvement and unilateral elementary auditory aura to contralateral seizure onset. The illustrative case reports left temporal ictal EEG onset and a left-sided structural/metabolic temporal extension. The review links ictal or postictal dysphasia to the dominant hemisphere, formed nonsensical ictal speech to the nondominant hemisphere, and explicitly describes speech arrest as non-lateralising. Speech arrest is restated as an insular-stimulation speech impairment in a series spanning dominant and nondominant language hemispheres. The review restates opposite language-sign directions for aphasia and ictal speech/verbalization, with paraphasia described as not clearly lateralizing. The review restates left temporal resection association for dysphasia and a non-lateralizing result for speech automatisms. The cited study is restated as finding anterior/posterior aphasia lateralizing and vocal disturbances without lateralizing value. The cited stimulation series describes left superior temporal stimulation effects that vary by task and subregion, including auditory phenomena, phonological errors, and naming or reading deficits. The cited source associates ictal speech arrest at onset with dominant-hemisphere seizure origin. Two patients had difficulty speaking at onset with epileptogenic zones in the speech-dominant parietal lobe. Three aphasic-aura entries are listed, with dominant-side information not aggregated. Aphasic seizure was reproduced by stimulation of the left supramarginal gyrus in one patient. The source educational statement associates aphasic aurae with seizures originating in the dominant parietal lobe. Early naming difficulties are associated with a left epileptogenic zone, while late comprehension deficits are associated with posterior basal temporal involvement. The cited mapping study is restated as producing two speech arrests in the dominant inferior parietal lobule after more than 1,000 low-frequency ECS stimulations. The review reports speech- or language-induced aphasic seizures in a dominant temporal-lobe seizure-origin context. The case reports left temporooccipital lateralized periodic discharges during aphasic status epilepticus. A single case caption reports left temporal rhythmic 4–6/sec EEG activity during a focal seizure with restlessness, aphasia, and eye blinking. The cited series restates ictal dysphasia in 16 of 33 patients with dominant temporal-lobe lesions and in none of 24 patients with recessive temporal-lobe lesions. The cited Hecaen and Angelergues report describes 32 ictal speech-automatism cases among 208 patients: EEG focus was left in 11, right in 13, and undecided in 8; 176/208 remaining cases were dysphasic. The cited review associates temporal verbal automatisms with the non-dominant language hemisphere and describes speech arrest/vocalization in cortical language areas. Right facial pain, right-ear ringing, right hemibody and foot manifestations predominated in the early sequence, while left-sided stiffening occurred in half of seizures. The review describes ictal or postictal dys/aphasia as having approximately 90% lateralisation value but gives no direction and says its localisation value is poor. The review states that ictal and postictal aphasia point primarily to dominant-hemisphere involvement, while acknowledging non-dominant onset and poor localization after spread. The review associates memory/language deficits with dominant temporal seizures. The cited review associates aphasic seizures with dominant-hemisphere lateralization despite preserved awareness and memory. Dysphasia was much more frequent in dominant-origin temporal-lobe seizures (27 seizures in 12 patients) than in nondominant-origin seizures (3 seizures in 2 patients), with all nondominant events being isolated paraphasias. The cited Bingley report restates ictal dysphasia in 48% of 33 patients with dominant temporal-lobe lesions versus 0/24 with nondominant temporal-lobe lesions. The cited source reports significantly more paroxysmal expressive dysphasia or speech arrest with left-sided discharges than with right-sided discharges in right-handed patients. A single video case describes ictal dysphasia with left temporal/neocortical onset-related findings and dominant-language impairment affecting verbal commands, expressive language, and reading. The review distinguishes dominant-hemisphere dysphasia, nondominant ictal speech or preserved awareness, contralateral RINCH motions, and nonlateralizing speech arrest. The cited study is restated as finding speech arrest nonspecific and not significantly different between LTL- and RTL-origin seizures. The review summarizes prior association of aphasic fits with left-hemisphere lesions in right-handed patients and temporal-lobe seizures. Table I reports 13 aphasic-fit cases with left epileptic dysfunction and 0 with right dysfunction, with P<0.01 stated in the text and summary. The primary result reports speech arrest equally on the left and right, four cases each, with no significant laterality. The primary result reports sensory aphasia in two left postero-temporal cases and one left anterotemporal case. The cited report restates left-sided seizure patterns in four cases with aphasic fits. The cited Penfield restatement associates aphasic fits with left temporal seizure patterns based on cerebral stimulation. The review discusses aphasic focal aware seizures in dominant-hemisphere temporal-plus epilepsy and does not assign a fixed anatomic side beyond functional dominance. The cited cohort restates aphasic seizures in 80% of patients with left-hemisphere temporo-polar encephaloceles. The case reports a right temporal seizure focus with right-sided language dominance, a dominant-temporal exception to the usual nondominant pattern. The review and table identify the language-dominant hemisphere as the usual side for ictal aphasia or dysphasia. The cited series is restated as having 16 of 17 surgically confirmed epileptogenic zones on the left. Speech arrest occurred with nondominant temporal-lobe onset in two seizures and dominant temporal-lobe onset in one seizure. The source attributes to Hecaen the statement that ictal paraphasia/Jargon aphasia is present in the dominant hemisphere. No hemisphere or body-side direction is reported. The primary focal-cognitive-semiology prevalence result reports no hemisphere or lateralization direction. No hemisphere, dominance, or side-relative direction is reported. No lateralization relationship is reported. No lateralizing direction is reported for medial-frontal speech arrest and oral motor phenomena. No lateralizing direction is reported for isolated aphasia. No lateralizing direction is reported for aphasia as a sole manifestation or for the listed additional seizure types. No lateralizing direction is reported for aphasic status epilepticus. No lateralizing direction is reported for the stimulus-induced ictal language disturbances. No lateralization information is reported. No lateralizing direction is reported for jargonaphasia in the basal temporal language area network. No lateralizing direction is reported for speech inhibition or speech arrest. No lateralizing direction is reported for the the source's own speech-inhibition count. The pooled speech-inhibition prevalence result provides no hemispheric direction. The heterogeneity result for pooled speech inhibition provides no hemispheric direction. No lateralizing direction is reported for the speech-inhibition heterogeneity result. No lateralizing direction is reported for global aphasia during propagation. No lateralizing direction is reported for the cited speech manifestation frequency. The late-dysphasia comparison reports no lateralization. No lateralizing direction is reported for the aphasic-seizure definition. No lateralizing semiology is reported; the row concerns scalp and depth-electrode detection during aphasic fits. Either hemisphere is reported, but no side is specified for the speech-arrest observation. The aphasia-related EEG focus comparison provides no hemispheric direction. No lateralizing direction is reported for the educational aphasic-seizure definition.

Source-defined result groups 27

Lateralization: Does not lateralizeObserved proportion 5.3%DHS · 1 NHS patient · patients1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphere / Non-dominant hemisphereSource-defined values retained separatelyDominant temporal-lobe onset · Nondominant temporal-lobe onset · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphere / Right hemisphereObserved proportion 100.0%All reported · usual nondominant-hemisphere association · patient1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphere / Non-dominant hemisphereSource-defined values retained separatelynondominant-origin; first patient · dominant-origin versus nondominant-origin dysphasia observations · patient and seizure1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / right:0Observed proportion 0.0%Right · case1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphere / Non-dominant hemisphereSource-defined values retained separatelyNondominant temporal-lobe onset · Dominant temporal-lobe onset · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphereSource-defined values retained separatelyAll reported · no aphasic aura · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyleft postero-temporal · Postero-temporal versus anterotemporal region · case/patient1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphere / Non-dominant hemisphereSource-defined values retained separatelynondominant-origin; second patient · dominant-origin versus nondominant-origin dysphasia observations · patient and seizure1 manuscript · 1 reported value · not pooled

Localization: SMA / pre-SMA / speech inhibitionSource-defined values retained separatelyAll reported · patients with the ictal symptom1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphereObserved proportion 3.4%dominant-hemisphere onset · NHS versus DHS · seizure, with patient count in parentheses1 manuscript · 1 reported value · not pooled

Lateralization: dominant side not aggregatedSource-defined values retained separatelyAll reported · other aura categories · aura entries1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphere / Non-dominant hemisphereSource-defined values retained separatelynondominant-origin · dominant-origin versus nondominant-origin dysphasia observations · patient and seizure1 manuscript · 2 reported values · not pooled

Lateralization: Left hemisphere / right:0Observed proportion 100.0%Left · case1 manuscript · 1 reported value · not pooled

Lateralization: Does not lateralizeSource-defined values retained separatelyspeech arrest · right side · case/patient1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphere / Non-dominant hemisphereSource-defined values retained separatelydominant-origin · dominant-origin versus nondominant-origin dysphasia observations · patient and seizure1 manuscript · 1 reported value · not pooled

Lateralization: Does not lateralizeObserved proportion 5.3%NHS · 1 DHS patient · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyleft anterotemporal · Postero-temporal versus anterotemporal region · case/patient1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 100.0%All reported · usual nondominant-hemisphere association · patient1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphereObserved proportion 0.9%nondominant-hemisphere onset · NHS versus DHS · seizure, with patient count in parentheses1 manuscript · 1 reported value · not pooled

Lateralization: Does not lateralizeSource-defined values retained separatelyspeech arrest · left side · case/patient1 manuscript · 1 reported value · not pooled

Localization: ParietalSource-defined values retained separatelyAll reported · no aphasic aura · patients1 manuscript · 1 reported value · not pooled

Localization: ParietalObserved proportion 1.2%All reported · no reproduced aphasic seizure · patient1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphereSource-defined values retained separatelydominant-hemisphere onset · NHS versus DHS · seizure, with patient count in parentheses1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphereSource-defined values retained separatelynondominant-hemisphere onset · NHS versus DHS · seizure, with patient count in parentheses1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 25

Alphabetical by manuscript.

aron-jonas-language-mapping-stereo-electroencephalography-review-expert-opinion-2021.pdfNarrative, educational, or cited context · 3 findings · 7 reported values

aron-jonas-language-mapping-stereo-electroencephalography-review-expert-opinion-2021.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

This is not an original cohort or pooled analysis. The review discusses published sEEG/ECS, subdural ECS, intraoperative ECS, intracranial recording, fMRI, and surgical-outcome studies; Table 1 lists 16 reviewed depth-electrode studies with study-level subject counts ranging from 1 to 172, including pediatric and adult populations. The source does not define one aggregate analysis population, does not report a pooled estimate, and states that no proper comparison has been made between resections with and without extra-operative or intra-operative language mapping. Stimulation protocols and language-task choices are described as methodological context; findings below retain study-specific populations and units where the review reports them.

Findings

dominant inferior parietal speech arrestThe review reports that Balestrini et al. obtained only two speech arrests in the dominant inferior parietal lobule after more than a thousand low-frequency ECS delivered through sEEG electrodes.PDF p.6, Table 1; PDF p.7, Mapping Indispensable Eloquent Language Cortex Using sEEG
speech arrest during ecological language tasksIn the review's account of de Ribaupierre et al., speech arrest occurred at 8 of 184 depth-electrode contacts in 3 patients during 2-5 mA stimulation, while 6 mA with 0.3 ms phase duration was the maximum stimulation for negative contacts.PDF p.4, Procedural Considerations for Electrical Stimulation Mapping of Language; PDF p.6, Table 1
medial frontal speech arrest and mouth or tongue motor phenomenaThe review reports that medial frontal ECS can produce speech arrest, sometimes with positive or negative motor phenomena of the mouth or tongue, and relates this finding to a phonological-articulatory network between supplementary motor area and ALA.PDF p.9, Mapping Dispensable Eloquent Language Cortex Using sEEG

Reported values

172 subjectsdominant inferior parietal speech arrestCount · 172-subject Balestrini et al. study listed in Table 1; parietal sEEG exploration · Balestrini et al. study · low-frequency ECS during parietal language mappingPDF p.6, Table 1; PDF p.7, Mapping Indispensable Eloquent Language Cortex Using sEEG
two speech arrests after more than 1,000 ECSdominant inferior parietal speech arrestCount · n/N 2/>1,000 ECS · 172-subject Balestrini et al. study listed in Table 1; parietal sEEG exploration · dominant inferior parietal lobule · low-frequency ECS during parietal language mappingPDF p.6, Table 1; PDF p.7, Mapping Indispensable Eloquent Language Cortex Using sEEG
6 mAspeech arrest during ecological language tasksOther reported value · 3 patients for the narrative speech-arrest observation; Table 1 lists 8 subjects for the de Ribaupierre et al. study · negative contacts · ECS during ecological language production such as counting, reading aloud, or spontaneous speechPDF p.4, Procedural Considerations for Electrical Stimulation Mapping of Language; PDF p.6, Table 1
8 subjectsspeech arrest during ecological language tasksCount · 3 patients for the narrative speech-arrest observation; Table 1 lists 8 subjects for the de Ribaupierre et al. study · de Ribaupierre et al. study total in Table 1 · ECS during ecological language production such as counting, reading aloud, or spontaneous speechPDF p.4, Procedural Considerations for Electrical Stimulation Mapping of Language; PDF p.6, Table 1
0.3 msspeech arrest during ecological language tasksDuration · 3 patients for the narrative speech-arrest observation; Table 1 lists 8 subjects for the de Ribaupierre et al. study · maximum stimulation for negative contacts · ECS during ecological language production such as counting, reading aloud, or spontaneous speechPDF p.4, Procedural Considerations for Electrical Stimulation Mapping of Language; PDF p.6, Table 1
2–5 mAspeech arrest during ecological language tasksRange · 3 patients for the narrative speech-arrest observation; Table 1 lists 8 subjects for the de Ribaupierre et al. study · contacts producing speech arrest · ECS during ecological language production such as counting, reading aloud, or spontaneous speechPDF p.4, Procedural Considerations for Electrical Stimulation Mapping of Language; PDF p.6, Table 1
8 of 184 depth-electrode contactsspeech arrest during ecological language tasksCount · n/N 8/184 · 3 patients for the narrative speech-arrest observation; Table 1 lists 8 subjects for the de Ribaupierre et al. study · contacts producing speech arrest · ECS during ecological language production such as counting, reading aloud, or spontaneous speechPDF p.4, Procedural Considerations for Electrical Stimulation Mapping of Language; PDF p.6, Table 1

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfSystematic review or meta-analysis · 1 finding

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

early naming and late comprehensionThe review states that early naming difficulties are strongly associated with a left epileptogenic zone, whereas late comprehension deficits are more likely associated with posterior basal temporal involvement.PDF p.9, Discussion

blair-temporal-lobe-epilepsy-semiology-2012.pdfNarrative, educational, or cited context · 1 finding

blair-temporal-lobe-epilepsy-semiology-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Ictal speech arrestSpeech arrest at seizure onset before altered consciousness, or inability to speak despite clear attempts with later recall, is described as implying dominant-hemisphere seizure origin; the source attributes possible mechanisms to Wernicke’s area, Broca’s area, or the dominant basotemporal area.PDF p.4, Table 2; PDF p.5, language-disturbances paragraph

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 5 findings · 2 reported values

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

speech inhibition; speech arrestIctal speech inhibition is described as a well-documented SMA epilepsy manifestation; stimulation studies may produce speech arrest without affecting consciousness.PDF p.7, Discussion
speech inhibitionTable 3 lists 7 patients for the the source's own ictal symptom “speech inhibition”; its table phase label is onset.PDF p.6, Table 3
speech inhibitionTable 3 reports a pooled prevalence of 10% for the the source's own ictal symptom “speech inhibition”; its table phase label is onset.PDF p.6, Table 3
speech inhibition; between-study heterogeneityThe source reports I2 heterogeneity of 0.51% for pooled speech inhibition prevalence.PDF p.5, Results
speech inhibition; heterogeneity testThe source reports p = 0.45 for the between-study heterogeneity test of pooled speech inhibition prevalence.PDF p.5, Results

Reported values

10% pooled prevalencespeech inhibitionPercentage · Patients with SMA or pre-SMA epilepsy in the selected studies · onsetPDF p.6, Table 3
I2 = 0.51%speech inhibition; between-study heterogeneityHeterogeneity I2 · Patients with SMA or pre-SMA epilepsy in the selected studies · ictal symptom prevalence analysisPDF p.5, Results

chauvel-mcgonigal-emergence-semiology-epileptic-seizures-2014.pdfNarrative, educational, or cited context · 3 findings

chauvel-mcgonigal-emergence-semiology-epileptic-seizures-2014.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

ictal speech arrest, vocalization, and verbal automatismsThe review states that most seizures involving cortical language areas reduce to speech arrest or vocalization depending on the involved area and its distance from ventral central regions; verbal automatisms occur in temporal seizures and are associated with the non-dominant language hemisphere, while aphasia-like abnormal production is less frequent.PDF p.7, section 8
pre-SMA speech and movement arrest / negative motor areasSeizures arising from rostral SMA or pre-SMA may consist of speech arrest, optional quavering vocalization, movement arrest, or subtle leg repositioning; when the examiner raises the arms they gradually drop back, a negative motor phenomenon associated with dorsal or ventral premotor areas.PDF p.3, section 4
jargonaphasia and basal temporal language areaJargonaphasia is reported in seizures originating from the basal temporal language area, with fast discharges occurring simultaneously in BTLA and posterior superior temporal gyrus including Heschl’s gyrus and planum temporale; the review interprets desynchronization as a functional disconnection between language comprehension and speech production.PDF p.7, section 8

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 5 findings

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdf; chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

lateral/neocortical temporal seizure; auditory aura; ictal dysphasiaLateral or neocortical temporal seizures are described as having fewer auras and often auditory or vertiginous features; elementary sounds such as humming, ringing, and buzzing indicate primary auditory cortex, complex sounds indicate auditory association areas, elementary unilateral auditory aura indicates contralateral onset, and early ictal dysphasia may indicate dominant-hemisphere involvement.PDF p.6, Lateral/neocortical temporal lobe; PDF p.3, Figure 1
psychic aura; ictal dysphasiaIn an illustrative 27-year-old woman with a non-lesional MRI and left temporal PET abnormality, seizures began with fear/anxiety and sometimes ear noise followed by difficulty speaking; she could follow visual but not verbal commands, and ictal EEG showed left temporal onset suggesting neocortical onset.PDF p.6, Video case 4; PDF p.6, Figure 5 caption
ictal/postictal dysphasia; speech arrest; ictal speechIctal or postictal dysphasia lateralises to the dominant hemisphere but has poor localising value; speech arrest is described as non-lateralising, whereas ictal speech consisting of formed nonsensical phrases is a non-dominant sign.PDF p.10, Lateralising signs
ictal dysphasia; neocortical temporal onsetIn video case 4, a 27-year-old woman with a psychic aura and occasional ear noise had ictal dysphasia; she could follow visual but not verbal commands, with expressive-language and reading impairment, and PET, statistical analysis, and ictal EEG indicated a left temporal neocortical onset extending toward the temporoparieto-occipital junction.PDF p.6, Video case 4; PDF p.7, Figure 5
ictal/postictal dysphasia; ictal speech; preserved awareness; RINCH motionsIctal or postictal dysphasia lateralises to the dominant hemisphere but has poor localising value and must be distinguished from non-lateralising speech arrest; formed nonsensical ictal speech and preserved awareness during ictal automatisms point to the nondominant hemisphere, while rhythmic ictal non-clonic hand motions may be contralateral in temporal lobe epilepsy and peri-ictal drinking, spitting, vomiting, or urge to urinate point to a nondominant focus.PDF p.10, Lateralising signs

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdfNarrative, educational, or cited context · 1 finding

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Speech arrest in a cited studyThe current paper reports that Gabr et al. (1989) found no significant difference in speech arrest between LTL- and RTL-origin seizures and argued that speech arrest is nonspecific and may result from a negative or positive motor effect or altered consciousness.PDF p.5, Discussion, speech-arrest paragraph

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdfNarrative, educational, or cited context · 2 findings · 2 reported values

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

aphasic focal aware seizures in TPE and the basal temporal language areaAphasic focal aware seizures in dominant-hemisphere TPE are not necessarily explained by propagation through perisylvian language areas; the chapter also describes involvement of anterior temporo-basal structures, including a basal temporal language area 2–9 cm from the temporal tip and including the fusiform gyrus.PDF p.10, Temporal pole or temporo-polar epilepsy
aphasic seizures with left temporo-polar encephalocelesIn a cited cohort of patients with temporo-polar encephaloceles, 80% of patients with left-hemisphere lesions had aphasic seizures.PDF p.10, Temporal pole or temporo-polar epilepsy

Reported values

basal temporal language area located 2–9 cm from the temporal tipaphasic focal aware seizures in TPE and the basal temporal language areaCount · patients with dominant-hemisphere TPE or anterior temporo-basal lesions · focal aware ictalPDF p.10, Temporal pole or temporo-polar epilepsy
80% of patients with left-hemisphere lesions had aphasic seizuresaphasic seizures with left temporo-polar encephalocelesPercentage · patients with temporo-polar encephaloceles and left-hemisphere lesions in the cited cohort · ictal focal awarePDF p.10, Temporal pole or temporo-polar epilepsy

gabr-speech-manifestations-lateralization-temporal-lobe-seizures-1989.pdfStructured design not resolved · 5 findings · 19 reported values

gabr-speech-manifestations-lateralization-temporal-lobe-seizures-1989.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 2

Thirty-five patients aged 12-39 years (mean 24.6) were selected from an epilepsy-surgery population; all had intractable temporal-lobe epilepsy and subsequently underwent temporal lobectomy. The investigators reviewed up to four good-quality videotaped seizures per patient until 100 seizures were reached; 94 were spontaneous, 3 hyperventilation-induced, and 3 Metrazol-activated. The cohort comprised 80 complex partial seizures and 20 complex partial seizures with secondary generalization; 48 seizures arose from the dominant temporal lobe in 16 patients and 52 from the nondominant temporal lobe in 19 patients. Simultaneous scalp and chronically implanted subdural EEG-video monitoring was used, speech dominance was determined by intracarotid amobarbital testing, and patients with bihemispheric speech representation were excluded. One author reviewed the videotapes without knowledge of EEG localization or eventual surgical management.

Findings

dysphasiasDysphasias occurred in 30 seizures in 14 patients: 27 seizures in 12 patients with dominant-origin seizures and 3 seizures in 2 patients with nondominant-origin seizures; all three nondominant dysphasias were isolated paraphasias, one patient had 2 ictal seizures, the second had 1 postictal seizure, and all other dysphasias were postictal and arose from the dominant hemisphere.PDF p.3, Table 3 and Results; PDF p.4, Table 5 and Results; PDF p.5, Discussion
ictal dysphasiaThe source reports that Bingley found ictal dysphasia in 48% of 33 patients with dominant temporal-lobe lesions and epilepsy versus 0 of 24 patients with a lesion in the nondominant temporal lobe.PDF p.5, Discussion
paroxysmal expressive dysphasia or speech arrestThe source reports that McKeever and coworkers found significantly more paroxysmal expressive dysphasia or speech arrest in right-handed patients with left-sided discharges than in those with right-sided discharges (p <= 0.05).PDF p.5, Discussion
speech arrestSpeech arrest occurred in 3 seizures in 3 different patients: 2 episodes were ictal and 1 postictal; 1 seizure had dominant temporal-lobe onset and 2 had nondominant onset, and all patients appeared responsive during the arrest.PDF p.3, Table 3 and Results; PDF p.5, conclusion
expressive dysphasia/speech arrestThe source reports that McKeever and colleagues observed expressive dysphasia or speech arrest in at least one seizure in 94% of their cases.PDF p.5, Discussion

Reported values

27 dominant-origin seizuresdysphasiasCount · 14 patients and 30 dysphasia seizures within the 35-patient temporal-lobe epilepsy cohort · dominant-origin · mixed; 2 ictal seizures in one patient and 1 postictal seizure in a second nondominant-origin patient, with all other dysphasias postictalPDF p.3, Table 3 and Results; PDF p.4, Table 5 and Results; PDF p.5, Discussion
2 ictal nondominant dysphasia seizuresdysphasiasCount · 14 patients and 30 dysphasia seizures within the 35-patient temporal-lobe epilepsy cohort · nondominant-origin; first patient · mixed; 2 ictal seizures in one patient and 1 postictal seizure in a second nondominant-origin patient, with all other dysphasias postictalPDF p.3, Table 3 and Results; PDF p.4, Table 5 and Results; PDF p.5, Discussion
14 patients with dysphasiadysphasiasCount · 14 patients and 30 dysphasia seizures within the 35-patient temporal-lobe epilepsy cohort · mixed; 2 ictal seizures in one patient and 1 postictal seizure in a second nondominant-origin patient, with all other dysphasias postictalPDF p.3, Table 3 and Results; PDF p.4, Table 5 and Results; PDF p.5, Discussion
3 nondominant-origin seizuresdysphasiasCount · 14 patients and 30 dysphasia seizures within the 35-patient temporal-lobe epilepsy cohort · nondominant-origin · mixed; 2 ictal seizures in one patient and 1 postictal seizure in a second nondominant-origin patient, with all other dysphasias postictalPDF p.3, Table 3 and Results; PDF p.4, Table 5 and Results; PDF p.5, Discussion
2 nondominant-origin patientsdysphasiasCount · 14 patients and 30 dysphasia seizures within the 35-patient temporal-lobe epilepsy cohort · nondominant-origin · mixed; 2 ictal seizures in one patient and 1 postictal seizure in a second nondominant-origin patient, with all other dysphasias postictalPDF p.3, Table 3 and Results; PDF p.4, Table 5 and Results; PDF p.5, Discussion
1 postictal nondominant dysphasia seizuredysphasiasCount · 14 patients and 30 dysphasia seizures within the 35-patient temporal-lobe epilepsy cohort · nondominant-origin; second patient · mixed; 2 ictal seizures in one patient and 1 postictal seizure in a second nondominant-origin patient, with all other dysphasias postictalPDF p.3, Table 3 and Results; PDF p.4, Table 5 and Results; PDF p.5, Discussion
12 dominant-origin patientsdysphasiasCount · 14 patients and 30 dysphasia seizures within the 35-patient temporal-lobe epilepsy cohort · dominant-origin · mixed; 2 ictal seizures in one patient and 1 postictal seizure in a second nondominant-origin patient, with all other dysphasias postictalPDF p.3, Table 3 and Results; PDF p.4, Table 5 and Results; PDF p.5, Discussion
30 dysphasia seizuresdysphasiasCount · 14 patients and 30 dysphasia seizures within the 35-patient temporal-lobe epilepsy cohort · mixed; 2 ictal seizures in one patient and 1 postictal seizure in a second nondominant-origin patient, with all other dysphasias postictalPDF p.3, Table 3 and Results; PDF p.4, Table 5 and Results; PDF p.5, Discussion
Dominant temporal-lesion patients with ictal dysphasia 48% of 33ictal dysphasiaPercentage · Patients with temporal-lobe lesions and epilepsy in the cited Bingley report · Dominant temporal-lobe lesion · ictalPDF p.5, Discussion
Nondominant temporal-lesion patients with ictal dysphasia 0/24ictal dysphasiaPercentage · n/N 0/24 · Patients with temporal-lobe lesions and epilepsy in the cited Bingley report · Nondominant temporal-lobe lesion · ictalPDF p.5, Discussion
p ≤ 0.05paroxysmal expressive dysphasia or speech arrestP value · Right-handed patients in the cited McKeever study · paroxysmal; exact ictal/postictal phase not reported in this restatementPDF p.5, Discussion
Responsive patients during speech arrest 3/3speech arrestPercentage · n/N 3/3 · 3 patients and 3 seizures in the 35-patient temporal-lobe epilepsy cohort · 2 ictal episodes and 1 postictal episodePDF p.3, Table 3 and Results; PDF p.5, conclusion
Nondominant-origin speech-arrest seizures n=2speech arrestCount · 3 patients and 3 seizures in the 35-patient temporal-lobe epilepsy cohort · Nondominant temporal-lobe onset · 2 ictal episodes and 1 postictal episodePDF p.3, Table 3 and Results; PDF p.5, conclusion
Ictal speech-arrest episodes n=2speech arrestCount · 3 patients and 3 seizures in the 35-patient temporal-lobe epilepsy cohort · Ictal · 2 ictal episodes and 1 postictal episodePDF p.3, Table 3 and Results; PDF p.5, conclusion
Postictal speech-arrest episodes n=1speech arrestCount · 3 patients and 3 seizures in the 35-patient temporal-lobe epilepsy cohort · Postictal · 2 ictal episodes and 1 postictal episodePDF p.3, Table 3 and Results; PDF p.5, conclusion
Speech-arrest seizures n=3speech arrestCount · 3 patients and 3 seizures in the 35-patient temporal-lobe epilepsy cohort · 2 ictal episodes and 1 postictal episodePDF p.3, Table 3 and Results; PDF p.5, conclusion
Dominant-origin speech-arrest seizures n=1speech arrestCount · 3 patients and 3 seizures in the 35-patient temporal-lobe epilepsy cohort · Dominant temporal-lobe onset · 2 ictal episodes and 1 postictal episodePDF p.3, Table 3 and Results; PDF p.5, conclusion
Patients with speech arrest n=3speech arrestCount · 3 patients and 3 seizures in the 35-patient temporal-lobe epilepsy cohort · 2 ictal episodes and 1 postictal episodePDF p.3, Table 3 and Results; PDF p.5, conclusion
94% of cases with expressive dysphasia or speech arrest in at least one seizureexpressive dysphasia/speech arrestPercentage · Cases in the cited McKeever study; exact denominator not reported in this passage · ictal/seizure-related; exact phase not otherwise reported in this cited restatementPDF p.5, Discussion

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdfSystematic review or meta-analysis · 3 findings

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

speech arrest; anarthria; dysarthria; dysphasiaThe source states that speech arrest, including anarthria or dysarthria, can be the first sign of seizures starting from the frontal operculum, while anarthria alone is not sufficient to assign hemispheric lateralization.PDF p.9, Discussion
dominant hemisphere; non-dominant hemisphere; dysphasia; postictal language disorderThe source states that seizures in dominant and non-dominant hemispheres can produce the same phonatory symptoms, while dominant-hemisphere seizures may additionally produce dysphasia that can persist postictally.PDF p.9, Discussion
speech arrest; motor aphasia; dysprosody; dysarthriaThe discussion reports that language disorders in the cited Peltola series combined motor aphasia, dysprosody, or dysarthria early in seizure semiology but not at initial onset, suggesting opercular spread.PDF p.9, Discussion

ictal-paraphasia-atypical-temporal-lobe-epilepsy.pdfCase report or observation · 3 findings

ictal-paraphasia-atypical-temporal-lobe-epilepsy.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

aphasia; ictal speech; ictal verbalizationThe article states that aphasic seizures or aphasia are associated with dominant temporal/hemisphere seizures, whereas ictal speech or verbalization is generally interpreted as a non-dominant temporal/hemisphere sign.PDF p.2, Introduction; PDF p.3, Discussion
dysphasia; speech automatismsThe article reports that the Serafetinides and Falconer series described dysphasia as predominantly associated with left temporal resection, whereas speech automatisms did not show a lateralizing value.PDF p.3, Discussion
anterior and posterior aphasia; vocal disturbancesThe article reports that Dussaule et al. found anterior and posterior aphasia to be lateralizing language disturbances, whereas vocal disturbances showed no lateralizing value.PDF p.3, Discussion

ictal-speech-disturbance-cerebral-dominance.pdfIndependent primary study · 10 findings · 7 reported values

ictal-speech-disturbance-cerebral-dominance.pdf

Independent primary study · Class II · Evidence weight 3.42 · 2 × 1.1 × 1.557

The authors collected about 43 cases with ictal speech disturbances over 8 years. Interictal EEG was examined at least twice per case; laterality was defined by a spike or sharp-wave focus, unilateral dominant spike or sharp wave, or unilateral slow wave corresponding to same-region brain damage or tumor. Laterality was confirmed in 36 cases; 7 cases with independent foci, no laterality, or normal findings were excluded. The statistical report concerns 34 right-handed epileptics because 2 left-handed patients could not be tested statistically. A control pool comprised 243 right-handed patients with unilateral abnormal EEG findings, 136 left and 117 right, and was assessed by t test.

Findings

aphasic fitThe authors state that prior authors generally associated aphasic fits with temporal-lobe seizures and left-hemisphere epileptogenic lesions in right-handed patients, while the exact percentage remained controversial.PDF p.2, Introduction; PDF p.4, Discussion
aphasic fitIn the reported right-handed epileptic cases, aphasic fits were associated with left rather than right EEG-defined epileptic dysfunction, 13 cases versus 0, with statistical significance reported at P<0.01.PDF p.3, Results, Table I; PDF p.5, Summary item 1
speech arrestSpeech arrest showed no significant laterality in the reported right-handed epileptic cases, with 4 cases on the left and 4 on the right side of epileptic dysfunction.PDF p.3, Results, Table I; PDF p.4, Discussion; PDF p.5, Summary item 3
sensory aphasiaAmong the aphasic-fit cases, the authors report sensory aphasia in the left postero-temporal region in two cases and the left anterotemporal region in one case.PDF p.4, Results paragraph beginning “Three types with ictal speech disturbances”
aphasic fitThe current article reports that Alajouanine and Sabouraud observed seizure patterns on the left side in 4 cases with aphasic fits.PDF p.4, Discussion paragraph beginning “Alajouanine et al.”
aphasic fitThe current article reports that Penfield and coworkers assumed aphasic fits occurred in relation to left temporal seizure patterns based on cerebral stimulation.PDF p.4, Discussion paragraph beginning “Alajouanine et al.”
ictal paraphasia or Jargon aphasiaThe authors state that ictal paraphasia or Jargon aphasia has occasionally been mistaken for speech automatism and attribute to Hecaen the statement that ictal paraphasia is present in the dominant hemisphere.PDF p.5, Discussion paragraph beginning “The question of why”
aphasic fitThe current article reports that Ajmone Marsan and Abraham described cases in which scalp EEG did not change during an aphasic fit while seizure patterns appeared with depth electrodes.PDF p.4, Discussion paragraph beginning “Alajouanine et al.”
speech arrestThe current article reports that Penfield and coworkers found speech arrest caused by neural discharge involving the inferior Rolandic area or supplementary motor area of either hemisphere.PDF p.4, Discussion paragraph beginning “It seems that the side of focus”
aphasic fitThe current article reports from Brain that EEG findings varied from anterotemporal to posterotemporal focus depending on expressive versus comprehensive aphasic reciprocity.PDF p.4, Discussion final paragraph; PDF p.5, Discussion opening

Reported values

Aphasic-fit cases with right epileptic dysfunction n=0aphasic fitCount · n/N 0/13 · 34 right-handed epileptics in the report; 13 aphasic-fit cases in the Table II summation · Right · ictalPDF p.3, Results, Table I; PDF p.5, Summary item 1
Aphasic-fit cases with left epileptic dysfunction n=13aphasic fitCount · n/N 13/13 · 34 right-handed epileptics in the report; 13 aphasic-fit cases in the Table II summation · Left · ictalPDF p.3, Results, Table I; PDF p.5, Summary item 1
Right 4speech arrestCount · n/N 4/8 speech-arrest cases · 34 right-handed epileptics in the report; 8 speech-arrest cases in the Table II summation · speech arrest · ictalPDF p.3, Results, Table I; PDF p.4, Discussion; PDF p.5, Summary item 3
Left 4speech arrestCount · n/N 4/8 speech-arrest cases · 34 right-handed epileptics in the report; 8 speech-arrest cases in the Table II summation · speech arrest · ictalPDF p.3, Results, Table I; PDF p.4, Discussion; PDF p.5, Summary item 3
1 left anterotemporal casesensory aphasiaCount · Aphasic-fit cases with sensory aphasia; exact subgroup denominator Not reported · left anterotemporal · ictalPDF p.4, Results paragraph beginning “Three types with ictal speech disturbances”
2 left postero-temporal casessensory aphasiaCount · Aphasic-fit cases with sensory aphasia; exact subgroup denominator Not reported · left postero-temporal · ictalPDF p.4, Results paragraph beginning “Three types with ictal speech disturbances”
4 cases with left-sided seizure patternsaphasic fitCount · 4 cited aphasic-fit cases; denominator Not reported · ictalPDF p.4, Discussion paragraph beginning “Alajouanine et al.”

jobst-insula-and-its-epilepsies-2019.pdfNarrative, educational, or cited context · 1 finding

jobst-insula-and-its-epilepsies-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

speech arrest from insular stimulationSpeech arrest was one of the speech impairments evoked by insular stimulation.PDF p.5, Other Insular Responses

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdfIndependent primary study · 1 finding · 2 reported values

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdf

Independent primary study · Class II · Evidence weight 5.11 · 2 × 1.35 × 1.893

Findings

Focal cognitive (aphasia)Focal cognitive (aphasia) semiology was present in 1/61 individuals (2%) as initial semiology and 3/61 (5%) in the combined set-of-semiology.PDF p.5, Table 2

Reported values

Initial 1/61 (2%)Focal cognitive (aphasia)Percentage · n/N 1/61 · 61 individuals undergoing frontal lobe epilepsy surgery · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2
Combined 3/61 (5%)Focal cognitive (aphasia)Percentage · n/N 3/61 · 61 individuals undergoing frontal lobe epilepsy surgery · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 4 findings · 1 reported value

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Ictal or postictal dys/aphasiaThe review describes ictal or postictal dys/aphasia as a valuable finding with approximately 90% lateralisation value, while stating that its localisation value is poor.PDF p.5, section 1.9
Ictal aphasiaThe review states that ictal aphasia occurs only with dominant-hemisphere involvement, even when seizure onset is in the non-dominant hemisphere; one cited series associated ictal aphasia with parieto-occipital seizure onsets.PDF p.5, section 1.9
Memory, language, orientation, and expressive speech deficitsThe review states that dominant temporal lobe seizures result in memory and language deficits, whereas frontal seizures result in loss of orientation and expressive speech function.PDF p.3, section 1.3
Global aphasia with propagationThe review states that larger cortical-stimulation intensities engage more of the language network, resulting in global aphasia, and that this is typically what occurs in seizures undergoing propagation.PDF p.6, section 1.9

Reported values

Approximately 90% lateralisation valueIctal or postictal dys/aphasiaPercentage · Video-EEG seizure literature; exact population not reported · ictal or postictalPDF p.5, section 1.9

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdfCase report or observation · 3 findings · 6 reported values

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

automatisms with preserved responsiveness and ictal dysphasiaJanszky et al. reported a dominant-temporal exception to the usual nondominant lateralization of preserved-responsive automatisms.PDF p.7, section 3.10; PDF p.12, Table 1
ictal dysphasia and aphasiaIctal dysphasia or aphasia lateralizes to the language-dominant hemisphere.PDF p.9, section 4.2; PDF p.12, Table 1
ictal dysphasiaSerafetinides and Falconer reported ictal dysphasia in 34 TLE patients and postoperative confirmation in 17, 16 of whom had left-sided zones.PDF p.9, section 4.2

Reported values

1 caseautomatisms with preserved responsiveness and ictal dysphasiaCount · n/N 1/1 · one 25-year-old woman with right temporal lobe epilepsy · ictalPDF p.7, section 3.10; PDF p.12, Table 1
100% dominantictal dysphasia and aphasiaPercentage · epilepsy monitoring unit patients with ictal dysphasia or aphasia · patients with ictal dysphasia or aphasia · ictalPDF p.9, section 4.2; PDF p.12, Table 1
34.2% of EMU patientsictal dysphasia and aphasiaPercentage · epilepsy monitoring unit patients with ictal dysphasia or aphasia · EMU patients · ictalPDF p.9, section 4.2; PDF p.12, Table 1
TLE patients with ictal dysphasia n=34ictal dysphasiaCount · 34 patients with temporal lobe epilepsy and ictal dysphasia · ictalPDF p.9, section 4.2
Confirmed zones left-sided 16/17ictal dysphasiaPercentage · n/N 16/17 · 34 patients with temporal lobe epilepsy and ictal dysphasia · Postoperatively confirmed · ictalPDF p.9, section 4.2
Postoperative confirmation 17/34ictal dysphasiaPercentage · n/N 17/34 · 34 patients with temporal lobe epilepsy and ictal dysphasia · ictalPDF p.9, section 4.2

luders-semiological-seizure-classification-1998.pdfNarrative, educational, or cited context · 2 findings

luders-semiological-seizure-classification-1998.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

aphasic seizureAphasic seizures are described as episodes in which the patient cannot speak and often cannot understand spoken language; the source presents them as a probable negative phenomenon caused by activation of a cortical language center, analogous to cortical stimulation of language areas.PDF p.5, Special seizures
Aphasic seizureDuring aphasic seizures the patient cannot speak and often cannot understand spoken language; the source describes these as probably negative phenomena produced by epileptic activation of a cortical language center, analogous to cortical language-area stimulation.PDF p.5, Special seizures, Aphasic seizures; PDF p.2, Table 1

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdfIndependent primary study · 1 finding · 4 reported values

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdf

Independent primary study · Class II · Evidence weight 5.07 · 2 × 1.5 × 1.69

Findings

late dysphasiaLate dysphasia did not differ significantly across M, ML, and L groups.PDF p.7, Table 5; PDF p.9, Nondifferentiating ictal characteristics

Reported values

L=0/13 (0%)late dysphasiaPercentage · n/N 0/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · late ictal, second half of seizurePDF p.7, Table 5; PDF p.9, Nondifferentiating ictal characteristics
ML=3/18 (16.7%)late dysphasiaPercentage · n/N 3/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · late ictal, second half of seizurePDF p.7, Table 5; PDF p.9, Nondifferentiating ictal characteristics
M=6/24 (25%)late dysphasiaPercentage · n/N 6/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · late ictal, second half of seizurePDF p.7, Table 5; PDF p.9, Nondifferentiating ictal characteristics
p=0.14late dysphasiaP value · 55 patients with unilateral TLE; M=24, ML=18, L=13 · late ictal, second half of seizurePDF p.7, Table 5; PDF p.9, Nondifferentiating ictal characteristics

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdfCase report or observation · 1 finding · 5 reported values

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Case 2 painful somatosensory, auditory-reflex, hypermotor, and autonomic/speech semiologyCase 2 was a 46-year-old right-handed man whose seizures began with lancinating right facial pain followed within 2 seconds by high-pitched right-ear ringing descending along the right hemibody to the foot, sometimes with right-foot tremor, witnessed erratic right-sided and truncal movements, and left-sided stiffening in half the seizures; he was usually conscious without postictal paresis, had 10–15-second events up to 100 times per day triggered by sounds, and could develop hypersalivation, speech difficulty, later nocturnal hypermotor seizures, and urinary incontinence.PDF p.11, Case 2; PDF p.13, continuation of Case 2

Reported values

within 2 secondsCase 2 painful somatosensory, auditory-reflex, hypermotor, and autonomic/speech semiologyDuration · Individual Case 2; 46-year-old right-handed man, seizure onset age 16 · early sensory sequence · Ictal; longitudinal diurnal, nocturnal, and postoperative descriptionsPDF p.11, Case 2; PDF p.13, continuation of Case 2
10–15-second eventsCase 2 painful somatosensory, auditory-reflex, hypermotor, and autonomic/speech semiologyRange · Individual Case 2; 46-year-old right-handed man, seizure onset age 16 · habitual events · Ictal; longitudinal diurnal, nocturnal, and postoperative descriptionsPDF p.11, Case 2; PDF p.13, continuation of Case 2
2–3 per monthCase 2 painful somatosensory, auditory-reflex, hypermotor, and autonomic/speech semiologyRange · Individual Case 2; 46-year-old right-handed man, seizure onset age 16 · youth · Ictal; longitudinal diurnal, nocturnal, and postoperative descriptionsPDF p.11, Case 2; PDF p.13, continuation of Case 2
in half the seizuresCase 2 painful somatosensory, auditory-reflex, hypermotor, and autonomic/speech semiologyOther reported value · Individual Case 2; 46-year-old right-handed man, seizure onset age 16 · left-sided stiffening · Ictal; longitudinal diurnal, nocturnal, and postoperative descriptionsPDF p.11, Case 2; PDF p.13, continuation of Case 2
up to 100 times per dayCase 2 painful somatosensory, auditory-reflex, hypermotor, and autonomic/speech semiologyFrequency · Individual Case 2; 46-year-old right-handed man, seizure onset age 16 · later high-frequency period · Ictal; longitudinal diurnal, nocturnal, and postoperative descriptionsPDF p.11, Case 2; PDF p.13, continuation of Case 2

roh-lateralizing-value-ictal-behaviors-temporal-lobe-epilepsy-1996.pdfStructured design not resolved · 3 findings · 10 reported values

roh-lateralizing-value-ictal-behaviors-temporal-lobe-epilepsy-1996.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 2

Findings

speech arrestSpeech arrest occurred with equal frequency in dominant- and nondominant-hemisphere seizure-onset groups.PDF p.3, Methods/Results; PDF p.4, Results and Table 2; PDF p.5, Figure 2
dysphasiaDysphasia was more frequent in dominant-hemisphere than nondominant-hemisphere seizure-onset observations and was treated by the authors as a significant lateralizing feature.PDF p.1, Abstract; PDF p.4, Results and Table 2; PDF p.5, Figure 2; PDF p.6, Discussion
ictal normal speech and dysphasia in prior video/EEG reportsThe discussion states that prior video/EEG analyses confirmed the source’s directional language conclusion: ictal normal speech with nondominant temporal onset and dysphasia with dominant-hemisphere onset.PDF p.6, Discussion

Reported values

p=1speech arrestP value · 19 patients with unilateral TLE; 65 NHS seizures and 51 DHS seizures · ictalPDF p.3, Methods/Results; PDF p.4, Results and Table 2; PDF p.5, Figure 2
1 DHS patientspeech arrestCount · n/N 1/19 · 19 patients with unilateral TLE; 65 NHS seizures and 51 DHS seizures · DHS · ictalPDF p.3, Methods/Results; PDF p.4, Results and Table 2; PDF p.5, Figure 2
1 NHS patientspeech arrestCount · n/N 1/19 · 19 patients with unilateral TLE; 65 NHS seizures and 51 DHS seizures · NHS · ictalPDF p.3, Methods/Results; PDF p.4, Results and Table 2; PDF p.5, Figure 2
NHS 1 seizure (1% of all 116 seizures)speech arrestPercentage · n/N 1/116 · 19 patients with unilateral TLE; 65 NHS seizures and 51 DHS seizures · NHS · ictalPDF p.3, Methods/Results; PDF p.4, Results and Table 2; PDF p.5, Figure 2
DHS 1 seizure (1% of all 116 seizures)speech arrestPercentage · n/N 1/116 · 19 patients with unilateral TLE; 65 NHS seizures and 51 DHS seizures · DHS · ictalPDF p.3, Methods/Results; PDF p.4, Results and Table 2; PDF p.5, Figure 2
p=0.002dysphasiaP value · 19 patients with unilateral TLE; 65 NHS seizures and 51 DHS seizures; DHS dysphasia occurred in 3 patients · ictal language manifestation as classified by the studyPDF p.1, Abstract; PDF p.4, Results and Table 2; PDF p.5, Figure 2; PDF p.6, Discussion
DHS 4 seizures (4% of all 116)dysphasiaPercentage · n/N 4/116 · 19 patients with unilateral TLE; 65 NHS seizures and 51 DHS seizures; DHS dysphasia occurred in 3 patients · dominant-hemisphere onset · ictal language manifestation as classified by the studyPDF p.1, Abstract; PDF p.4, Results and Table 2; PDF p.5, Figure 2; PDF p.6, Discussion
1 NHS patientdysphasiaCount · 19 patients with unilateral TLE; 65 NHS seizures and 51 DHS seizures; DHS dysphasia occurred in 3 patients · nondominant-hemisphere onset · ictal language manifestation as classified by the studyPDF p.1, Abstract; PDF p.4, Results and Table 2; PDF p.5, Figure 2; PDF p.6, Discussion
NHS 1 seizure (1% of all 116)dysphasiaPercentage · n/N 1/116 · 19 patients with unilateral TLE; 65 NHS seizures and 51 DHS seizures; DHS dysphasia occurred in 3 patients · nondominant-hemisphere onset · ictal language manifestation as classified by the studyPDF p.1, Abstract; PDF p.4, Results and Table 2; PDF p.5, Figure 2; PDF p.6, Discussion
3 DHS patientsdysphasiaCount · 19 patients with unilateral TLE; 65 NHS seizures and 51 DHS seizures; DHS dysphasia occurred in 3 patients · dominant-hemisphere onset · ictal language manifestation as classified by the studyPDF p.1, Abstract; PDF p.4, Results and Table 2; PDF p.5, Figure 2; PDF p.6, Discussion

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdfIndependent primary study · 4 findings · 3 reported values

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdf

Independent primary study · Class II · Evidence weight 2.70 · 2 × 1.35 × 1

Findings

aphasic auraTwo patients with epileptogenic zones in the speech-dominant parietal lobe had difficulty speaking at seizure onset.PDF p.3, Results, Aurae
aphasic aura entries in Table 1Table 1 lists three aphasic-aura entries.PDF p.4, Table 1
aphasic seizure reproduced from left supramarginal gyrusAn aphasic seizure was reproduced in one patient by stimulation of the left supramarginal gyrus.PDF p.5, Electrical cortical stimulation
aphasic aura and dominant parietal originThe source states that aphasic aurae occurred in a few patients whose seizures originated in the dominant parietal lobe.PDF p.9, Discussion

Reported values

2 patientsaphasic auraCount · 82-patient parietal epilepsy series · aura or seizure onsetPDF p.3, Results, Aurae
3 source-reported aura entriesaphasic aura entries in Table 1Count · 82-patient parietal epilepsy series · aura or seizure onsetPDF p.4, Table 1
1 patientaphasic seizure reproduced from left supramarginal gyrusCount · n/N 1/80 · 80 stimulated patients · stimulation responsePDF p.5, Electrical cortical stimulation

serafetinides-falconer-speech-disturbances-temporal-lobe-seizures-100-patients-1963.pdfNarrative, educational, or cited context · 2 findings · 7 reported values

serafetinides-falconer-speech-disturbances-temporal-lobe-seizures-100-patients-1963.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

The first 100 consecutive patients with temporal lobe epilepsy operated on by anterior temporal lobectomy were studied; pre-operative documentation recorded the presence or absence and nature of speech disturbance connected with fits, and follow-up was mostly by personal interview for 2-10 years. The operated side was used as an imperfect reference for the presumed primary epileptogenic site: Group A comprised 53 patients who became seizure-free or almost so and were presumed correctly diagnosed, while Group B comprised 47 patients with continuing attacks and lower localization validity, including 30 improved patients and 17 slightly benefited or unchanged patients. Table I reports 56 left-sided and 44 right-sided resections. All patients had pre-operative psychomotor seizures and many also had grand mal attacks. All but three patients were right-handed for ordinary tasks; cerebral speech dominance was presumed from left-sided resection in right-handed persons because intracarotid sodium amytal testing had not yet been used in doubtful cases.

Findings

ictal dysphasiaThe current article reports that Bingley found ictal dysphasia in 16/33 patients with a dominant temporal-lobe lesion and in 0/24 with a recessive temporal-lobe lesion.PDF p.10, discussion of prior dysphasia reports
ictal speech automatism; dysphasic speech disorderThe current article reports that Hecaen and Angelergues described 32 cases of ictal speech automatism among 208 epileptic patients with paroxysmal speech disorders; EEG focus was left-sided in 11, right-sided in 13, and undecided in 8, while the remaining 176 cases were dysphasic.PDF p.10, discussion of prior speech-automatism reports

Reported values

recessive lesion 0/24ictal dysphasiaPercentage · n/N 0/24 · Bingley’s cited patients with temporal-lobe lesions and epilepsy · recessive temporal-lobe lesion · Ictal dysphasiaPDF p.10, discussion of prior dysphasia reports
dominant lesion 16/33 (48%)ictal dysphasiaPercentage · n/N 16/33 · Bingley’s cited patients with temporal-lobe lesions and epilepsy · dominant temporal-lobe lesion · Ictal dysphasiaPDF p.10, discussion of prior dysphasia reports
13 of 32ictal speech automatism; dysphasic speech disorderPercentage · n/N 13/32 · Hecaen and Angelergues’ cited 208 epileptic patients with paroxysmal speech disorders · speech automatism; right-sided EEG focus · Ictal speech automatism or dysphasic speech disorderPDF p.10, discussion of prior speech-automatism reports
8 of 32ictal speech automatism; dysphasic speech disorderPercentage · n/N 8/32 · Hecaen and Angelergues’ cited 208 epileptic patients with paroxysmal speech disorders · speech automatism; undecided EEG focus · Ictal speech automatism or dysphasic speech disorderPDF p.10, discussion of prior speech-automatism reports
32 cases ... among 208ictal speech automatism; dysphasic speech disorderPercentage · n/N 32/208 · Hecaen and Angelergues’ cited 208 epileptic patients with paroxysmal speech disorders · ictal speech automatism · Ictal speech automatism or dysphasic speech disorderPDF p.10, discussion of prior speech-automatism reports
176/208ictal speech automatism; dysphasic speech disorderPercentage · n/N 176/208 · Hecaen and Angelergues’ cited 208 epileptic patients with paroxysmal speech disorders · dysphasic speech disorder · Ictal speech automatism or dysphasic speech disorderPDF p.10, discussion of prior speech-automatism reports
11 of 32ictal speech automatism; dysphasic speech disorderPercentage · n/N 11/32 · Hecaen and Angelergues’ cited 208 epileptic patients with paroxysmal speech disorders · speech automatism; left-sided EEG focus · Ictal speech automatism or dysphasic speech disorderPDF p.10, discussion of prior speech-automatism reports

trebuchon-drane-electrical-stimulation-functional-mapping-seeg-2025.pdfNarrative, educational, or cited context · 2 findings

trebuchon-drane-electrical-stimulation-functional-mapping-seeg-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

hallucinations or illusions; auditory symptoms; articulatory or phonological errors; naming or reading deficitsIn the posterior left superior temporal region, the source reports task- and subregion-specific effects: word-repetition stimulation of Heschl’s gyrus induced hallucinations or illusions without language deficit; planum temporale stimulation induced auditory symptoms with comprehension deficit; left planum temporale or Spt stimulation during word or pseudoword repetition elicited articulatory or phonological errors and difficulty maintaining the phonological loop; and posterior left STS stimulation during naming or reading produced naming or reading deficits without positive auditory symptoms, including the source’s reported “graphene” decoding, comprehension, and “graphene to phoneme” deficits.PDF p.7, posterior left superior temporal gyrus paragraph; PDF p.8, Fig. 10.3 caption
task-specific language effects in medial and basal temporal regions; elementary speech arrest or slowing; semantic picture matchingThe source reports that naming or reading stimulation in medial and basal temporal regions was more likely to induce a language deficit than repetition or automatic speech; naming was described as most sensitive in the inferior frontal gyrus and mesial temporal anterior region, while the insula showed more elementary speech arrest or slowing during automatic speech. At a basal temporal site, stimulation disrupted naming while the same site and stimulation parameters allowed a semantic picture-matching task to be performed perfectly.PDF p.9, medial and basal temporal task paragraph; PDF p.9, basal temporal region paragraph; PDF p.17, Table 10.1, Semantic Processing

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdfNarrative, educational, or cited context · 1 finding

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

aphasic seizuresThe review states that aphasic seizures occur despite preserved awareness and memory, are often mixed aphasias, and lateralize the epilepsy to the dominant hemisphere; they can also present as status epilepticus.PDF p.5, Aphasic seizures

unterberger-epileptic-aphasia-critical-appraisal-2021.pdfCase report or observation · 7 findings · 1 reported value

unterberger-epileptic-aphasia-critical-appraisal-2021.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

The authors report an extensive literature search on the term “epileptic aphasia,” analysis of semiology and terminology indicating language-associated seizure symptoms, and an overview of EEG, etiology, brain imaging, and ictal language disorders. The document is not a single-cohort study; its evidence base includes cited case reports, case series, and studies involving ictal aphasia, aphasic status epilepticus (ASE), temporal/frontal/other focal epilepsies, and postictal language dysfunction. The review does not report one pooled analysis population or common denominator.

Findings

speech- or language-induced aphasic seizuresThe review reports speech- or language-induced aphasic seizures all originating in the dominant temporal lobe.PDF p.2, §2.3
aphasic status epilepticus with left temporooccipital LPDsFigure 1 depicts a 75-year-old male with aphasic status epilepticus in structural focal epilepsy due to intracerebral bleeding and ictal left temporooccipital lateralized periodic discharges.PDF p.3, Fig.1 caption and EEG rendering
focal seizure with restlessness, aphasia, and eye blinkingFigure 2 depicts a 59-year-old female with a focal seizure involving restlessness, aphasia, and eye blinking, with a seizure pattern showing left temporal rhythmic 4–6/sec activity.PDF p.3, Fig.2 caption and EEG rendering
isolated aphasiaThe review states that isolated aphasia is reported to be a rare ictal phenomenon.PDF p.2, §2 opening paragraph
aphasia as sole manifestation and additional seizure typesThe review states that aphasia can occur as the sole manifestation of epileptic seizures, while additional seizure types are frequently reported; its Table 2 lists secondary generalized seizures, generalized tonic seizures, focal motor seizures/Epilepsia partialis continua, head turning, somato-sensory seizures, complex partial or psychic seizures, and various auras as additional types.PDF p.2, §2.1; PDF p.2, Table 2
aphasic status epilepticus (ASE)The review describes aphasia as a symptom of nonconvulsive status epilepticus and states that ASE may occur with or without additional seizure types; prolonged fluent aphasia seems rare, whereas most cases are characterized by deficit symptoms presenting as non-fluent aphasia.PDF p.2, §2.2
stimulus-induced ictal language disturbancesThe review describes telephone calls and watching television as triggers of speech arrest or aphasic seizures, photic stimulation as producing bleating vocalizations, and reading epilepsy as producing ictal dyslexia.PDF p.2, §2.3

Reported values

Rhythmic 4–6/sec EEG activityfocal seizure with restlessness, aphasia, and eye blinkingCount · Female, 59 years; focal seizure · ictalPDF p.3, Fig.2 caption and EEG rendering

25 contributing manuscripts; source-reported values remain separate and are not pooled.

motor signsReported: BilateralAlso reported: ContralateralAlso reported: IpsilateralAlso reported: Left hemisphereAlso reported: Right hemisphere20 manuscripts · 45 findings · 71 reported values

Weighted evidence supportevidence weight 37.13 across 20 manuscripts · 4 manuscript weight pending · 4 independent primary study · 5 systematic review or meta-analysis · 4 structured design not resolved · 4 narrative, educational, or cited context · 3 case report or observation

The review describes early upper-limb and orofacial elementary motor signs as mainly contralateral tonic, clonic, or dystonic manifestations. Left focal motor seizures occurred in a patient with a right parietal BOSD and right-centroparietal interictal maximum. The case began with a right frontal ictal field and left facial twitching, then evolved through bilateral propagation and bilateral motor activity. Group 1 includes several source-labeled contralateral motor components, but the composite group also contains signs without a stated direction. Both reported simple motor signs were contralateral to the resected side. One typical anterior patient had equally frequent contralateral simple motor seizures along with hypermotor activity. The cited review restates early facial activity and contralateral motor activity as suggestive of neocortical temporal epilepsy. In Case 2, initial forced right eye deviation was ipsilateral to the right temporal epileptogenic region, whereas later left-arm tonic posturing and left facial clonia were contralateral motor signs. When arm or face motor activity accompanied contraversion, the source describes it as contralateral to the seizure focus. Contralateral focal motor activity occurred in 16 of 42 patients. The source text does not provide a hemisphere direction, but the prefilled lateralization value says right. The source reports no lateralizing direction for the network-propagation account of occipital-onset seizures. No lateralizing information is supplied. No lateralization information is reported. No hemispheric lateralization is reported. This record provides no hemispheric lateralization. The frontal motor hierarchy provides no lateralizing direction. The posterior cingulate epilepsy cohort included bilateral asymmetric tonic manifestations, but no side-of-onset relationship is reported. This record provides no seizure lateralization. The review classification of ictal feature categories reports no lateralizing direction. The prevalence estimate is not lateralizing. The subgroup occurrence estimate is not lateralizing. The co-occurrence coefficient is not lateralizing. The symptom co-occurrence coefficient is not lateralizing. The surgical-extent association is not lateralizing. The duplicate body-text statistic is not lateralizing. The cited coupling comparison provides no lateralizing information. The cited frontal rostrocaudal gradient is not lateralizing. No hemisphere or body-side direction is reported. The review mentions asymmetric, bilateral, and body-distribution features but provides no hemisphere-relative direction for a lateralizing conclusion. The cited coupling patterns provide no lateralizing information. The rostrocaudal cluster gradient is not lateralizing.

Source-defined result groups 30

Lateralization: ContralateralObserved proportion 38.1%All reported · no focal motor activity · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyparietal · arm versus face activity and temporal versus extratemporal onset · seizure; patient counts in parentheses in Table 31 manuscript · 2 reported values · not pooled

Localization: TemporalSource-defined values retained separatelyoccipital · arm versus face activity and temporal versus extratemporal onset · seizure; patient counts in parentheses in Table 31 manuscript · 2 reported values · not pooled

Localization: TemporalSource-defined values retained separatelytemporal · arm versus face activity and temporal versus extratemporal onset · seizure; patient counts in parentheses in Table 31 manuscript · 2 reported values · not pooled

Localization: TemporalSource-defined values retained separatelytotal · arm versus face activity and temporal versus extratemporal onset · seizure; patient counts in parentheses in Table 31 manuscript · 1 reported value · not pooled

Localization: Frontal / ParietalSource-defined values retained separatelyGroup 1 · other patient groups · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyfrontal · arm versus face activity and temporal versus extratemporal onset · seizure; patient counts in parentheses in Table 31 manuscript · 2 reported values · not pooled

Localization: FrontalObserved proportion 50.0%12 patients with EZ in the prefrontal operculum · precentral Rolandic operculum group (N=9) · patients in the prefrontal operculum group1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 47.3%total · arm versus face activity and temporal versus extratemporal onset · seizure; patient counts in parentheses in Table 31 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 11.1%All reported · ipsilateral resected side · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 52.5%total · arm versus face activity and temporal versus extratemporal onset · seizure; patient counts in parentheses in Table 31 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 42.9%All reported · prefrontal operculum versus precentral Rolandic operculum · all included patients1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / Ipsilateral / Left hemisphere / Right hemisphereObserved proportion 33.3%All reported · seizure1 manuscript · 2 reported values · not pooled

Localization: FrontalObserved proportion 61.9%All reported · prefrontal operculum versus precentral Rolandic operculum · all included patients1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 16.7%All reported · other typical anterior patients · patients1 manuscript · 1 reported value · not pooled

Localization: Frontal / ParietalSource-defined values retained separatelyGroup 1 early spread network · other patient groups/whole population · anatomical-area involvement1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 77.8%9 patients with EZ in the precentral Rolandic operculum · prefrontal operculum group (N=12) · patients in the precentral Rolandic operculum group1 manuscript · 1 reported value · not pooled

Localization: FrontalSource-defined values retained separatelyAll reported · patients with the ictal symptom1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 20

Alphabetical by manuscript.

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfStructured design not resolved · 2 findings · 2 reported values

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.301

Findings

typical anterior contralateral simple motor seizuresOne typical anterior patient had equally frequent contralateral simple motor seizures along with hypermotor activity.PDF p.4, Clinical Presentation
posterior cingulate motor phenomenaMotor phenomena were observed in three of four posterior cingulate patients.PDF p.5, Clinical Presentation

Reported values

1/6 with contralateral simple motor seizures accompanying hypermotor activitytypical anterior contralateral simple motor seizuresProportion · n/N 1/6 · 6 typical anterior cingulate cases · ictal semiologyPDF p.4, Clinical Presentation
3/4 (75%) with motor phenomenaposterior cingulate motor phenomenaPercentage · n/N 3/4 · 4 posterior cingulate cases · ictal semiologyPDF p.5, Clinical Presentation

asadollahi-drug-resistant-parietal-lobe-epilepsy-clinical-manifestations-surgery-outcome-2017.pdfIndependent primary study · 1 finding · 1 reported value

asadollahi-drug-resistant-parietal-lobe-epilepsy-clinical-manifestations-surgery-outcome-2017.pdf

Independent primary study · Class II · Evidence weight 3.91 · 2 × 1.2 × 1.628

Findings

contralateral simple motor signsTwo patients had contralateral simple motor signs.PDF p.2, Results

Reported values

2/18 (11%) contralateral simple motor signscontralateral simple motor signsPercentage · n/N 2/18 · 18-patient drug-resistant parietal lobe epilepsy cohort · auraPDF p.2, Results

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfSystematic review or meta-analysis · 1 finding

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

language disturbances and motor phenomenaThe abstract characterizes basal temporal seizures as frequently presenting with language disturbances and motor phenomena, with less pronounced emotional and sensory signs than other temporal lobe epilepsy forms.PDF p.1, Abstract; PDF p.2, Key points

bonini-frontal-lobe-seizures-clinical-semiology-localization-2014-46edb4.pdfStructured design not resolved · 1 finding · 2 reported values

bonini-frontal-lobe-seizures-clinical-semiology-localization-2014-838eb8.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1

This single-center presurgical series included 54 patients whose SEEG-defined epileptogenic zone (EZ) predominantly involved the frontal lobe, selected from 180 SEEG explorations performed from February 2000 through November 2010; one inconclusive exploration and nonpredominantly frontal cases were excluded. The cohort included 22 male and 32 female patients, mean age 24.9 ± 9.5 years, mean epilepsy duration 16.9 ± 8 years, and 27/54 with normal MRI. Three epileptologists independently reviewed all seizures and scored presence/absence of 31 ictal signs; each patient's sign was assigned 0, 1, or 2 according to reproducibility. The “early spread network” was the cortical tissue involved from electrical onset through completion of clinical semiology and was explicitly distinguished from the EZ. SEEG sampling is described as 20 frontal cortical regions, while the later matrices are described as containing 24 brain-area variables. Analyses used correlation matrices, Kendall tests with p < 0.05, PCA on rank-transformed sign scores, hierarchical clustering, and value-test ≥ 2 to identify characteristic variables.

Findings

Group 1 elementary motor signsGroup 1 comprised 16 patients and was characterized by one or more elementary motor signs, including clonic signs, contralateral tonic posture, contralateral versive signs, asymmetric tonic posture, secondary generalization, or asymmetric facial contraction; somesthetic localized aura and tonic vocalization could also occur. Gestural motor behavior and emotional features were absent. Its early spread network showed significant involvement of rolandic cortex (BA 4), rolandic operculum (low BA 4), and parietal cortex, with other caudal and premotor regions also possible; discharge could begin in medial or lateral premotor regions or propagate lateromedially.PDF p.5, Figure 2; PDF p.8, Table 1; PDF p.9, Group 1

Reported values

value-test > 2Group 1 elementary motor signsThreshold · Group 1, 16 patients · Group 1 early spread network · Ictal; early spread networkPDF p.5, Figure 2; PDF p.8, Table 1; PDF p.9, Group 1
16 patientsGroup 1 elementary motor signsCount · Group 1, 16 patients · Group 1 · Ictal; early spread networkPDF p.5, Figure 2; PDF p.8, Table 1; PDF p.9, Group 1

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 2 findings · 1 reported value

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

elementary motor signsTable 3 lists 5 patients for the the source's own ictal symptom “elementary motor signs”; its table phase label is onset.PDF p.6, Table 3
elementary motor signsTable 3 reports a pooled prevalence of 4% for the the source's own ictal symptom “elementary motor signs”; its table phase label is onset.PDF p.6, Table 3

Reported values

4% pooled prevalenceelementary motor signsPercentage · Patients with SMA or pre-SMA epilepsy in the selected studies · onsetPDF p.6, Table 3

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 2 findings

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdf; chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

elementary motor sign; complex motor sign; gestural behaviourIntracranial stereo-EEG literature is summarized as placing elementary clonic, tonic, and versive signs in precentral and premotor regions; less-natural proximal stereotypies such as rocking and turning in premotor/posterior prefrontal regions; and more integrated natural gestural behaviour with distal stereotypies such as manual automatisms in more anterior prefrontal regions including orbitofrontal cortex, frontal pole, and anterior cingulate.PDF p.2, Frontal lobe seizures; PDF p.3, Figure 1
elementary motor signs; complex motor signs; gestural behaviourThe review reports that intracranial stereo-EEG studies associate elementary clonic, tonic, and versive signs with precentral and premotor regions; more complex motor signs with more rostral frontal regions; non-integrated proximal stereotypies such as rocking and turning with premotor and posterior prefrontal regions; and integrated distal stereotypies such as manual automatisms with anterior prefrontal regions including orbitofrontal cortex, frontal pole, and anterior cingulate.PDF p.2, Frontal lobe seizures

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.54 · 1 × 0.9 × 1.707

Findings

elementary motor phenomenaElementary motor phenomena were reported in two of 26 restricted-OFC cases.PDF p.2, Semiology patterns of seizures with EZN restricted to the OFC

Reported values

2/26 (7.6%)elementary motor phenomenaPercentage · n/N 2/26 · OFC-restricted EZN cases · OFC-restricted EZN cases · ictalPDF p.2, Semiology patterns of seizures with EZN restricted to the OFC

enatsu-posterior-cingulate-epilepsy-clinical-neurophysiological-analysis-2014.pdfStructured design not resolved · 1 finding · 1 reported value

enatsu-posterior-cingulate-epilepsy-clinical-neurophysiological-analysis-2014.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.423

Findings

motor manifestations in PCEThree of seven patients showed motor manifestations.PDF p.1, Abstract; PDF p.5, Ictal semiology and SEEG findings

Reported values

3/7 motor manifestationsmotor manifestations in PCEProportion · n/N 3/7 · 7 PCE patients · ictal semiologyPDF p.1, Abstract; PDF p.5, Ictal semiology and SEEG findings

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 1 finding · 4 reported values

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

early dystonia, oral automatisms, and early facial or contralateral motor activity in NTLE versus MTLEDystonic limb posturing within 20 seconds of seizure onset was reported more often in MTLE than NTLE, 52% versus 26%, and oral automatisms were reported 69% versus 11%, respectively. Early facial grimacing or twitching and contralateral motor activity were suggestive of NTLE.PDF p.6, section 8.1 Neocortical temporal lobe epilepsy

Reported values

Oral automatisms in MTLE 69%early dystonia, oral automatisms, and early facial or contralateral motor activity in NTLE versus MTLEPercentage · patients with NTLE and MTLE · MTLE · within 20 seconds of seizure onset; early ictalPDF p.6, section 8.1 Neocortical temporal lobe epilepsy
Early dystonic posturing in NTLE 26%early dystonia, oral automatisms, and early facial or contralateral motor activity in NTLE versus MTLEPercentage · patients with NTLE and MTLE · NTLE · within 20 seconds of seizure onset; early ictalPDF p.6, section 8.1 Neocortical temporal lobe epilepsy
Early dystonic posturing in MTLE 52%early dystonia, oral automatisms, and early facial or contralateral motor activity in NTLE versus MTLEPercentage · patients with NTLE and MTLE · MTLE · within 20 seconds of seizure onset; early ictalPDF p.6, section 8.1 Neocortical temporal lobe epilepsy
Oral automatisms in NTLE 11%early dystonia, oral automatisms, and early facial or contralateral motor activity in NTLE versus MTLEPercentage · patients with NTLE and MTLE · NTLE · within 20 seconds of seizure onset; early ictalPDF p.6, section 8.1 Neocortical temporal lobe epilepsy

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdfSystematic review or meta-analysis · 10 findings · 6 reported values

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

elementary motor symptoms; orofacial; brachial; tonic; clonic; dystonicElementary motor symptoms were described as early, mainly involving the orofacial regions and/or arms; arm manifestations were mainly contralateral tonic, clonic, or dystonic seizures or postures.PDF p.6, Anatomical and clinical correlations; PDF p.8, Discussion
elementary motor symptoms; speech dysfunction; complex motor behavior; respiratory symptoms; salivation; laughter; preserved consciousnessThe source's abstract identifies elementary motor symptoms, speech dysfunction, complex motor behavior, respiratory symptoms, salivation, and laughter as ictal signs with preserved consciousness in fronto-opercular epilepsy.PDF p.1, Abstract; PDF p.2, Key points
Elementary motor: orofacial (tonic and/or clonic, grimace)Table 2 reports 9/21 (43%) for Elementary motor: orofacial (tonic and/or clonic, grimace); timing is onset, and the source's overall agreement that the sign is suggestive of fronto-opercular epilepsy is graded High.PDF p.7, Table 2
Elementary motor: orofacial (tonic and/or clonic, grimace)Table 2 reports 4/12 patients with Elementary motor: orofacial (tonic and/or clonic, grimace) in the prefrontal operculum group.PDF p.7, Table 2
Elementary motor: orofacial (tonic and/or clonic, grimace)Table 2 reports 5/9 patients with Elementary motor: orofacial (tonic and/or clonic, grimace) in the precentral Rolandic operculum group.PDF p.7, Table 2
Elementary motor: orofacial (tonic and/or clonic, grimace)Fisher's exact comparison of Elementary motor: orofacial (tonic and/or clonic, grimace) between the prefrontal and precentral Rolandic operculum groups has p=0.396.PDF p.7, Table 2
Elementary motor: otherTable 2 reports 13/21 (62%) for Elementary motor: other; timing is onset, and the source's overall agreement that the sign is suggestive of fronto-opercular epilepsy is graded Moderate.PDF p.7, Table 2
Elementary motor: otherTable 2 reports 6/12 patients with Elementary motor: other in the prefrontal operculum group.PDF p.7, Table 2
Elementary motor: otherTable 2 reports 7/9 patients with Elementary motor: other in the precentral Rolandic operculum group.PDF p.7, Table 2
Elementary motor: otherFisher's exact comparison of Elementary motor: other between the prefrontal and precentral Rolandic operculum groups has p=0.367.PDF p.7, Table 2

Reported values

9/21 (43%)Elementary motor: orofacial (tonic and/or clonic, grimace)Percentage · n/N 9/21 · 21 included fronto-opercular epilepsy patients · OnsetPDF p.7, Table 2
4/12 patientsElementary motor: orofacial (tonic and/or clonic, grimace)Proportion · n/N 4/12 · 12 patients with EZ in the prefrontal operculum · 12 patients with EZ in the prefrontal operculum · OnsetPDF p.7, Table 2
5/9 patientsElementary motor: orofacial (tonic and/or clonic, grimace)Proportion · n/N 5/9 · 9 patients with EZ in the precentral Rolandic operculum · 9 patients with EZ in the precentral Rolandic operculum · OnsetPDF p.7, Table 2
13/21 (62%)Elementary motor: otherPercentage · n/N 13/21 · 21 included fronto-opercular epilepsy patients · OnsetPDF p.7, Table 2
6/12 patientsElementary motor: otherProportion · n/N 6/12 · 12 patients with EZ in the prefrontal operculum · 12 patients with EZ in the prefrontal operculum · OnsetPDF p.7, Table 2
7/9 patientsElementary motor: otherProportion · n/N 7/9 · 9 patients with EZ in the precentral Rolandic operculum · 9 patients with EZ in the precentral Rolandic operculum · OnsetPDF p.7, Table 2

hwang-painful-seizures-review-ictal-pain-2019.pdfNarrative, educational, or cited context · 1 finding

hwang-painful-seizures-review-ictal-pain-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Gastaut syndrome headache-associated seizure semiologyThe review describes Gastaut syndrome as rare and usually occurring in the first decade; seizures begin with visual symptoms such as scintillating scotomas or hallucinations and eye deviation, then evolve to impaired awareness and focal motor activity, with migraine headaches common after seizures.PDF p.3, Localization; PDF p.4, Localization (continued)

jain-bottom-of-sulcus-dysplasia-surgical-outcomes-2021.pdfCase report or observation · 1 finding

jain-bottom-of-sulcus-dysplasia-surgical-outcomes-2021.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

The study included consecutive children with focal epilepsy and MRI-defined BOSD evaluated at The Hospital for Sick Children in Toronto between January 2007 and July 2019; patients with less than 1 year of postsurgical follow-up were excluded. Forty-one children were included. Medical-record data included seizure semiology, seizure frequency, age at seizure onset, antiseizure medications, and comorbidities. Mean age at surgery was 9.7 years (SD 4.5), 29 patients were male (70.7%), and mean age at seizure onset was 4.7 years (SD 3.5). Table 1 reported daily seizures in 30 of 41 patients (73.2%), weekly seizures in 9 (22.0%), monthly seizures in 1 (2.4%), yearly seizures in 1 (2.4%), and a history of focal status epilepticus requiring hospitalization in 8 (19.5%); these are cohort descriptors, not separate findings here. Presurgical evaluation included scalp video EEG, MEG, FDG-PET, and invasive video EEG when indicated. Thirty-seven patients underwent IVEEG, and 34 had available ictal data. Forty patients underwent MEG. MRI context included left-sided lesions in 23 of 41 patients (56.1%) and right-sided lesions in 18 (43.9%); lesion distributions were frontal 21 (51.2%), parietal 6 (14.6%), temporal 2 (4.9%), insular 4 (9.8%), and pre- or postcentral 8 (19.5%). These lesion-distribution and treatment details are contextual only and are not findings in this report.

Findings

frequent left focal motor seizuresFigure 2 describes a 13-year-old right-handed, developmentally normal female with frequent left focal motor seizures and a right parietal BOSD; interictal EEG showed characteristic EKG-like spike waves in the right centroparietal head region with fields in the left centroparietal region.PDF p.5, Figure 2 caption

mcgonigal-on-seizure-semiology-2021-5ba29d.pdfNarrative, educational, or cited context · 4 findings · 11 reported values

mcgonigal-on-seizure-semiology-2021-5ba29d.pdf; mcgonigal-on-seizure-semiology-2021-9127f2.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

motor signs; frontal semiologyThe review reports that Hagiwara et al. (2017) found strong couplings with mesial frontal and cingulate regions in the three patients with frontal semiology, whereas the two patients with insular semiology only showed couplings between the insula and cingulate regions.PDF p.5, Table 1, Motor signs row
elementary motor signs; gestural motor behavior; emotional expressionThe review reports that Bonini, McGonigal et al. (2014) identified four frontal-lobe semiologic groups along a rostro-caudal gradient: Group 1 had elementary motor signs without gestural motor behavior; Group 2 combined elementary and gestural motor signs, often with mainly proximal tonic signs and facial contraction; Group 3 had no elementary motor signs and often distal, integrated gestural behavior; and Group 4 had no elementary motor signs with integrated gestural behavior in an emotional, usually fearful, context.PDF p.6, Table 2, Frontal lobe row
motor signs; frontal semiology; insular semiologyIn the summarized Hagiwara et al. study, the three patients with frontal semiology showed strong couplings between insula and mesial frontal or cingulate regions, including medial orbitofrontal cortex, pre-SMA/SMA, and anterior-to-posterior cingulate, whereas the two patients with insular semiology only showed couplings between insula and cingulate regions.PDF p.5, Table 1 (continued), Hagiwara et al. 2017 row
elementary motor signs; gestural motor behavior; emotional expression; frontal lobe seizuresIn the summarized Bonini, McGonigal et al. study, automated clustering of clinical signs and brain areas involved in seizure onset and early propagation found a rostrocaudal frontal gradient with four groups: elementary motor signs without gestural behavior; elementary plus gestural signs with mainly proximal tonic signs and facial contraction; gestural behavior without elementary signs and often distal or integrated; and gestural behavior in an emotional, often fearful, context with an integrated appearance.PDF p.6, Table 2, Bonini, McGonigal et al. 2014 row

Reported values

2 patients with insular semiology onlymotor signs; frontal semiologyCount · 5 subjects with insular epilepsy; 3 with frontal semiology and 2 with insular semiology only · insular semiology only · Period of semiologic expressionPDF p.5, Table 1, Motor signs row
3 patients with frontal semiologymotor signs; frontal semiologyCount · 5 subjects with insular epilepsy; 3 with frontal semiology and 2 with insular semiology only · frontal semiology · Period of semiologic expressionPDF p.5, Table 1, Motor signs row
n=5 subjectsmotor signs; frontal semiologyCount · 5 subjects with insular epilepsy; 3 with frontal semiology and 2 with insular semiology only · cited study · Period of semiologic expressionPDF p.5, Table 1, Motor signs row
374 seizureselementary motor signs; gestural motor behavior; emotional expressionCount · 54 subjects with frontal-lobe epilepsy and 374 seizures · Seizure onset and early propagationPDF p.6, Table 2, Frontal lobe row
54 subjectselementary motor signs; gestural motor behavior; emotional expressionCount · 54 subjects with frontal-lobe epilepsy and 374 seizures · Seizure onset and early propagationPDF p.6, Table 2, Frontal lobe row
2 patients with insular semiology onlymotor signs; frontal semiology; insular semiologyCount · 5 subjects with insular epilepsy; 3 with frontal semiology and 2 with insular semiology only; number of seizures Not reported · insular semiology only · ictal, during motor semiologyPDF p.5, Table 1 (continued), Hagiwara et al. 2017 row
3 patients with frontal semiologymotor signs; frontal semiology; insular semiologyCount · 5 subjects with insular epilepsy; 3 with frontal semiology and 2 with insular semiology only; number of seizures Not reported · frontal semiology · ictal, during motor semiologyPDF p.5, Table 1 (continued), Hagiwara et al. 2017 row
5 subjects totalmotor signs; frontal semiology; insular semiologyCount · 5 subjects with insular epilepsy; 3 with frontal semiology and 2 with insular semiology only; number of seizures Not reported · cited study · ictal, during motor semiologyPDF p.5, Table 1 (continued), Hagiwara et al. 2017 row
Semiology clusters n=4elementary motor signs; gestural motor behavior; emotional expression; frontal lobe seizuresCount · 54 subjects with frontal-lobe epilepsy; 374 seizures · seizure onset and early propagation; ictal semiologic expressionPDF p.6, Table 2, Bonini, McGonigal et al. 2014 row
Patients in semiology series n=54elementary motor signs; gestural motor behavior; emotional expression; frontal lobe seizuresCount · 54 subjects with frontal-lobe epilepsy; 374 seizures · seizure onset and early propagation; ictal semiologic expressionPDF p.6, Table 2, Bonini, McGonigal et al. 2014 row
Seizures in semiology series n=374elementary motor signs; gestural motor behavior; emotional expression; frontal lobe seizuresCount · 54 subjects with frontal-lobe epilepsy; 374 seizures · seizure onset and early propagation; ictal semiologic expressionPDF p.6, Table 2, Bonini, McGonigal et al. 2014 row

misulis-sonmezturk-ess-abou-khalil-atlas-eeg-seizure-semiology-management-3e-2022.pdfCase report or observation · 2 findings

misulis-sonmezturk-ess-abou-khalil-atlas-eeg-seizure-semiology-management-3e-2022.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

multifocal status with focal motor onset and bilateral propagationIn the illustrated new-onset refractory status case, initial right frontal focal ictal discharges with left facial twitching became more intense and spread to the right temporal region, then left frontal and left temporal regions; recurrent motor seizures progressed from left facial twitching to bifacial and bilateral upper-extremity jerking, while other multifocal ictal discharges had no visible motor correlate, leading the source to classify the course as focal motor status evolving to focal nonconvulsive status and then focal-onset bilateral convulsive status.PDF p.416; PDF p.417; PDF p.418; PDF p.420
frontal aura, primary motor, and supplementary motor semiologyFrontal auras are less common and less specific than temporal auras; abdominal sensations can arise from orbitofrontal or cingulate regions; forced thinking suggests dorsolateral frontal involvement; preserved-awareness clonic activity is most localizing to primary motor cortex, with lower-extremity signs suggesting mesial frontal and facial signs suggesting inferior frontal involvement; supplementary sensorimotor seizures tend to be brief, clustered, nocturnal, asymmetrical tonic or postural events with proximal predominance, and may include vocalization, startle precipitation, or bilateral symptoms without loss of consciousness.PDF p.51; PDF p.52; PDF p.53

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 9 findings · 8 reported values

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

automatisms; elementary motor; hyperkinetic; autonomic; emotional; grimace; cognitive; other subjectiveThe source classifies ictal features into automatisms, elementary motor, hyperkinetic, autonomic, emotional, grimace, cognitive, and other subjective categories for the cluster and prevalence analyses.PDF p.4, Statistical analysis
elementary motor signs; whole groupElementary motor signs were reported in 47% of the whole review group.PDF p.5, All group; PDF p.9, Figure 2
elementary motor signs; fronto-temporal subgroupElementary motor signs was reported in 24% of the fronto-temporal subgroup (33 patients).PDF p.5, Fronto-temporal subgroup
elementary motor signs; temporo-frontal subgroupElementary motor signs was reported in 57% of the temporo-frontal subgroup (76 patients).PDF p.5, Temporo-frontal subgroup
association coefficient; motor elementary and other clusterThe source reports an association coefficient of 0.553 for motor elementary and other cluster in the whole group.PDF p.9, Seizure semiology; PDF p.10, Figure 3A
association coefficient; motor elementary and other subjectiveThe source reports an association coefficient of 0.818 for motor elementary and other subjective in the fronto-temporal subgroup.PDF p.5, Fronto-temporal subgroup; PDF p.10, Figure 3B
elementary motor signs; multilobar resection; whole groupElementary motor signs were significantly more frequent among patients receiving multilobar resection in the whole-group analysis, with p=.022.PDF p.1, Abstract; PDF p.9, Seizure semiology
elementary motor signs; multilobar resection; fronto-temporal subgroupThe source reports a fronto-temporal subgroup p value for the association between elementary motor signs and multilobar resection as .0012 in the abstract.PDF p.1, Abstract
elementary motor signs; multilobar resection; fronto-temporal subgroupThe source reports a fronto-temporal subgroup p value for the association between elementary motor signs and multilobar resection as .12 in the body text.PDF p.9, Seizure semiology

Reported values

47%elementary motor signs; whole groupPercentage · 109 review patients, whole group · ictalPDF p.5, All group; PDF p.9, Figure 2
24%elementary motor signs; fronto-temporal subgroupPercentage · 33 patients, fronto-temporal subgroup · ictalPDF p.5, Fronto-temporal subgroup
57%elementary motor signs; temporo-frontal subgroupPercentage · 76 patients, temporo-frontal subgroup · ictalPDF p.5, Temporo-frontal subgroup
association coefficient 0.553association coefficient; motor elementary and other clusterAssociation Coefficient · 109 review patients · ictal symptom co-occurrencePDF p.9, Seizure semiology; PDF p.10, Figure 3A
association coefficient 0.818association coefficient; motor elementary and other subjectiveAssociation Coefficient · 33 fronto-temporal subgroup patients · ictal symptom co-occurrencePDF p.5, Fronto-temporal subgroup; PDF p.10, Figure 3B
p=0.022elementary motor signs; multilobar resection; whole groupP value · Review patients undergoing surgery with whole-group sign/resection comparison · ictal sign associated with surgical extentPDF p.1, Abstract; PDF p.9, Seizure semiology
p=0.0012elementary motor signs; multilobar resection; fronto-temporal subgroupP value · Fronto-temporal subgroup patients undergoing surgery with sign/resection comparison · ictal sign associated with surgical extentPDF p.1, Abstract
p=0.12elementary motor signs; multilobar resection; fronto-temporal subgroupP value · Fronto-temporal subgroup patients undergoing surgery with sign/resection comparison · ictal sign associated with surgical extentPDF p.9, Seizure semiology

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdfIndependent primary study · 2 findings · 2 reported values

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdf

Independent primary study · Class II · Evidence weight 4.89 · 2 × 1.35 × 1.812

Findings

contralateral focal motor activityContralateral focal motor activity occurred in 16 of 42 patients.PDF p.6, Results, Non-visual manifestations
focal motor activity in cited reportsThe source reports focal motor activity in as many as 47% of patients in a cited occipital epilepsy series.PDF p.21, Discussion

Reported values

16/42 (38%) patientscontralateral focal motor activityPercentage · n/N 16/42 · 42 medically refractory patients with source-defined occipital lobe epilepsy · ictal propagation or later ictal manifestationPDF p.6, Results, Non-visual manifestations
up to 47%focal motor activity in cited reportsUpper-bound percentage · cited occipital lobe epilepsy reports · ictal propagation or later ictal manifestationPDF p.21, Discussion

wang-electroclinical-insulo-opercular-epilepsy-seeg-pet-2019.pdfIndependent primary study · 1 finding

wang-electroclinical-insulo-opercular-epilepsy-seeg-pet-2019.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

ictal motor signs; elementary motor signs; complex motor behaviorAll patients had ictal motor signs; elementary tonic and/or dystonic motor signs occurred more commonly than complex motor behavior, although both could occur in the same seizure.PDF p.3, Results—Seizure semiology; PDF p.7, Discussion

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdfIndependent primary study · 1 finding

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

occipital onset with temporal-like automatism and motor expressionThe source concludes that occipital-onset seizures can produce temporal-like automatisms and frontal- or parietal-like motor symptoms through network propagation.PDF p.12, Key Findings and Phenotype-Propagation Pattern Correspondences; PDF p.14, Clinical Translation

wyllie1986.pdfStructured design not resolved · 1 finding · 30 reported values

wyllie1986.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.893

Findings

ictal arm and face involvement on the side of contraversionDuring contraversion, arm and face motor activity occurred on the side toward which contraversion was directed: arm clonic movement or tonic posturing occurred in 32 of 61 versive seizures (52%), face tonic or clonic contraction in 26 of 55 seizures with continuously visible faces (47%), and arm and face involvement occurred with equal frequency in temporal and extratemporal onset seizures.PDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement

Reported values

total arm activity: 17 patientsictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · total · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
frontal all versive seizures: 10 patientsictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · frontal · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
temporal arm activity: 12 seizuresictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · temporal · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
parietal arm activity: 0 patientsictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · parietal · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
total face activity 26/55 (47%)ictal arm and face involvement on the side of contraversionPercentage · n/N 26/55 · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · total · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
parietal all versive seizures: 2 patientsictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · parietal · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
temporal all versive seizures: 14 patientsictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · temporal · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
occipital arm activity: 0 patientsictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · occipital · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
occipital face activity: 0 patientsictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · occipital · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
parietal face activity: 1 seizuresictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · parietal · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
frontal arm activity: 20 seizuresictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · frontal · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
parietal all versive seizures: 2 seizuresictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · parietal · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
occipital arm activity: 0 seizuresictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · occipital · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
total all versive seizures: 61 seizuresictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · total · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
temporal face activity: 8 seizuresictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · temporal · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
frontal arm activity: 6 patientsictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · frontal · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
temporal face activity: 7 patientsictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · temporal · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
frontal face activity: 17 seizuresictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · frontal · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
parietal face activity: 1 patientsictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · parietal · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
frontal all versive seizures: 37 seizuresictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · frontal · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
parietal arm activity: 0 seizuresictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · parietal · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
total all versive seizures: 27 patientsictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · total · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
occipital all versive seizures: 2 seizuresictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · occipital · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
temporal all versive seizures: 20 seizuresictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · temporal · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
temporal arm activity: 11 patientsictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · temporal · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
occipital all versive seizures: 1 patientsictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · occipital · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
occipital face activity: 0 seizuresictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · occipital · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
total arm activity 32/61 (52%)ictal arm and face involvement on the side of contraversionPercentage · n/N 32/61 · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · total · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
frontal face activity: 8 patientsictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · frontal · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement
total face activity: 16 patientsictal arm and face involvement on the side of contraversionCount · 61 versive seizures from 27 patients; face analysis restricted to 55 seizures with continuous full facial visibility · total · During contraversion; focal motor activity began within 5 seconds after contraversion onsetPDF p.3, Table 3; PDF p.3, paragraphs describing arm/face activity and timing; PDF p.4, discussion of contralateral arm and face movement

zhang-ipsiversive-ictal-eye-deviation-temporal-epilepsy-2017.pdfCase report or observation · 1 finding · 2 reported values

zhang-ipsiversive-ictal-eye-deviation-temporal-epilepsy-2017.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

This is a two-case report with no control or comparator group. Case-1 was a 24-year-old right-handed man; 32 habitual seizures were recorded during 3 days of scalp video-EEG, with two followed by secondary GTCS, and two right-hemisphere SEEG implantations were performed 4 months apart. Case-2 was a 19-year-old right-handed man; three habitual seizures were captured on video-EEG and right temporal neocortical, temporal-pole, and medial-structure regions were explored with SEEG. The source describes scalp EEG, MRI, FDG-PET, SEEG onset and propagation, anatomical reconstruction, cortical resection, and seizure-free follow-up of 17 months for Case-1 and 25 months for Case-2. Case-1 MRI/FDG-PET was reported unremarkable for an evaluable lesion; Case-2 MRI and PET findings were reported in the right middle-posterior inferior temporal/fusiform and medial temporal regions. No cohort-wide denominator for ipsiversive eye deviation, no control comparison, and no population-level frequency or diagnostic statistic are reported.

Findings

Case-2 forced right eye deviation with left motor signsIn Case-2, the reported habitual seizure chronology was eyes open and staring followed by forced deviation to the right, proximal left-arm tonic posturing with a clenched left fist, and left facial clonia in one seizure; the episodes included loss of consciousness.PDF p.5, Case-2 case presentation; PDF p.8-9, Discussion

Reported values

left facial clonia occurred in 1 of 3 captured habitual seizuresCase-2 forced right eye deviation with left motor signsCount · n/N 1/3 · Case-2; three habitual seizures were captured on video-EEG, but the source does not state that every listed component occurred in all three · ictal onset and progressionPDF p.5, Case-2 case presentation; PDF p.8-9, Discussion
Qualitative semiologic sequenceCase-2 forced right eye deviation with left motor signsCount · n/N 1/3 · Case-2; three habitual seizures were captured on video-EEG, but the source does not state that every listed component occurred in all three · ictal onset and progressionPDF p.5, Case-2 case presentation; PDF p.8-9, Discussion

20 contributing manuscripts; source-reported values remain separate and are not pooled.

Gustatory auraReported: IpsilateralAlso reported: Right hemisphereNo single reliable side17 manuscripts · 36 findings · 23 reported values

Weighted evidence supportevidence weight 36.98 across 17 manuscripts · 1 manuscript weight pending · 3 independent primary study · 8 narrative, educational, or cited context · 5 systematic review or meta-analysis · 1 structured design not resolved

The temporal-plus description preserves contraversive eye/head and ipsilateral tonic-motor relations without assigning a left/right cerebral hemisphere. Gustatory aura is restated as non-lateralising. Gustatory auras are described as having no lateralizing value. Olfactory and gustatory auras are summarized as generally nonlateralizing. No source-supported hemispheric or body-side lateralization is reported. Gustatory aura was associated with the TS subgroup and vestibular aura with the TPO subgroup; no lateralization is reported. No seizure lateralization is reported. No lateralizing direction is reported for gustatory symptoms. No lateralizing direction is reported. No hemisphere or body-side direction is reported. The mesial-versus-lateral temporal comparison provides no hemispheric direction. The study-count record provides no hemispheric direction. This lateral-versus-mesial temporal statistic provides no hemispheric lateralization. The lateral-temporal prevalence result provides no hemispheric direction. The occurrence odds provide no hemispheric direction. The lateral-TLE prevalence result provides no hemispheric direction. The mesial-TLE prevalence range provides no hemispheric direction. No seizure lateralization is reported for the 7% gustatory-sensation summary. No seizure lateralization is reported for the 6-case, 7% gustatory-symptom entry. No seizure lateralization is reported for the 4/60 (7%) gustatory-symptom entry. No lateralizing direction is reported for gustatory sensations. The patient-level falling, gustatory, and abdominal aura entry gives no body-side or hemisphere information. The review places fear, auditory or gustatory hallucinations, sensory hallucinations, and vertigo between lateral and medial temporal patterns.

Source-defined result groups 15

Localization: TemporalSource-defined values retained separatelyAll reported · reported sign prevalence across included studies1 manuscript · 1 reported value · not pooled

Localization: InsularObserved proportion 40.0%not clearly identifiable · gustatory response1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyMesial TLE patients assessed for Olfactory/gustatory aura · lateral TLE percentage shown separately · reported mesial-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Lateralization: response frequencyObserved proportion 2.7%gustatory sensation · other evoked response types · evoked response1 manuscript · 1 reported value · not pooled

Localization: InsularObserved proportion 60.0%nasty or unpleasant · gustatory response1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyT+ group · TL group versus T+ group · seizures1 manuscript · 1 reported value · not pooled

Lateralization: description subtypeObserved proportion 60.0%nasty or unpleasant · gustatory response1 manuscript · 1 reported value · not pooled

Localization: L group / M group / ML groupObserved proportion 8.3%M · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: L group / M group / ML groupObserved proportion 0.0%L · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: L group / M group / ML groupObserved proportion 5.6%ML · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTL group · TL group versus T+ group · seizures1 manuscript · 1 reported value · not pooled

Lateralization: description subtypeObserved proportion 40.0%not clearly identifiable · gustatory response1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyLateral TLE patients assessed for Olfactory/gustatory aura · mesial TLE percentage shown separately · reported lateral-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Localization: InsularObserved proportion 2.7%gustatory sensation · other evoked response types · evoked response1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 17

Alphabetical by manuscript.

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfStructured design not resolved · 2 findings · 1 reported value

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.301

Findings

posterior cingulate gustatory auraThe source reports 1 posterior cingulate patient with gustatory aura.PDF p.5, Clinical Presentation
patient 12 falling/gustatory/abdominal auraFalling, gustatory, and abdominal aura terms were listed for patient 12.PDF p.4, Figure 3

Reported values

1/4 gustatory auraposterior cingulate gustatory auraProportion · n/N 1/4 · 4 posterior cingulate cases · auraPDF p.5, Clinical Presentation

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 4 findings · 5 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

gustatory hallucinationGustatory hallucinations were more frequent in T+ than TL seizures.PDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Auras
T+ subgroup associations for gustatory and vestibular aurasAmong T+ cases, gustatory auras were significantly associated with the TS subgroup and vestibular auras with the TPO subgroup.PDF p.5, Seizure clinical semiology; PDF p.7, Auras
gustatory, vestibular, and auditory symptomsThe source states that the localizing significance of gustatory, vestibular, and auditory symptoms remains uncertain in the cited literature.PDF p.7, Auras
gustatory symptoms and insulo-opercular cortexThe source states that cortical electrical stimulation studies support a role for the suprasylvian opercular cortex and/or insula in the occurrence of gustatory symptoms.PDF p.7, Auras

Reported values

T+ 21.7%gustatory hallucinationPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Auras
P=0.02gustatory hallucinationP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Auras
TL 5.1%gustatory hallucinationPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Auras
P=0.02T+ subgroup associations for gustatory and vestibular aurasP value · T+ subgroup patients and their one analyzed typical seizure; TS n=7 and TPO n=6 · TPO subgroup · ictal onsetPDF p.5, Seizure clinical semiology; PDF p.7, Auras
P=0.009T+ subgroup associations for gustatory and vestibular aurasP value · T+ subgroup patients and their one analyzed typical seizure; TS n=7 and TPO n=6 · TS subgroup · ictal onsetPDF p.5, Seizure clinical semiology; PDF p.7, Auras

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfSystematic review or meta-analysis · 3 findings · 3 reported values

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

gustatory sensationsGustatory sensations accounted for 7% of the sensory manifestations in the narrative summary.PDF p.4, Semiology and clinical features; PDF p.6, Table 3
Gustatory (Table 3)Table 3 reports gustatory symptoms in 6 cases (7%), with propagation timing marked uncertain.PDF p.6, Table 3
Gustatory (Table 4)In the 60 high/very-high-confidence cases, Table 4 reports gustatory symptoms in 4 cases (7%).PDF p.7, Table 4

Reported values

7% gustatory sensationsgustatory sensationsPercentage · reviewed basal temporal seizure cases · ictal propagation uncertain in Table 3PDF p.4, Semiology and clinical features; PDF p.6, Table 3
6 cases (7%)Gustatory (Table 3)Percentage · Table 3 basal temporal seizure cases · propagation?PDF p.6, Table 3
4/60 (7%)Gustatory (Table 4)Percentage · n/N 4/60 · 60 basal temporal seizure cases with high or very-high EZ confidence · ictalPDF p.7, Table 4

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 1 finding

chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

gustatory; olfactory; vestibular; autonomic auraTable 3 maps gustatory aura to insula or mesiotemporal regions, olfactory aura to insula, mesiotemporal, or orbitofrontal regions, vestibular aura to posterior temporal or parietal regions, and autonomic aura to insula, amygdala, or cingulate regions.PDF p.10, Table 3; PDF p.3, Figure 1

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdfSystematic review or meta-analysis · 12 findings · 4 reported values

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

epigastric aura; olfactory/gustatory auraThe source states that absence of epigastric or olfactory/gustatory auras may be more indicative of lateral than mesial temporal seizures, whereas their presence points toward mesial rather than lateral onset.PDF p.7, Discussion; PDF p.10, Conclusions
Olfactory/gustatory auraTable 3 reports 3 studies assessing Olfactory/gustatory aura.PDF p.6, Table 3
Olfactory/gustatory auraTable 3 reports 42 patients assessed for Olfactory/gustatory aura.PDF p.6, Table 3
Olfactory/gustatory auraTable 3 reports 0% as the percentage range or value for Olfactory/gustatory aura; the overall association grade is Low.PDF p.6, Table 3
odds of occurrence; Olfactory/gustatory auraTable 4 reports overall odds of 0.04 for occurrence of Olfactory/gustatory aura in lateral TLE.PDF p.7, Table 4; PDF p.8, Figure 2
odds confidence interval; Olfactory/gustatory auraTable 4 reports a 95% confidence interval of 0.01–0.19 for the overall odds of Olfactory/gustatory aura.PDF p.7, Table 4; PDF p.8, Figure 2
heterogeneity test; Olfactory/gustatory auraThe heterogeneity test for the Table 4 odds estimate for Olfactory/gustatory aura has p=0.9159.PDF p.7, Table 4
Olfactory/gustatory aura; lateral versus mesial comparisonTable 5 reports 3 studies comparing Olfactory/gustatory aura in lateral and mesial TLE.PDF p.9, Table 5
Olfactory/gustatory aura; lateral TLE patient denominatorTable 5 reports 42 lateral-TLE patients assessed for Olfactory/gustatory aura.PDF p.9, Table 5
Olfactory/gustatory aura; mesial TLE patient denominatorTable 5 reports 67 mesial-TLE patients assessed for Olfactory/gustatory aura.PDF p.9, Table 5
Olfactory/gustatory aura; lateral TLE prevalenceTable 5 reports a lateral-TLE percentage of 0% for Olfactory/gustatory aura.PDF p.9, Table 5
Olfactory/gustatory aura; mesial TLE prevalenceTable 5 reports a mesial-TLE percentage of 0–18.8% for Olfactory/gustatory aura.PDF p.9, Table 5

Reported values

0%Olfactory/gustatory auraPercentage · Lateral temporal epilepsy patients assessed for Olfactory/gustatory aura · ictalPDF p.6, Table 3
odds 0.04odds of occurrence; Olfactory/gustatory auraOdds · Lateral temporal epilepsy patients assessed for Olfactory/gustatory aura · ictalPDF p.7, Table 4; PDF p.8, Figure 2
0%Olfactory/gustatory aura; lateral TLE prevalencePercentage · Lateral TLE patients assessed for Olfactory/gustatory aura · Lateral TLE patients assessed for Olfactory/gustatory aura · ictalPDF p.9, Table 5
0–18.8%Olfactory/gustatory aura; mesial TLE prevalencePercentage Range · Mesial TLE patients assessed for Olfactory/gustatory aura · Mesial TLE patients assessed for Olfactory/gustatory aura · ictalPDF p.9, Table 5

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 1 finding

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

olfactory and gustatory aurasOlfactory auras are typically unpleasant and often associated with gustatory phenomena; stimulation of the amygdala, olfactory bulb, insula, or posterior orbitofrontal region can produce olfactory sensations or illusions. Gustatory auras can be difficult to distinguish from olfactory disturbances, and stimulation of the parietal operculum or mesiobasal temporal regions can produce gustatory hallucinations.PDF p.2, section 3.1 Auras; PDF p.2, Table 1

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdfNarrative, educational, or cited context · 1 finding

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

olfactory and gustatory hallucinationsUnpleasant olfactory and gustatory hallucinations can result from seizures involving mesial temporal structures, particularly the amygdala, but are not pathognomonic because gustatory symptoms with hypersalivation and olfactory symptoms have also been reported with opercular and orbitofrontal seizures, respectively.PDF p.8, Focal sensory seizures; PDF p.10, Temporal plus epilepsy

jobst-insula-and-its-epilepsies-2019.pdfNarrative, educational, or cited context · 3 findings · 1 reported value

jobst-insula-and-its-epilepsies-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

gustatory auraGustatory auras are among the reported clinical manifestations of insular seizures.PDF p.2, Clinical Features
gustatory aura as suggestive insular featureGustatory auras are described as highly suggestive of insular or insulo-opercular seizures.PDF p.2, Clinical Features
gustatory stimulation responsesGustatory sensations represented 2.7% of all responses in the cited insular stimulation series.PDF p.5, Other Insular Responses; PDF p.5, Figure 4 panel 5

Reported values

2.7% gustatory responsesgustatory stimulation responsesPercentage · all responses in the cited insular stimulation series · stimulation-evoked semiologyPDF p.5, Other Insular Responses; PDF p.5, Figure 4 panel 5

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdfIndependent primary study · 1 finding · 2 reported values

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdf

Independent primary study · Class II · Evidence weight 5.11 · 2 × 1.35 × 1.893

Findings

Focal sensory (gustatory)Focal sensory (gustatory) semiology occurred in 2/61 individuals (3%) both as initial semiology and in the combined set-of-semiology.PDF p.5, Table 2

Reported values

2/61 (3%) initialFocal sensory (gustatory)Percentage · n/N 2/61 · 61 individuals undergoing frontal lobe epilepsy surgery · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2
2/61 (3%) combinedFocal sensory (gustatory)Percentage · n/N 2/61 · 61 individuals undergoing frontal lobe epilepsy surgery · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 1 finding

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Gustatory auraTable 2 associates gustatory aura with Rolandic and parietal operculum, basal/mesial temporal regions, and insula and describes it as non-lateralising.PDF p.3, Table 2

luders-semiological-seizure-classification-1998.pdfNarrative, educational, or cited context · 1 finding

luders-semiological-seizure-classification-1998.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Gustatory auraPerception of a taste as an epileptic phenomenon is a gustatory aura, but the term is applied only when the gustatory hallucination is the predominant symptom.PDF p.3, Auras, subsection Gustatory auras; PDF p.2, Table 1

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdfIndependent primary study · 1 finding · 4 reported values

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdf

Independent primary study · Class II · Evidence weight 5.07 · 2 × 1.5 × 1.69

Findings

gustatory hallucinationGustatory hallucination frequencies did not differ significantly across M, ML, and L groups.PDF p.5, Table 2

Reported values

p=0.78gustatory hallucinationP value · 55 patients with unilateral TLE; M=24, ML=18, L=13 · initial ictal subjective symptomPDF p.5, Table 2
M=2/24 (8.3%)gustatory hallucinationPercentage · n/N 2/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · initial ictal subjective symptomPDF p.5, Table 2
ML=1/18 (5.6%)gustatory hallucinationPercentage · n/N 1/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · initial ictal subjective symptomPDF p.5, Table 2
L=0/13 (0%)gustatory hallucinationPercentage · n/N 0/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · initial ictal subjective symptomPDF p.5, Table 2

mazzola-electrical-stimulation-human-insula-ictal-semiology-2017.pdfNarrative, educational, or cited context · 1 finding · 3 reported values

mazzola-electrical-stimulation-human-insula-ictal-semiology-2017.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.80 · 1 × 0.9 × 2

Findings

gustatory sensationsGustatory sensations occurred in 15 responses (2.7%), were obtained exclusively from a relatively restricted medium-upper insular zone corresponding to the posterior short gyrus, and were described as nasty or unpleasant in 9 cases or not clearly identifiable in 6.PDF p.3, Results and Table 1; PDF p.5, Other Types of Evoked Sensations and Fig. 5A

Reported values

9 casesgustatory sensationsCount · n/N 9/15 · 15 gustatory responses in the 550-response series · nasty or unpleasant · stimulation-evoked gustatory sensationPDF p.3, Results and Table 1; PDF p.5, Other Types of Evoked Sensations and Fig. 5A
15 responses (2.7%)gustatory sensationsPercentage · n/N 15/550 · 15 gustatory responses in the 550-response series · gustatory sensation · stimulation-evoked gustatory sensationPDF p.3, Results and Table 1; PDF p.5, Other Types of Evoked Sensations and Fig. 5A
6gustatory sensationsCount · n/N 6/15 · 15 gustatory responses in the 550-response series · not clearly identifiable · stimulation-evoked gustatory sensationPDF p.3, Results and Table 1; PDF p.5, Other Types of Evoked Sensations and Fig. 5A

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 1 finding

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

temporal plus epilepsy; gustatory; vestibular; auditory; contraversive eyes/head; piloerection; ipsilateral tonic motor; postictal dysphoriaThe source describes temporal-plus semiology as more often including gustatory, vestibular, or auditory symptoms, contraversive eye or head manifestations, piloerection, ipsilateral tonic motor signs, and a more dysphoric postictal phase.PDF p.2, Introduction

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdfNarrative, educational, or cited context · 1 finding

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

stimulation-evoked somatosensory, auditory, vestibular, olfactory, gustatory, and viscerosensory symptomsThe chapter reports that electrical stimulation studies evoked somatosensory symptoms, including pain, from the posterior two-thirds of the insula; auditory and vestibular symptoms from the posterior insula; and olfactory, gustatory, and viscerosensory symptoms, including laryngeal constriction, from the midinsula, whereas stimulation of the most anterior portion rarely evoked symptoms unless a larger network seizure was elicited.PDF p.3, insular functional differentiation and electrical cortical stimulation

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdfSystematic review or meta-analysis · 1 finding

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

fear; auditory hallucinations; gustatory hallucinations; sensory hallucinations; vertigoThe source describes fear, auditory or gustatory hallucinations, sensory hallucinations, and vertigo as intermediate features between lateral and medial temporal patterns.PDF p.5, Discussion

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdfNarrative, educational, or cited context · 1 finding

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

gustatory aurasThe review describes gustatory auras as unpleasant tastes, states that cortical stimulation studies identify the insula as a symptomatogenic zone, and states that these auras have no lateralizing value.PDF p.2, Gustatory auras

17 contributing manuscripts; source-reported values remain separate and are not pooled.

Late forced/tonic head version (>30s, sustained, contralateral)Source terms: Late forced/tonic head version; Late forced head versionReported: BilateralAlso reported: ContralateralAlso reported: IpsilateralAlso reported: Left hemisphereAlso reported: Right hemisphereNo single reliable side22 manuscripts · 52 findings · 138 reported values

Weighted evidence supportevidence weight 36.57 across 22 manuscripts · 3 manuscript weight pending · 4 independent primary study · 3 case report or observation · 9 narrative, educational, or cited context · 3 systematic review or meta-analysis · 3 structured design not resolved

The review restates that early nonforced head turning is usually ipsilateral, whereas later forceful involuntary version is most often contralateral to the seizure focus. In this case, right head version and right-arm extension were contralateral to left onset, while the left last clonic jerk was ipsilateral to left onset. In the cited study, late forced head deviation was contralateral in more than 90% of qualifying seizures. Two patients had one or two atypical post-tapering seizures with contralateral version; these observations were excluded from propagation-pattern classification. Version was more frequent in T+ than TL seizures, with TL 35.6% versus T+ 60.9% overall and a significant contralateral subtype association (P=0.001); ipsilateral and bilateral categories remain separately recorded. The cited restatement describes contralateral versive manifestations, more frequent association with T+ epilepsy, and occurrence in temporal-origin seizures. The case observation records right-sided version during habitual partial seizures. Version was reported as contralateral with 100% PPV and inter-observer kappa 0.74; sign-positive occurrences were distributed across temporal, frontal, parietal, and occipital cohorts. The educational tables label forced head version as contralateral. The cited series includes delayed motor signs, including source-described contralateral dystonia, without a reported onset-side direction. The review restates contralateral frontal-eye-field involvement for versive seizures and possible SMA involvement for asymmetric tonic posturing. Versive seizures are described as highly lateralizing toward the contralateral hemisphere, especially shortly before secondary generalization, with reliability depending on the source-defined conditions. Version occurred in 9/16 TLE and 8/15 XTLE patients and was contralateral to ictal onset in all patients with version in each subgroup. Version occurred in 13/26 Group II patients and was contralateral to ictal onset in all 13 patients with version. The review states that sustained pre-GTCS head/eye version is contralateral to the seizure-onset hemisphere and distinguishes earlier frontal from later impaired-awareness temporal version. The review restates greater-than-90% contralateral head version immediately before SGTCS, up to 15–20% ipsilateral version at the end, and an ipsilateral-nonversive to contralateral-versive temporal sequence. Tonic head deviation was predominantly contralateral to seizure onset, with 19/21 pooled episodes contralateral; LTL had 16/73 (22%) late contralateral episodes versus RTL 3/54 (6%). The study reports sign-specific epileptogenic-zone direction, predominantly contralateral, with ipsilateral direction for asymmetric clonic ending. Version-first and version-plus-tonic sequence counts are reported, with correct EZ lateralization in 3/4 tonic-start/asymmetric-clonic sequences and 1/1 M2e-to-clonic sequence, but no direction is stated. The review restates contralateral lateralization above 90% under specified timing/quality conditions and 100% under other cited conditions. All 61 versive seizures were contralateral to onset and none ipsilateral, while nonversive turning was nearly evenly split (6/13 contralateral, 7/13 ipsilateral) and nonlocalizing. Head-and-eye version or eye-only version was contralateral to seizure onset; head and eyes moved together in 40/61 versive seizures, with separate head-only, eye-only, frontal-onset, and occipital-onset counts. Versive movement was contraversive relative to seizure-onset hemisphere regardless of whether it was smooth (40/61) or jerking (21/61). Contraversive head/eye movement persisted into the generalized phase in 8/27 seizures, while 12/27 generalized seizures ended with ipsiversion. The review describes forced sustained head and eye version as generally contralateral to seizure onset and particularly reliable in specified late or tonic-clonic contexts. The cited Wyllie series reviewed 74 seizures in 37 patients and described versive movements as always contralateral to seizure onset. The cited study is restated as finding a lateralizing value for version, with high reliability only under specified conditions and no direction reported here. No lateralizing direction is reported for overall versive manifestations. No source-supported hemispheric or body-side lateralization is reported. Lateral-temporal versus mesial-temporal is a localization comparison, not a cerebral hemisphere direction. No lateralizing direction is reported for version. No hemisphere or body-side direction is reported. No lateralizing direction is reported for version heterogeneity. Patient 9 had forced tonic head-and-eye deviation to the right, but the onset hemisphere is not supplied. Patient 14 had right version followed by a generalized tonic-clonic or dialeptic seizure. No seizure lateralization is reported. The supplied evidence identifies the subsequent contraversion as directed contralateral to the hemisphere of seizure onset. The educational definition describes sustained extreme movement to one side, but does not provide a seizure-onset hemisphere.

Source-defined result groups 61

Localization: TemporalSource-defined values retained separatelyAll reported · reported sign prevalence across included studies1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 100.0%Staring with automatisms · quiet staring versus staring with automatisms before contraversion · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyT+ · TL 0% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyasymmetric clonic ending · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: unspecifiedObserved proportion 75.0%Correct EZ lateralization among tonic-start/asymmetric-clonic sequences · Version-first versus non-version-first order; variable sequence patterns · representative seizure (source also uses patient labels)1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralObserved proportion 21.9%LTL; contralateral late deviation · RTL · seizure1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 100.0%XTLE with version · TLE versus XTLE · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyversion first; temporal · Version-first versus non-version-first; temporal versus extra-temporal origin · seizure, one representative seizure per patient1 manuscript · 1 reported value · not pooled

Lateralization: unspecifiedObserved proportion 100.0%Correct EZ lateralization in M2e-to-clonic sequence · Version-first versus non-version-first order; variable sequence patterns · representative seizure (source also uses patient labels)1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralObserved proportion 2.7%LTL; ipsilateral late deviation · RTL · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelywaning after return to midline · contraversion persistence versus waning or continuation; temporal versus extratemporal onset · seizure; patient counts reported for the waning and continuing subsets1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / Ipsilateral / Does not lateralizeObserved proportion 100.0%Versive; contralateral · versive versus nonversive lateral head and eye movement · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyT+ · TL 35.6% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / Ipsilateral / Does not lateralizeSource-defined values retained separatelyFrontal onset; Nonversive contralateral · versive versus nonversive lateral head and eye movement · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / Ipsilateral / Does not lateralizeObserved proportion 53.8%Nonversive; ipsilateral · versive versus nonversive lateral head and eye movement · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyunilateral tonic · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralObserved proportion 90.5%Pooled tonic-head-deviation episodes · RTL versus LTL and contralateral versus ipsilateral relation to onset · episode1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyTL · T+ 43.5% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 65.6%smooth versive movement · jerking versive movement · seizure1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · Table 3 point estimate 6% · Table 3 between-report frequency range1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelynon-version first; extra-temporal · Version-first versus non-version-first; temporal versus extra-temporal origin · seizure, one representative seizure per patient1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyversion first · Version-first versus non-version-first; temporal versus extra-temporal origin · seizure, one representative seizure per patient1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyunilateral clonic · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelywaning · contraversion persistence versus waning or continuation; temporal versus extratemporal onset · seizure; patient counts reported for the waning and continuing subsets1 manuscript · 2 reported values · not pooled

Localization: TemporalSource-defined values retained separatelyLateral TLE patients assessed for Versive seizure · mesial TLE percentage shown separately · reported lateral-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / Ipsilateral / Does not lateralizeSource-defined values retained separatelyTemporal onset; Nonversive contralateral · versive versus nonversive lateral head and eye movement · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / Ipsilateral / Does not lateralizeObserved proportion 0.0%Versive; ipsilateral · versive versus nonversive lateral head and eye movement · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralObserved proportion 44.4%end of generalized seizure · contraversion persistence versus waning or continuation; temporal versus extratemporal onset · seizure; patient counts reported for the waning and continuing subsets1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyM2e · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / Ipsilateral / Does not lateralizeObserved proportion 46.2%Nonversive; contralateral · versive versus nonversive lateral head and eye movement · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyFig of 4 · representative seizure with sign1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyQuiet staring; extratemporal origin · Temporal origin · seizure1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyQuiet staring; temporal origin · Extratemporal origin · seizure1 manuscript · 1 reported value · not pooled

Localization: Frontal / OccipitalSource-defined values retained separatelyoccipital onset · combined head-and-eye movement versus head-only or eye-only version · seizure and patient for the explicitly reported patient counts1 manuscript · 2 reported values · not pooled

Localization: TemporalSource-defined values retained separatelynon-version first; temporal · Version-first versus non-version-first; temporal versus extra-temporal origin · seizure, one representative seizure per patient1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralObserved proportion 5.6%RTL; contralateral late deviation · LTL · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / Ipsilateral / Does not lateralizeSource-defined values retained separatelyVersive; contralateral · versive versus nonversive lateral head and eye movement · seizure1 manuscript · 4 reported values · not pooled

Localization: TemporalSource-defined values retained separatelyMesial TLE patients assessed for Versive seizure · lateral TLE percentage shown separately · reported mesial-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyTL · T+ 30.4% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 34.4%jerking versive movement · smooth versive movement · seizure1 manuscript · 1 reported value · not pooled

Localization: Frontal / OccipitalSource-defined values retained separatelyfrontal onset · combined head-and-eye movement versus head-only or eye-only version · seizure and patient for the explicitly reported patient counts1 manuscript · 2 reported values · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelydystonia · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelypersistent contraversion · contraversion persistence versus waning or continuation; temporal versus extratemporal onset · seizure; patient counts reported for the waning and continuing subsets1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyT+ · TL 10.2% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · Version-first versus non-version-first; temporal versus extra-temporal origin · seizure, one representative seizure per patient1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyTL · T+ 60.9% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyT+ · TL 32.2% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyversion first; extra-temporal · Version-first versus non-version-first; temporal versus extra-temporal origin · seizure, one representative seizure per patient1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralObserved proportion 29.6%persistent contraversion · contraversion persistence versus waning or continuation; temporal versus extratemporal onset · seizure; patient counts reported for the waning and continuing subsets1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyversion · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyAll reported · Seizure and patient counts for sign occurrence; PPV analysis unit not otherwise reported.1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralObserved proportion 0.0%RTL; ipsilateral late deviation · LTL · seizure1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 100.0%Group II · patient with version1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyTodd's paralysis · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / Ipsilateral / Does not lateralizeSource-defined values retained separatelyTemporal onset; Nonversive ipsilateral · versive versus nonversive lateral head and eye movement · seizure1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelynon-version first · Version-first versus non-version-first; temporal versus extra-temporal origin · seizure, one representative seizure per patient1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelycontinued throughout · contraversion persistence versus waning or continuation; temporal versus extratemporal onset · seizure; patient counts reported for the waning and continuing subsets1 manuscript · 2 reported values · not pooled

Evidence by contributing manuscript 22

Alphabetical by manuscript.

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfCase report or observation · 2 findings

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

patient 9 forced right head/eye deviationHead and eyes forced tonic deviation to the right was listed for patient 9.PDF p.4, Figure 3
patient 14 right version evolutionRight version followed by generalized tonic-clonic or dialeptic seizure was listed for patient 14.PDF p.4, Figure 3

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 3 findings · 11 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 5.65 · 2 × 1.5 × 1.882

Findings

version of head and/or eyesVersion of the head and/or eyes was more frequent in T+ than TL seizures, with the significant subtype association occurring for contralateral version.PDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
versive manifestationsThe source states that versive manifestations of the eyes and head have extratemporal localizing associations in prior reports but have also been observed in seizures of TL origin.PDF p.8, Motor signs
versive manifestationsSimple motor signs were common and included versive manifestations, reported in 43.7% of analyzed seizures.PDF p.5, Seizure clinical semiology

Reported values

TL 10.2%version of head and/or eyesPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
TL 0%version of head and/or eyesPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
TL 35.6%version of head and/or eyesPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
T+ 43.5%version of head and/or eyesPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
T+ 0%version of head and/or eyesPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
TL 32.2%version of head and/or eyesPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
P=0.04version of head and/or eyesP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
P=0.001version of head and/or eyesP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
T+ 30.4%version of head and/or eyesPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
T+ 60.9%version of head and/or eyesPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
versive manifestations 43.7%versive manifestationsPercentage · 80 analyzed seizures, one typical seizure per patient · ictalPDF p.5, Seizure clinical semiology

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfNarrative, educational, or cited context · 1 finding

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

delayed motor signs (Duchowny study)The cited Duchowny series is described as having behavioral arrest and delayed motor signs including version, contralateral dystonia, clonic jerks, and automatisms.PDF p.7, cited-study discussion

blair-temporal-lobe-epilepsy-semiology-2012.pdfNarrative, educational, or cited context · 1 finding

blair-temporal-lobe-epilepsy-semiology-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Early head turn and late versionAn early nonforced head turn or head tilt, especially with preserved consciousness, is usually ipsilateral to seizure onset, whereas later, more forceful involuntary version is most often contralateral to the seizure focus.PDF p.4, Table 2; PDF p.4, section 4 Lateralizing Features in Temporal Lobe Epilepsy

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 5 findings · 2 reported values

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

versionThe discussion identifies version as a possible early localizing sign in SMA epilepsy because it was mostly reported at seizure onset.PDF p.8, Discussion
versionTable 3 lists 11 patients for the the source's own ictal symptom “version”; its table phase label is onset.PDF p.6, Table 3
versionTable 3 reports a pooled prevalence of 23% for the the source's own ictal symptom “version”; its table phase label is onset.PDF p.6, Table 3
version; between-study heterogeneityThe source reports I2 heterogeneity of 0.00% for pooled version prevalence.PDF p.4, Results
version; heterogeneity testThe source reports p = 0.47 for the between-study heterogeneity test of pooled version prevalence.PDF p.4, Results

Reported values

23% pooled prevalenceversionPercentage · Patients with SMA or pre-SMA epilepsy in the selected studies · onsetPDF p.6, Table 3
I2 = 0.00%version; between-study heterogeneityHeterogeneity I2 · Patients with SMA or pre-SMA epilepsy in the selected studies · ictal symptom prevalence analysisPDF p.4, Results

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfCase report or observation · 1 finding

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

Narrative review; the authors summarize literature on focal seizures and present illustrative cases from their centre using clinical history, videotelemetry, scalp or intracranial stereo-EEG, MRI/PET, and surgical outcome where stated. No single review cohort, systematic eligibility set, pooled analysis, or uniform endpoint denominator is reported. Populations, analysis units, and reference standards are therefore retained at finding level; source-reported reference standards include ictal EEG, imaging, lesion location, clinical semiology, and seizure freedom after resection.

Findings

head version; figure-of-4 sign; last clonic jerkIn video case 7, a 33-year-old man with left temporal hypometabolism had head version to the right followed by right-arm extension in a figure-of-4 posture, indicating left hemispheric onset; in one seizure the last clonic jerk was on the left, also pointing to left onset, while ictal EEG was non-localisable in one seizure and lateralised left in another.PDF p.10, Video case 7

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

versive elementary motor phenomenonOne restricted-OFC case had a versive elementary motor phenomenon.PDF p.2, Semiology patterns of seizures with EZN restricted to the OFC

Reported values

1 patientversive elementary motor phenomenonCount · OFC-restricted EZN cases · OFC-restricted EZN cases · ictalPDF p.2, Semiology patterns of seizures with EZN restricted to the OFC

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdfSystematic review or meta-analysis · 11 findings · 4 reported values

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

Versive seizureTable 3 reports 2 studies assessing Versive seizure.PDF p.6, Table 3
Versive seizureTable 3 reports 39 patients assessed for Versive seizure.PDF p.6, Table 3
Versive seizureTable 3 reports 0–13.6% as the percentage range or value for Versive seizure; the overall association grade is Low.PDF p.6, Table 3
odds of occurrence; Versive seizureTable 4 reports overall odds of 0.11 for occurrence of Versive seizure in lateral TLE.PDF p.7, Table 4; PDF p.8, Figure 2
odds confidence interval; Versive seizureTable 4 reports a 95% confidence interval of 0.03–0.43 for the overall odds of Versive seizure.PDF p.7, Table 4; PDF p.8, Figure 2
heterogeneity test; Versive seizureThe heterogeneity test for the Table 4 odds estimate for Versive seizure has p=0.2741.PDF p.7, Table 4
Versive seizure; lateral versus mesial comparisonTable 5 reports 1 studies comparing Versive seizure in lateral and mesial TLE.PDF p.9, Table 5
Versive seizure; lateral TLE patient denominatorTable 5 reports 17 lateral-TLE patients assessed for Versive seizure.PDF p.9, Table 5
Versive seizure; mesial TLE patient denominatorTable 5 reports 20 mesial-TLE patients assessed for Versive seizure.PDF p.9, Table 5
Versive seizure; lateral TLE prevalenceTable 5 reports a lateral-TLE percentage of 0% for Versive seizure.PDF p.9, Table 5
Versive seizure; mesial TLE prevalenceTable 5 reports a mesial-TLE percentage of 0% for Versive seizure.PDF p.9, Table 5

Reported values

0–13.6%Versive seizurePercentage Range · Lateral temporal epilepsy patients assessed for Versive seizure · ictalPDF p.6, Table 3
odds 0.11odds of occurrence; Versive seizureOdds · Lateral temporal epilepsy patients assessed for Versive seizure · ictalPDF p.7, Table 4; PDF p.8, Figure 2
0%Versive seizure; lateral TLE prevalencePercentage · Lateral TLE patients assessed for Versive seizure · Lateral TLE patients assessed for Versive seizure · ictalPDF p.9, Table 5
0%Versive seizure; mesial TLE prevalencePercentage · Mesial TLE patients assessed for Versive seizure · Mesial TLE patients assessed for Versive seizure · ictalPDF p.9, Table 5

elwan-kotagal-lateralizing-localizing-seizure-semiology-2018.pdfIndependent primary study · 1 finding · 4 reported values

elwan-kotagal-lateralizing-localizing-seizure-semiology-2018.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

VersionIn the surgical cohort, version was reported as a contralateral lateralizing sign with 100% PPV for seizure lateralization and inter-observer kappa of 0.74.PDF p.3, Table 1; PDF p.3, §5.1

Reported values

PPV 100% (contralateral)VersionPositive predictive value · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 2 seizures/1 patient, frontal 8/6, parietal 6/4, and occipital 6/3. · IctalPDF p.3, Table 1; PDF p.3, §5.1
22 seizures with versionVersionCount · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 2 seizures/1 patient, frontal 8/6, parietal 6/4, and occipital 6/3. · IctalPDF p.3, Table 1; PDF p.3, §5.1
14 patients with versionVersionCount · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 2 seizures/1 patient, frontal 8/6, parietal 6/4, and occipital 6/3. · IctalPDF p.3, Table 1; PDF p.3, §5.1
inter-observer kappa 0.74VersionKappa · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 2 seizures/1 patient, frontal 8/6, parietal 6/4, and occipital 6/3. · IctalPDF p.3, Table 1; PDF p.3, §5.1

epilepsy-fellowship-handbook-semiologyreferences.pdfNarrative, educational, or cited context · 1 finding

epilepsy-fellowship-handbook-semiologyreferences.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Forced head versionBoth tables list Forced head version as Contralateral.PDF p.2, Lateralizing signs/Localization table row "Forced head version" (printed p.7); PDF p.3, Lateralizing signs/Localization table row "Forced head version" (printed p.5)

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdfStructured design not resolved · 1 finding · 5 reported values

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.932

Findings

Tonic head deviationTonic head deviation, predominantly contralateral to the hemisphere of seizure origin, was more common in LTL than RTL seizures; across 21 episodes it was contralateral to seizure onset in 19 (90%).PDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion

Reported values

RTL ipsilateral late tonic head deviation 0/54Tonic head deviationPercentage · n/N 0/54 · RTL seizure group, n=54, versus LTL seizure group, n=73; pooled tonic-head-deviation episodes n=21 · RTL; ipsilateral late deviation · Late ictal phase; source states it most often occurred before secondary generalizationPDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion
LTL contralateral late tonic head deviation 16/73 (22%)Tonic head deviationPercentage · n/N 16/73 · RTL seizure group, n=54, versus LTL seizure group, n=73; pooled tonic-head-deviation episodes n=21 · LTL; contralateral late deviation · Late ictal phase; source states it most often occurred before secondary generalizationPDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion
Contralateral to seizure onset 19/21 episodes (90%)Tonic head deviationPercentage · n/N 19/21 · RTL seizure group, n=54, versus LTL seizure group, n=73; pooled tonic-head-deviation episodes n=21 · Pooled tonic-head-deviation episodes · Late ictal phase; source states it most often occurred before secondary generalizationPDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion
RTL contralateral late tonic head deviation 3/54 (6%)Tonic head deviationPercentage · n/N 3/54 · RTL seizure group, n=54, versus LTL seizure group, n=73; pooled tonic-head-deviation episodes n=21 · RTL; contralateral late deviation · Late ictal phase; source states it most often occurred before secondary generalizationPDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion
LTL ipsilateral late tonic head deviation 2/73 (3%)Tonic head deviationPercentage · n/N 2/73 · RTL seizure group, n=54, versus LTL seizure group, n=73; pooled tonic-head-deviation episodes n=21 · LTL; ipsilateral late deviation · Late ictal phase; source states it most often occurred before secondary generalizationPDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 2 findings · 3 reported values

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

versive seizuresSustained forced turning of the head or eyes, usually with same-side mouth deviation and head hyperextension, is contralateral to the hemisphere of seizure onset when it occurs immediately before a GTCS. In temporal lobe seizures version occurs later while consciousness is impaired, unlike the earlier pattern described in FLE.PDF p.3, section 3.2 Simple motor seizures
head version during SGTCSHead version is contralateral to the epileptogenic zone in more than 90% of cases, especially when it occurs in the 10 seconds preceding an SGTCS. Ipsilateral head version at the end of an SGTCS occurs in as many as 15–20% of patients with focal seizures and is more common in FLE than TLE; in temporal-lobe seizures, brief initial ipsilateral nonversive turning often precedes contralateral version immediately before SGTCS.PDF p.6, section 7 Lateralizing signs of secondarily generalized tonic–clonic seizures; PDF p.5, Table 2

Reported values

in the 10 seconds preceding an SGTCShead version during SGTCSOther reported value · patients with focal seizures, including FLE and TLE · pre-SGTCS · initial phase of generalization; particularly 10 seconds before SGTCS; end of SGTCSPDF p.6, section 7 Lateralizing signs of secondarily generalized tonic–clonic seizures; PDF p.5, Table 2
ipsilateral end-of-SGTCS version up to 15–20%head version during SGTCSRange · patients with focal seizures, including FLE and TLE · end-of-SGTCS · initial phase of generalization; particularly 10 seconds before SGTCS; end of SGTCSPDF p.6, section 7 Lateralizing signs of secondarily generalized tonic–clonic seizures; PDF p.5, Table 2
more than 90% contralateralhead version during SGTCSPercentage · patients with focal seizures, including FLE and TLE · pre-SGTCS head version · initial phase of generalization; particularly 10 seconds before SGTCS; end of SGTCSPDF p.6, section 7 Lateralizing signs of secondarily generalized tonic–clonic seizures; PDF p.5, Table 2

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 1 finding

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Versive seizures and asymmetric tonic posturingThe review states that electrical stimulation of M1 and SMA produces myoclonic, tonic, clonic, tonic-clonic, or version responses; versive seizures indicate contralateral frontal eye field involvement, and asymmetric tonic posturing can indicate SMA involvement.PDF p.4, section 1.6

kotagal-asymmetric-tonic-limb-posturing-secondarily-generalized.pdfStructured design not resolved · 2 findings · 6 reported values

kotagal-asymmetric-tonic-limb-posturing-secondarily-generalized.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.707

Findings

versionIn Group I, version occurred in 9 of 16 TLE patients (56.3%) and 8 of 15 XTLE patients (53.3%), and was contralateral to ictal onset in all patients with version in each subgroup.PDF p.3, Table 1—Patients with version and Patients with version contralateral to focus; PDF p.3, Results—Group I
versionIn Group II, version occurred in 13 of 26 patients (50%) and was contralateral to ictal onset in all 13 patients with version.PDF p.3, Table 1—Patients with version and Patients with version contralateral to focus; PDF p.3, Results—Group II

Reported values

TLE occurrence 9/16 (56.3%)versionPercentage · n/N 9/16 · Group I patients with seizures progressing to secondary generalization; TLE and XTLE subgroups · TLEPDF p.3, Table 1—Patients with version and Patients with version contralateral to focus; PDF p.3, Results—Group I
XTLE occurrence 8/15 (53.3%)versionPercentage · n/N 8/15 · Group I patients with seizures progressing to secondary generalization; TLE and XTLE subgroups · XTLEPDF p.3, Table 1—Patients with version and Patients with version contralateral to focus; PDF p.3, Results—Group I
XTLE lateralization 8/8 (100%)versionPercentage · n/N 8/8 · Group I patients with seizures progressing to secondary generalization; TLE and XTLE subgroups · XTLE with versionPDF p.3, Table 1—Patients with version and Patients with version contralateral to focus; PDF p.3, Results—Group I
TLE lateralization 9/9 (100%)versionPercentage · n/N 9/9 · Group I patients with seizures progressing to secondary generalization; TLE and XTLE subgroups · TLEPDF p.3, Table 1—Patients with version and Patients with version contralateral to focus; PDF p.3, Results—Group I
13/13 (100%)versionPercentage · n/N 13/13 · Group II patients · Group IIPDF p.3, Table 1—Patients with version and Patients with version contralateral to focus; PDF p.3, Results—Group II
13/26 (50%)versionPercentage · n/N 13/26 · Group II patients · Group IIPDF p.3, Table 1—Patients with version and Patients with version contralateral to focus; PDF p.3, Results—Group II

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdfNarrative, educational, or cited context · 4 findings · 8 reported values

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Forced head deviationKernan et al. found forced head deviation contralateral in more than 90% of seizures when the seizure developed into a generalized tonic-clonic seizure or occurred within 10 seconds before generalization.PDF p.4, section 3.1 Version
VersionThe review treats forced, involuntary, sustained head and eye version as a lateralizing sign that is generally contralateral to seizure onset and particularly reliable immediately before the tonic-clonic phase, with neck extension, or with late ipsiversion.PDF p.4, section 3.1 Version; PDF p.4, section 3.1.1 Mechanism; PDF p.12, Table 1
Versive head and eye movementWyllie et al. reviewed 74 seizures in 37 patients and defined version as a forced and involuntary movement resulting in sustained unnatural positioning; only versive movements were lateralizing and they were always contralateral to seizure onset as determined by EEG.PDF p.4, section 3.1 Version
VersionChee et al. found version in 45% of 38 selected patients with frontal and temporal lobe epilepsy, with a positive predictive value of 94%; the review states reliability was 100% under specified conditions including immediate pre-tonic-clonic version, neck extension, or association with late ipsiversion.PDF p.4, section 3.1 Version

Reported values

More than 90% contralateralForced head deviationPercentage · Patients with seizures developing into generalized tonic-clonic seizures or occurring within 10 seconds before generalization · Immediately before or during generalizationPDF p.4, section 3.1 Version
Version in 22.2% of frontal-lobe epilepsy patientsVersionPercentage · Patients with focal seizures and frontal or temporal lobe epilepsy as summarized by the review · Frontal lobe epilepsy · Ictal; immediately before or during secondary generalizationPDF p.4, section 3.1 Version; PDF p.4, section 3.1.1 Mechanism; PDF p.12, Table 1
Version contralateral in 100%VersionPercentage · Patients with focal seizures and frontal or temporal lobe epilepsy as summarized by the review · Version · Ictal; immediately before or during secondary generalizationPDF p.4, section 3.1 Version; PDF p.4, section 3.1.1 Mechanism; PDF p.12, Table 1
37 patientsVersive head and eye movementCount · 37 patients with 74 seizures and lateral head and eye movements · Wyllie et al. cohort · IctalPDF p.4, section 3.1 Version
74 seizuresVersive head and eye movementCount · 37 patients with 74 seizures and lateral head and eye movements · Wyllie et al. cohort · IctalPDF p.4, section 3.1 Version
Version PPV 94%VersionPositive predictive value · 38 selected patients with frontal and temporal lobe epilepsy · Ictal; immediately before tonic-clonic phase or with late ipsiversionPDF p.4, section 3.1 Version
Reliability 100% under specified version conditionsVersionPercentage · 38 selected patients with frontal and temporal lobe epilepsy · Immediate pre-tonic-clonic version, neck extension, or late ipsiversion · Ictal; immediately before tonic-clonic phase or with late ipsiversionPDF p.4, section 3.1 Version
Version in 45% of 38 selected patientsVersionPercentage · 38 selected patients with frontal and temporal lobe epilepsy · Ictal; immediately before tonic-clonic phase or with late ipsiversionPDF p.4, section 3.1 Version

luders-semiological-seizure-classification-1998.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

luders-semiological-seizure-classification-1998.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Versive seizureVersive seizures involve sustained and extreme conjugate eye movement or lateral movement of the head, and sometimes the whole body, to one side; eye movements may combine smooth tonic deviation with superimposed saccades, body version replaces saccades with small clonic lateral movements, and the body may complete one or more 360-degree turns.PDF p.4, Simple motor seizures, Versive seizures; PDF p.2, Table 1

Reported values

One or more 360-degree turns may occurVersive seizureCount · IctalPDF p.4, Simple motor seizures, Versive seizures; PDF p.2, Table 1

marashly-ictal-motor-sequences-lateralization-localization-values-2016.pdfIndependent primary study · 4 findings · 47 reported values

marashly-ictal-motor-sequences-lateralization-localization-values-2016.pdf

Independent primary study · Class II · Evidence weight 4.22 · 2 × 1.15 × 1.836

Findings

version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisIn the 47 representative seizures, Table 1 reports the following prevalence counts, PPVs, and Fleiss Kappa indices: version 36, 97%, 0.6961; unilateral tonic 24, 96%, 0.2594; M2e 21, 100%, 0.7364; unilateral clonic 10, 90%, 0.3643; Fig of 4 23, 74%, 0.4873; dystonia 6, 67%, 0.2620; asymmetric clonic ending 28, 89%, 0.6761; Todd's paralysis 6, 83%, 0.4360.PDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
version-first ictal motor sequence; version plus tonic and/or M2e progressionAmong the 38 sequence seizures, version was the first motor sign in 29/38; among those 29 version-first seizures, M2e followed in 15/29 and tonic posturing in 7/29, which the authors combine as version followed by a tonic seizure in 22/29 because they treat M2e as a special tonic form. One seizure had simultaneous version and tonic posturing as the first sign followed by secondary generalization and asymmetric clonic ending; three of the remaining non-version-first seizures showed version plus tonic activity in a different order; in total 33/38 showed version plus tonic activity in variable order. Version was absent in 5/38, four seizures started with tonic activity and ended with asymmetric clonic ending, three of those lateralized the EZ correctly, and one M2e-to-clonic sequence lateralized the EZ correctly.PDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
version; versive head and eye movementsThe current paper reports that defined versive head and eye deviation lateralized the EZ to the contralateral hemisphere, describes a value above 90% when version occurred within 10 seconds or less before motor generalization, and reports 100% contralateral lateralization under the cited conditions of neck extension and late ipsiversion after the end of a generalized tonic-clonic seizure.PDF p.7, Version definition and cited value; PDF p.13, discussion of version; PDF p.14, discussion of cited version conditions
version as the initial sign versus non-version as the initial signTable 2 compares 29 seizures with version as the first sign (15 temporal and 14 extra-temporal) with 9 seizures without version as the first sign (4 temporal and 5 extra-temporal) and reports no statistically significant difference in temporal versus extra-temporal origin, with p=0.693.PDF p.10, Results; PDF p.11, Discussion; PDF p.19, Table 2

Reported values

0.262version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · dystonia · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
28/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 28/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · asymmetric clonic ending · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
89%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · asymmetric clonic ending · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
67%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · dystonia · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
96%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral tonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
10/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 10/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral clonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
23/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 23/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Fig of 4 · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
36/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 36/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · version · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.2594version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral tonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.3643version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral clonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
90%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral clonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
21/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 21/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · M2e · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
83%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Todd's paralysis · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
6/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 6/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Todd's paralysis · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.6961version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · version · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
100%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · M2e · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
97%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · version · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
6/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 6/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · dystonia · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
74%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Fig of 4 · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.6761version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · asymmetric clonic ending · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.7364version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · M2e · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.4873version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Fig of 4 · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
24/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 24/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral tonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.436version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Todd's paralysis · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
Correct EZ lateralization in M2e-to-clonic sequence 1/1version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 1/1 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Correct EZ lateralization in M2e-to-clonic sequence · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
M2e-to-clonic sequence 1/38version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 1/38 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · M2e-to-clonic sequence · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Version absent 5/38version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 5/38 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Version absent · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Version as second sign in non-version-first seizures 4/9version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 4/9 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Version as second sign in non-version-first seizures · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Non-version-first with version plus tonic in different order 3/9version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 3/9 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Non-version-first with version plus tonic in different order · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Version plus tonic in variable order 33/38version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 33/38 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Version plus tonic in variable order · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Tonic start with asymmetric clonic ending 4/38version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 4/38 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Tonic start with asymmetric clonic ending · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Tonic posturing second after version 7/29version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 7/29 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Tonic posturing second after version · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Version followed by tonic including M2e 22/29version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 22/29 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Version followed by tonic including M2e · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Version first 29/38version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 29/38 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Version first · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
M2e second after version 15/29version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 15/29 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · M2e second after version · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Simultaneous version and tonic as first sign 1/38version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 1/38 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Simultaneous version and tonic as first sign · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Correct EZ lateralization among tonic-start/asymmetric-clonic sequences 3/4version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 3/4 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Correct EZ lateralization among tonic-start/asymmetric-clonic sequences · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
100%version; versive head and eye movementsPercentage · Cited-study populations as summarized in the current paper; Not reported · neck extension and late ipsiversion after generalized tonic-clonic seizure · Version within 10 seconds before motor generalization; late ipsiversion after generalized tonic-clonic seizure in the cited conditionPDF p.7, Version definition and cited value; PDF p.13, discussion of version; PDF p.14, discussion of cited version conditions
above 90%version; versive head and eye movementsOther reported value · Cited-study populations as summarized in the current paper; Not reported · version within 10 seconds or less before motor generalization · Version within 10 seconds before motor generalization; late ipsiversion after generalized tonic-clonic seizure in the cited conditionPDF p.7, Version definition and cited value; PDF p.13, discussion of version; PDF p.14, discussion of cited version conditions
4 temporal non-version-first seizuresversion as the initial sign versus non-version as the initial signCount · 38 representative sequence seizures classified by temporal versus extra-temporal EZ origin · non-version first; temporal · initial sign of the pre-secondary-generalization motor sequencePDF p.10, Results; PDF p.11, Discussion; PDF p.19, Table 2
29 version-first seizuresversion as the initial sign versus non-version as the initial signCount · 38 representative sequence seizures classified by temporal versus extra-temporal EZ origin · version first · initial sign of the pre-secondary-generalization motor sequencePDF p.10, Results; PDF p.11, Discussion; PDF p.19, Table 2
5 extra-temporal non-version-first seizuresversion as the initial sign versus non-version as the initial signCount · 38 representative sequence seizures classified by temporal versus extra-temporal EZ origin · non-version first; extra-temporal · initial sign of the pre-secondary-generalization motor sequencePDF p.10, Results; PDF p.11, Discussion; PDF p.19, Table 2
38 sequence seizuresversion as the initial sign versus non-version as the initial signCount · 38 representative sequence seizures classified by temporal versus extra-temporal EZ origin · initial sign of the pre-secondary-generalization motor sequencePDF p.10, Results; PDF p.11, Discussion; PDF p.19, Table 2
p=0.693version as the initial sign versus non-version as the initial signP value · 38 representative sequence seizures classified by temporal versus extra-temporal EZ origin · initial sign of the pre-secondary-generalization motor sequencePDF p.10, Results; PDF p.11, Discussion; PDF p.19, Table 2
14 extra-temporal version-first seizuresversion as the initial sign versus non-version as the initial signCount · 38 representative sequence seizures classified by temporal versus extra-temporal EZ origin · version first; extra-temporal · initial sign of the pre-secondary-generalization motor sequencePDF p.10, Results; PDF p.11, Discussion; PDF p.19, Table 2
15 temporal version-first seizuresversion as the initial sign versus non-version as the initial signCount · 38 representative sequence seizures classified by temporal versus extra-temporal EZ origin · version first; temporal · initial sign of the pre-secondary-generalization motor sequencePDF p.10, Results; PDF p.11, Discussion; PDF p.19, Table 2
9 non-version-first seizuresversion as the initial sign versus non-version as the initial signCount · 38 representative sequence seizures classified by temporal versus extra-temporal EZ origin · non-version first · initial sign of the pre-secondary-generalization motor sequencePDF p.10, Results; PDF p.11, Discussion; PDF p.19, Table 2

montavont-ictal-dysprosody-nondominant-frontal-operculum-2005.pdfCase report or observation · 1 finding

montavont-ictal-dysprosody-nondominant-frontal-operculum-2005.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

recurrent ictal speech utterances; oro-alimentary automatisms; right-sided versionIn the patient’s habitual partial seizures, an aura of nausea was followed by staring gaze, partial loss of consciousness, oro-alimentary automatisms, right-sided version, and postictal confusion; family reported recurrent stereotyped French or English sentence repetitions from age 18.PDF p.2, left column, paragraph beginning “Partial seizures began”; PDF p.2, right column, paragraph beginning “Five stereotyped and spontaneous electroclinical seizures”

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdfSystematic review or meta-analysis · 2 findings · 2 reported values

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

versionTable 3 reports version in 6% of the temporo-polar synthesis (evidence grade Low).PDF p.5, Table 3
versionTable 3 reports a 0–100% range for version across the temporo-polar reports (evidence grade Low).PDF p.5, Table 3

Reported values

6%versionPercentage · Temporo-polar semiology synthesis represented in Table 3 · later after propagation to symptomatogenic areasPDF p.5, Table 3
range 0–100%versionPercentage Range · Temporo-polar semiology synthesis represented in Table 3 · later after propagation to symptomatogenic areasPDF p.5, Table 3

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

versive seizuresThe review defines versive seizures as forced involuntary turning of the head and eyes in one direction with neck extension; the frontal eye fields are the symptomatogenic zone. Versive seizures appear earlier in frontal than temporal seizures and can be the first frontal-lobe sign; they have highly lateralizing value toward the contralateral hemisphere, especially within 10 seconds before secondary generalization. Reliability requires distinguishing epileptic versive seizures from non-versive natural head turning.PDF p.4, Versive seizures

Reported values

Within 10 seconds before secondary generalizationversive seizuresCount · Patients with frontal-lobe, temporal-lobe, or partial seizures; no cohort reported · Ictal; especially within 10 seconds before secondary generalizationPDF p.4, Versive seizures

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdfIndependent primary study · 1 finding

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

atypical post-tapering seizures with contralateral versionTwo patients had one or two atypical post-tapering seizures with contralateral version; these were excluded from propagation-pattern classification because they deviated from habitual semiology and reflected inadequate contralateral electrode coverage.PDF p.5, Ictal Semiology and Seizure Capture During SEEG Monitoring

wyllie1986.pdfStructured design not resolved · 5 findings · 43 reported values

wyllie1986.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.893

Findings

versive and nonversive head and eye movementsIn the 74 seizures from 37 patients, all 61 versive seizures were contralateral to the cerebral hemisphere of seizure onset and none was ipsilateral, whereas nonversive turning occurred on both sides and was judged nonlocalizing.PDF p.1, Article abstract; PDF p.2, Table 1; PDF p.2, results paragraph
versive head and eye movement together or separatelyThe head and eyes moved together in 40 of 61 versive seizures; the remaining 21 included 14 with head version but incomplete eye visibility and 7 with eye version without head movement, and isolated eye version occurred in 2 occipital-onset seizures from one patient and 5 frontal-onset seizures from another.PDF p.2, results paragraph describing visibility and isolated eye version; PDF p.2, paragraph stating contralaterality for head-and-eye or eye-only version
smooth and jerking versive movementThe versive movement was smooth in 40 seizures (65%) and jerking in 21 (35%), independently of other ictal EEG and clinical features.PDF p.3, paragraph beginning “The clinical appearance of contraversion varied”
persistence of contraversion and ipsiversion after generalizationAmong versive seizures with secondary generalization, contraversive head and eye movement persisted through the generalized tonic-clonic phase in 8 seizures (30%) for 6-53 seconds (mean 24); in 4 seizures it waned and the head and eyes returned to midline before another 42-62 seconds (mean 55) of convulsion, while in 4 seizures it continued throughout the convulsion, and 12 (44%) generalized seizures ended with ipsiversion.PDF p.3, paragraphs describing persistence through generalized tonic-clonic activity and ipsiversion at the end
quiet staring and staring with automatisms before contraversionQuiet staring preceded contraversion for 8 versive seizures for 2-31 seconds (mean 17), while staring with automatisms preceded contraversion for 18 seizures for 4-227 seconds (mean 34); all seizures with automatisms before contraversion originated in temporal lobes, whereas the quiet-staring subgroup arose from temporal (25%) and extratemporal (75%) locations.PDF p.2, Table 2; PDF p.3, paragraphs reporting quiet-staring and automatisms durations and onset regions; PDF p.4, discussion of temporal localization before contraversion

Reported values

Versive movements contralateral 61/61versive and nonversive head and eye movementsPercentage · n/N 61/61 · 37 patients; 74 seizures with lateral head and eye movement; onset regions frontal, temporal, parietal, and occipital · Versive; contralateral · ictal; first or observed lateral head and eye movementPDF p.1, Article abstract; PDF p.2, Table 1; PDF p.2, results paragraph
Patients n=37versive and nonversive head and eye movementsCount · 37 patients; 74 seizures with lateral head and eye movement; onset regions frontal, temporal, parietal, and occipital · Overall · ictal; first or observed lateral head and eye movementPDF p.1, Article abstract; PDF p.2, Table 1; PDF p.2, results paragraph
Occipital Versive contralateral n=2versive and nonversive head and eye movementsCount · 37 patients; 74 seizures with lateral head and eye movement; onset regions frontal, temporal, parietal, and occipital · Versive; contralateral · ictal; first or observed lateral head and eye movementPDF p.1, Article abstract; PDF p.2, Table 1; PDF p.2, results paragraph
Frontal Nonversive contralateral n=2versive and nonversive head and eye movementsCount · 37 patients; 74 seizures with lateral head and eye movement; onset regions frontal, temporal, parietal, and occipital · Frontal onset; Nonversive contralateral · ictal; first or observed lateral head and eye movementPDF p.1, Article abstract; PDF p.2, Table 1; PDF p.2, results paragraph
Temporal-onset seizures n=31versive and nonversive head and eye movementsCount · 37 patients; 74 seizures with lateral head and eye movement; onset regions frontal, temporal, parietal, and occipital · Temporal onset · ictal; first or observed lateral head and eye movementPDF p.1, Article abstract; PDF p.2, Table 1; PDF p.2, results paragraph
Versive movements ipsilateral 0/61versive and nonversive head and eye movementsPercentage · n/N 0/61 · 37 patients; 74 seizures with lateral head and eye movement; onset regions frontal, temporal, parietal, and occipital · Versive; ipsilateral · ictal; first or observed lateral head and eye movementPDF p.1, Article abstract; PDF p.2, Table 1; PDF p.2, results paragraph
Temporal Nonversive contralateral n=4versive and nonversive head and eye movementsCount · 37 patients; 74 seizures with lateral head and eye movement; onset regions frontal, temporal, parietal, and occipital · Temporal onset; Nonversive contralateral · ictal; first or observed lateral head and eye movementPDF p.1, Article abstract; PDF p.2, Table 1; PDF p.2, results paragraph
Nonversive movements contralateral 6/13versive and nonversive head and eye movementsPercentage · n/N 6/13 · 37 patients; 74 seizures with lateral head and eye movement; onset regions frontal, temporal, parietal, and occipital · Nonversive; contralateral · ictal; first or observed lateral head and eye movementPDF p.1, Article abstract; PDF p.2, Table 1; PDF p.2, results paragraph
Nonversive movements ipsilateral 7/13versive and nonversive head and eye movementsPercentage · n/N 7/13 · 37 patients; 74 seizures with lateral head and eye movement; onset regions frontal, temporal, parietal, and occipital · Nonversive; ipsilateral · ictal; first or observed lateral head and eye movementPDF p.1, Article abstract; PDF p.2, Table 1; PDF p.2, results paragraph
Temporal Nonversive ipsilateral n=7versive and nonversive head and eye movementsCount · 37 patients; 74 seizures with lateral head and eye movement; onset regions frontal, temporal, parietal, and occipital · Temporal onset; Nonversive ipsilateral · ictal; first or observed lateral head and eye movementPDF p.1, Article abstract; PDF p.2, Table 1; PDF p.2, results paragraph
Seizures with lateral head/eye movement n=74versive and nonversive head and eye movementsCount · 37 patients; 74 seizures with lateral head and eye movement; onset regions frontal, temporal, parietal, and occipital · Overall · ictal; first or observed lateral head and eye movementPDF p.1, Article abstract; PDF p.2, Table 1; PDF p.2, results paragraph
Frontal-onset seizures n=39versive and nonversive head and eye movementsCount · 37 patients; 74 seizures with lateral head and eye movement; onset regions frontal, temporal, parietal, and occipital · Frontal onset · ictal; first or observed lateral head and eye movementPDF p.1, Article abstract; PDF p.2, Table 1; PDF p.2, results paragraph
Temporal Versive contralateral n=20versive and nonversive head and eye movementsCount · 37 patients; 74 seizures with lateral head and eye movement; onset regions frontal, temporal, parietal, and occipital · Versive; contralateral · ictal; first or observed lateral head and eye movementPDF p.1, Article abstract; PDF p.2, Table 1; PDF p.2, results paragraph
Parietal-onset seizures n=2versive and nonversive head and eye movementsCount · 37 patients; 74 seizures with lateral head and eye movement; onset regions frontal, temporal, parietal, and occipital · Parietal onset · ictal; first or observed lateral head and eye movementPDF p.1, Article abstract; PDF p.2, Table 1; PDF p.2, results paragraph
Parietal Versive contralateral n=2versive and nonversive head and eye movementsCount · 37 patients; 74 seizures with lateral head and eye movement; onset regions frontal, temporal, parietal, and occipital · Versive; contralateral · ictal; first or observed lateral head and eye movementPDF p.1, Article abstract; PDF p.2, Table 1; PDF p.2, results paragraph
Frontal Versive contralateral n=37versive and nonversive head and eye movementsCount · 37 patients; 74 seizures with lateral head and eye movement; onset regions frontal, temporal, parietal, and occipital · Versive; contralateral · ictal; first or observed lateral head and eye movementPDF p.1, Article abstract; PDF p.2, Table 1; PDF p.2, results paragraph
Occipital-onset seizures n=2versive and nonversive head and eye movementsCount · 37 patients; 74 seizures with lateral head and eye movement; onset regions frontal, temporal, parietal, and occipital · Occipital onset · ictal; first or observed lateral head and eye movementPDF p.1, Article abstract; PDF p.2, Table 1; PDF p.2, results paragraph
one patient with occipital-onset isolated eye versionversive head and eye movement together or separatelyCount · 27 patients; 61 versive seizures · occipital onset · ictal versive movementPDF p.2, results paragraph describing visibility and isolated eye version; PDF p.2, paragraph stating contralaterality for head-and-eye or eye-only version
head version with incomplete eye visibility 14 seizuresversive head and eye movement together or separatelyCount · 27 patients; 61 versive seizures · head version; eyes incompletely visible · ictal versive movementPDF p.2, results paragraph describing visibility and isolated eye version; PDF p.2, paragraph stating contralaterality for head-and-eye or eye-only version
eye version without head movement 7 seizuresversive head and eye movement together or separatelyCount · 27 patients; 61 versive seizures · eye version without head movement · ictal versive movementPDF p.2, results paragraph describing visibility and isolated eye version; PDF p.2, paragraph stating contralaterality for head-and-eye or eye-only version
one patient with frontal-onset isolated eye versionversive head and eye movement together or separatelyCount · 27 patients; 61 versive seizures · frontal onset · ictal versive movementPDF p.2, results paragraph describing visibility and isolated eye version; PDF p.2, paragraph stating contralaterality for head-and-eye or eye-only version
2 occipital-onset seizuresversive head and eye movement together or separatelyCount · 27 patients; 61 versive seizures · occipital onset · ictal versive movementPDF p.2, results paragraph describing visibility and isolated eye version; PDF p.2, paragraph stating contralaterality for head-and-eye or eye-only version
5 frontal-onset seizuresversive head and eye movement together or separatelyCount · 27 patients; 61 versive seizures · frontal onset · ictal versive movementPDF p.2, results paragraph describing visibility and isolated eye version; PDF p.2, paragraph stating contralaterality for head-and-eye or eye-only version
head and eyes together 40/61versive head and eye movement together or separatelyPercentage · n/N 40/61 · 27 patients; 61 versive seizures · head and eyes together · ictal versive movementPDF p.2, results paragraph describing visibility and isolated eye version; PDF p.2, paragraph stating contralaterality for head-and-eye or eye-only version
21 (35%)smooth and jerking versive movementPercentage · n/N 21/61 · 61 versive seizures from 27 patients · jerking versive movement · Ictal contraversionPDF p.3, paragraph beginning “The clinical appearance of contraversion varied”
40 (65%)smooth and jerking versive movementPercentage · n/N 40/61 · 61 versive seizures from 27 patients · smooth versive movement · Ictal contraversionPDF p.3, paragraph beginning “The clinical appearance of contraversion varied”
persistence duration 6–53 secondspersistence of contraversion and ipsiversion after generalizationRange · Versive seizures with secondary generalized tonic-clonic activity · persistent contraversion · Generalized tonic-clonic phase and end of seizure after secondary generalizationPDF p.3, paragraphs describing persistence through generalized tonic-clonic activity and ipsiversion at the end
another 42–62 seconds of convulsionpersistence of contraversion and ipsiversion after generalizationRange · Versive seizures with secondary generalized tonic-clonic activity · waning after return to midline · Generalized tonic-clonic phase and end of seizure after secondary generalizationPDF p.3, paragraphs describing persistence through generalized tonic-clonic activity and ipsiversion at the end
waning with return to midline in 4 seizurespersistence of contraversion and ipsiversion after generalizationCount · Versive seizures with secondary generalized tonic-clonic activity · waning · Generalized tonic-clonic phase and end of seizure after secondary generalizationPDF p.3, paragraphs describing persistence through generalized tonic-clonic activity and ipsiversion at the end
mean 55 seconds of convulsionpersistence of contraversion and ipsiversion after generalizationMean · Versive seizures with secondary generalized tonic-clonic activity · waning after return to midline · Generalized tonic-clonic phase and end of seizure after secondary generalizationPDF p.3, paragraphs describing persistence through generalized tonic-clonic activity and ipsiversion at the end
continued subset from 3 patientspersistence of contraversion and ipsiversion after generalizationCount · Versive seizures with secondary generalized tonic-clonic activity · continued throughout · Generalized tonic-clonic phase and end of seizure after secondary generalizationPDF p.3, paragraphs describing persistence through generalized tonic-clonic activity and ipsiversion at the end
continued throughout convulsion in 4 seizurespersistence of contraversion and ipsiversion after generalizationCount · Versive seizures with secondary generalized tonic-clonic activity · continued throughout · Generalized tonic-clonic phase and end of seizure after secondary generalizationPDF p.3, paragraphs describing persistence through generalized tonic-clonic activity and ipsiversion at the end
waning subset from 3 patientspersistence of contraversion and ipsiversion after generalizationCount · Versive seizures with secondary generalized tonic-clonic activity · waning · Generalized tonic-clonic phase and end of seizure after secondary generalizationPDF p.3, paragraphs describing persistence through generalized tonic-clonic activity and ipsiversion at the end
mean persistence duration 24 secondspersistence of contraversion and ipsiversion after generalizationMean · Versive seizures with secondary generalized tonic-clonic activity · persistent contraversion · Generalized tonic-clonic phase and end of seizure after secondary generalizationPDF p.3, paragraphs describing persistence through generalized tonic-clonic activity and ipsiversion at the end
12/27 (44%) ended with ipsiversionpersistence of contraversion and ipsiversion after generalizationPercentage · n/N 12/27 · Versive seizures with secondary generalized tonic-clonic activity · end of generalized seizure · Generalized tonic-clonic phase and end of seizure after secondary generalizationPDF p.3, paragraphs describing persistence through generalized tonic-clonic activity and ipsiversion at the end
persistent contraversion 8/27 (30%)persistence of contraversion and ipsiversion after generalizationPercentage · n/N 8/27 · Versive seizures with secondary generalized tonic-clonic activity · persistent contraversion · Generalized tonic-clonic phase and end of seizure after secondary generalizationPDF p.3, paragraphs describing persistence through generalized tonic-clonic activity and ipsiversion at the end
Quiet staring before contraversion 8/61 (13%)quiet staring and staring with automatisms before contraversionPercentage · n/N 8/61 · 26 versive seizures with a reported pre-contraversion staring phase · Quiet staring · Ictal period before contraversionPDF p.2, Table 2; PDF p.3, paragraphs reporting quiet-staring and automatisms durations and onset regions; PDF p.4, discussion of temporal localization before contraversion
Staring-with-automatisms duration mean 34 seconds (range 4–227)quiet staring and staring with automatisms before contraversionMean · 26 versive seizures with a reported pre-contraversion staring phase · Staring with automatisms · Ictal period before contraversionPDF p.2, Table 2; PDF p.3, paragraphs reporting quiet-staring and automatisms durations and onset regions; PDF p.4, discussion of temporal localization before contraversion
Quiet-staring subgroup temporal origin 25%quiet staring and staring with automatisms before contraversionPercentage · 26 versive seizures with a reported pre-contraversion staring phase · Quiet staring; temporal origin · Ictal period before contraversionPDF p.2, Table 2; PDF p.3, paragraphs reporting quiet-staring and automatisms durations and onset regions; PDF p.4, discussion of temporal localization before contraversion
Staring-with-automatisms subgroup temporal origin 18/18quiet staring and staring with automatisms before contraversionPercentage · n/N 18/18 · 26 versive seizures with a reported pre-contraversion staring phase · Staring with automatisms · Ictal period before contraversionPDF p.2, Table 2; PDF p.3, paragraphs reporting quiet-staring and automatisms durations and onset regions; PDF p.4, discussion of temporal localization before contraversion
Quiet-staring duration mean 17 seconds (range 2–31)quiet staring and staring with automatisms before contraversionMean · 26 versive seizures with a reported pre-contraversion staring phase · Quiet staring · Ictal period before contraversionPDF p.2, Table 2; PDF p.3, paragraphs reporting quiet-staring and automatisms durations and onset regions; PDF p.4, discussion of temporal localization before contraversion
Quiet-staring subgroup extratemporal origin 75%quiet staring and staring with automatisms before contraversionPercentage · 26 versive seizures with a reported pre-contraversion staring phase · Quiet staring; extratemporal origin · Ictal period before contraversionPDF p.2, Table 2; PDF p.3, paragraphs reporting quiet-staring and automatisms durations and onset regions; PDF p.4, discussion of temporal localization before contraversion
Staring with automatisms before contraversion 18/61 (30%)quiet staring and staring with automatisms before contraversionPercentage · n/N 18/61 · 26 versive seizures with a reported pre-contraversion staring phase · Staring with automatisms · Ictal period before contraversionPDF p.2, Table 2; PDF p.3, paragraphs reporting quiet-staring and automatisms durations and onset regions; PDF p.4, discussion of temporal localization before contraversion

22 contributing manuscripts; source-reported values remain separate and are not pooled.

Auditory auraReported: BilateralAlso reported: ContralateralAlso reported: Dominant hemisphereAlso reported: IpsilateralAlso reported: Right hemisphereNo single reliable side17 manuscripts · 41 findings · 47 reported values

Weighted evidence supportevidence weight 35.15 across 17 manuscripts · 4 independent primary study · 9 narrative, educational, or cited context · 3 systematic review or meta-analysis · 1 case report or observation

The review links early ictal dysphasia to dominant-hemisphere involvement and unilateral elementary auditory aura to contralateral seizure onset. The review restates that prior analyses associated auditory aura with the dominant hemisphere. The temporal-plus description preserves contraversive eye/head and ipsilateral tonic-motor relations without assigning a left/right cerebral hemisphere. The review states that the perceived side of a simple auditory aura is not a reliable epilepsy-lateralizing sign. The cited 2018 auditory-seizure study was reported to have a dominant-hemisphere SOZ in 60%. Unilateral ear plugging was reported in three cases to indicate seizure onset in the contralateral temporal lobe auditory cortex. In the cited 18-patient auditory-aura series, bilateral sound perception predominated, with three contralateral-ear cases. Stimulation-evoked auditory sensations were perceived mostly in the ear contralateral to stimulation (57.6%), with bilateral perception in 36.4% and ipsilateral perception in 6%. This finding provides no lateralization information. The TL-versus-T+ auditory-aura comparison provides no lateralization information. The cited EZ-extent statement provides no lateralization information. The combined somatosensory and auditory aura observation reports no hemisphere direction. This finding provides no hemispheric lateralization information. No cerebral hemisphere or body-side direction is reported. No seizure lateralization is reported. The primary comparison reports no hemisphere-level lateralization; it compares M, ML, and L temporal-onset subtypes. No lateralization result is reported in this corpus-size finding. The educational definition of auditory aura supplies no lateralizing direction.

Source-defined result groups 25

Localization: TemporalSource-defined values retained separatelyTL · T+ · seizures1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyT+ · seizures1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTL · T+ · seizures1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyauditory manifestation; operculoinsular SOZ · auditory versus visual manifestation and extrafrontal SOZ subgroup · patient as represented by Table 2 n; sign-specific denominator Not reported1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · reported sign prevalence across included studies1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyT+ · seizures1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyauditory manifestation; temporal SOZ · auditory versus visual manifestation and extrafrontal SOZ subgroup · patient as represented by Table 2 n; sign-specific denominator Not reported1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyipsilateral · posterior/inferior versus other insular sites; simple versus complex auditory response; ear-laterality categories · evoked auditory response1 manuscript · 1 reported value · not pooled

Localization: ParietalObserved proportion 5.6%All reported · patients1 manuscript · 1 reported value · not pooled

Localization: InsularObserved proportion 8.0%auditory responses · posterior/inferior versus other insular sites; simple versus complex auditory response; ear-laterality categories · evoked auditory response1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelycontralateral · posterior/inferior versus other insular sites; simple versus complex auditory response; ear-laterality categories · evoked auditory response1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyvisual manifestation; posterior SOZ · auditory versus visual manifestation and extrafrontal SOZ subgroup · patient as represented by Table 2 n; sign-specific denominator Not reported1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 12.5%M · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyLateral TLE patients assessed for Auditory aura · mesial TLE percentage shown separately · reported lateral-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyMesial TLE patients assessed for Auditory aura · lateral TLE percentage shown separately · reported mesial-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separately2 diagnostic-accuracy studies comparing lateral and mesial TLE for Auditory aura · lateral TLE versus mesial TLE · random-effects diagnostic-accuracy estimate1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 33.3%ML · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelybilateral · posterior/inferior versus other insular sites; simple versus complex auditory response; ear-laterality categories · evoked auditory response1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 84.6%L · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: orbitofrontal cortex-restricted epileptogenic-zone networkSource-defined values retained separatelyOFC-restricted EZN cases · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTL · T+ · seizures1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyAll reported · posterior/inferior versus other insular sites; simple versus complex auditory response; ear-laterality categories · evoked auditory response1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 17

Alphabetical by manuscript.

asadollahi-drug-resistant-parietal-lobe-epilepsy-clinical-manifestations-surgery-outcome-2017.pdfIndependent primary study · 1 finding · 1 reported value

asadollahi-drug-resistant-parietal-lobe-epilepsy-clinical-manifestations-surgery-outcome-2017.pdf

Independent primary study · Class II · Evidence weight 3.91 · 2 × 1.2 × 1.628

Findings

auditory auraOne patient had an auditory aura.PDF p.2, Results

Reported values

1/18 (5.5%) auditory auraauditory auraPercentage · n/N 1/18 · 18-patient drug-resistant parietal lobe epilepsy cohort · auraPDF p.2, Results

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 2 findings · 6 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

auditory auraAuditory auras did not differ significantly overall or across the source's illusion and hallucination subcategories.PDF p.6, Table 2; PDF p.8, auditory aura discussion
auditory aura and extensive epileptogenic zoneThe source reports that prior findings suggested that, in TL epilepsy, patients with auditory auras may have an extensive epileptogenic zone extending beyond the temporal lobe.PDF p.8, auditory aura discussion

Reported values

T+ 4.3%auditory auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictal onsetPDF p.6, Table 2; PDF p.8, auditory aura discussion
T+ 8.7%auditory auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictal onsetPDF p.6, Table 2; PDF p.8, auditory aura discussion
TL 3.4%auditory auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictal onsetPDF p.6, Table 2; PDF p.8, auditory aura discussion
TL 3.4%auditory auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictal onsetPDF p.6, Table 2; PDF p.8, auditory aura discussion
T+ 8.7%auditory auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictal onsetPDF p.6, Table 2; PDF p.8, auditory aura discussion
TL 0%auditory auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictal onsetPDF p.6, Table 2; PDF p.8, auditory aura discussion

blair-temporal-lobe-epilepsy-semiology-2012.pdfNarrative, educational, or cited context · 1 finding

blair-temporal-lobe-epilepsy-semiology-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Auditory features in ADPEAFIn autosomal dominant partial epilepsy with auditory features, the review describes simple unformed auditory symptoms such as humming, buzzing, or ringing as most common, with less frequent complex sounds or distortions; specific sounds may precipitate seizures, and olfactory, visceral, vertiginous, experiential, or autonomic auras may also occur.PDF p.3, ADPEAF paragraph

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 1 finding

chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

lateral/neocortical temporal seizure; auditory aura; ictal dysphasiaLateral or neocortical temporal seizures are described as having fewer auras and often auditory or vertiginous features; elementary sounds such as humming, ringing, and buzzing indicate primary auditory cortex, complex sounds indicate auditory association areas, elementary unilateral auditory aura indicates contralateral onset, and early ictal dysphasia may indicate dominant-hemisphere involvement.PDF p.6, Lateral/neocortical temporal lobe; PDF p.3, Figure 1

cossette-roberge-localizing-lateralizing-auditory-phenomena-seizures-2023.pdfCase report or observation · 2 findings · 11 reported values

cossette-roberge-localizing-lateralizing-auditory-phenomena-seizures-2023.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

PubMed, Scopus, and Google Scholar were searched without language or date restrictions through 11 December 2022. The review narratively summarized auditory-network anatomy and compiled encountered cortical-stimulation studies reporting auditory phenomena (AP) plus case reports/series with AS-like phenomena and enough information to determine seizure-onset-zone (SOZ) lateralization and/or localization; acute symptomatic seizures and cases without evident auditory semiology were excluded. Level A evidence comprised seizure freedom after surgery with more than 1 year follow-up, seizures demonstrated from a SOZ on intracranial EEG, a concordant structural MRI lesion, or a concordant MEG cluster of at least 6 spike sources within 1 cm; Level B used MEG scatters, scalp EEG, PET/SPECT, and/or other clinical features. Localization and lateralization were analyzed for Level A, but only lateralization for Level B; data were tabulated as count (frequency), missing data were pairwise-deleted, and no comparative statistical tests were performed.

Findings

auditory seizures in a cited 2018 retrospective studyThe review attributes to a 2018 retrospective study that the SOZ was mainly in the dominant hemisphere (60%) and that 89% of AS had a temporal SOZ.PDF p.5, section 6.1; PDF p.7, section 6.2.1
auditory seizures (AS) and auditory phenomena (AP)The review analyzed 174 cases comprising 200 AS from 70 articles; Level A covered 115 cases/131 AS, Level B covered 59 cases/69 AS, and the SOZ-to-perceived-side lateralization analysis included 99 cases comprising 114 AS.PDF p.1, Abstract; PDF p.2, Methods sections 2.1-2.3; PDF p.5, section 6

Reported values

60%auditory seizures in a cited 2018 retrospective studyPercentage · Cited 2018 retrospective AS study; endpoint sample sizes were not stated in this review · cited 2018 retrospective study · Ictal ASPDF p.5, section 6.1; PDF p.7, section 6.2.1
89%auditory seizures in a cited 2018 retrospective studyPercentage · Cited 2018 retrospective AS study; endpoint sample sizes were not stated in this review · cited 2018 retrospective study · Ictal ASPDF p.5, section 6.1; PDF p.7, section 6.2.1
70 articlesauditory seizures (AS) and auditory phenomena (AP)Count · Literature case reports and series for AS, with a separate cortical-stimulation literature synthesis for AP · overall review corpus · Ictal AS; electrically induced AP analyzed separatelyPDF p.1, Abstract; PDF p.2, Methods sections 2.1-2.3; PDF p.5, section 6
99 casesauditory seizures (AS) and auditory phenomena (AP)Count · n/N 99/174 cases · Literature case reports and series for AS, with a separate cortical-stimulation literature synthesis for AP · paired SOZ-to-perceived-side lateralization analysis · Ictal AS; electrically induced AP analyzed separatelyPDF p.1, Abstract; PDF p.2, Methods sections 2.1-2.3; PDF p.5, section 6
59 casesauditory seizures (AS) and auditory phenomena (AP)Count · n/N 59/174 cases · Literature case reports and series for AS, with a separate cortical-stimulation literature synthesis for AP · Level B · Ictal AS; electrically induced AP analyzed separatelyPDF p.1, Abstract; PDF p.2, Methods sections 2.1-2.3; PDF p.5, section 6
131 ASauditory seizures (AS) and auditory phenomena (AP)Count · n/N 131/200 AS · Literature case reports and series for AS, with a separate cortical-stimulation literature synthesis for AP · Level A · Ictal AS; electrically induced AP analyzed separatelyPDF p.1, Abstract; PDF p.2, Methods sections 2.1-2.3; PDF p.5, section 6
200 ASauditory seizures (AS) and auditory phenomena (AP)Count · Literature case reports and series for AS, with a separate cortical-stimulation literature synthesis for AP · overall review corpus · Ictal AS; electrically induced AP analyzed separatelyPDF p.1, Abstract; PDF p.2, Methods sections 2.1-2.3; PDF p.5, section 6
69 ASauditory seizures (AS) and auditory phenomena (AP)Count · n/N 69/200 AS · Literature case reports and series for AS, with a separate cortical-stimulation literature synthesis for AP · Level B · Ictal AS; electrically induced AP analyzed separatelyPDF p.1, Abstract; PDF p.2, Methods sections 2.1-2.3; PDF p.5, section 6
174 casesauditory seizures (AS) and auditory phenomena (AP)Count · Literature case reports and series for AS, with a separate cortical-stimulation literature synthesis for AP · overall review corpus · Ictal AS; electrically induced AP analyzed separatelyPDF p.1, Abstract; PDF p.2, Methods sections 2.1-2.3; PDF p.5, section 6
115 casesauditory seizures (AS) and auditory phenomena (AP)Count · n/N 115/174 cases · Literature case reports and series for AS, with a separate cortical-stimulation literature synthesis for AP · Level A · Ictal AS; electrically induced AP analyzed separatelyPDF p.1, Abstract; PDF p.2, Methods sections 2.1-2.3; PDF p.5, section 6
114 ASauditory seizures (AS) and auditory phenomena (AP)Count · n/N 114/200 AS · Literature case reports and series for AS, with a separate cortical-stimulation literature synthesis for AP · paired SOZ-to-perceived-side lateralization analysis · Ictal AS; electrically induced AP analyzed separatelyPDF p.1, Abstract; PDF p.2, Methods sections 2.1-2.3; PDF p.5, section 6

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdfNarrative, educational, or cited context · 2 findings · 2 reported values

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.37 · 1 × 0.9 × 1.521

Findings

auditory sensationOne restricted-OFC case had an auditory sensation.PDF p.2, Semiology patterns of seizures with EZN restricted to the OFC
somatosensory and auditory aura; frontal subgroupOne frontal-subgroup aura combined a nonpainful somatosensory aura with an auditory sensation.PDF p.3, Aura

Reported values

1 patientauditory sensationCount · OFC-restricted EZN cases · OFC-restricted EZN cases · ictalPDF p.2, Semiology patterns of seizures with EZN restricted to the OFC
1 patientsomatosensory and auditory aura; frontal subgroupCount · n/N 1/11 · Frontal subgroup of OFC-extended EZN · Frontal subgroup of OFC-extended EZN · ictal auraPDF p.3, Aura

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdfSystematic review or meta-analysis · 20 findings · 6 reported values

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

auditory aura; dominant hemisphereThe source cites prior analyses in which auditory auras were considered a predictor of epileptogenic-zone lateralization to the dominant hemisphere, while this review evaluates lateral versus mesial temporal localization instead.PDF p.8, Differentiating ictal semiologies
transverse gyrus of Heschl; auditory auraThe source states that intraoperative stimulation of the lateral temporal lobe, particularly the transverse gyrus of Heschl, can produce an auditory sensation, especially when an auditory aura is part of habitual seizures.PDF p.1, Introduction
auditory auraThe source concludes that auditory aura is the only specific semiology identified for lateral temporal lobe seizures, although it occurs in a minority of patients.PDF p.1, Abstract; PDF p.7, Discussion; PDF p.10, Conclusions
Auditory auraTable 3 reports 3 studies assessing Auditory aura.PDF p.6, Table 3
Auditory auraTable 3 reports 54 patients assessed for Auditory aura.PDF p.6, Table 3
Auditory auraTable 3 reports 5.9–9.1% as the percentage range or value for Auditory aura; the overall association grade is Low.PDF p.6, Table 3
odds of occurrence; Auditory auraTable 4 reports overall odds of 0.08 for occurrence of Auditory aura in lateral TLE.PDF p.7, Table 4; PDF p.8, Figure 2
odds confidence interval; Auditory auraTable 4 reports a 95% confidence interval of 0.03–0.23 for the overall odds of Auditory aura.PDF p.7, Table 4; PDF p.8, Figure 2
heterogeneity test; Auditory auraThe heterogeneity test for the Table 4 odds estimate for Auditory aura has p=0.9237.PDF p.7, Table 4
Auditory aura; lateral versus mesial comparisonTable 5 reports 2 studies comparing Auditory aura in lateral and mesial TLE.PDF p.9, Table 5
Auditory aura; lateral TLE patient denominatorTable 5 reports 32 lateral-TLE patients assessed for Auditory aura.PDF p.9, Table 5
Auditory aura; mesial TLE patient denominatorTable 5 reports 51 mesial-TLE patients assessed for Auditory aura.PDF p.9, Table 5
Auditory aura; lateral TLE prevalenceTable 5 reports a lateral-TLE percentage of 5.9–6.7% for Auditory aura.PDF p.9, Table 5
Auditory aura; mesial TLE prevalenceTable 5 reports a mesial-TLE percentage of 0–12.9% for Auditory aura.PDF p.9, Table 5
Auditory aura; diagnostic sensitivityTable 6 reports overall sensitivity 0.06 for Auditory aura in 2 studies comparing lateral with mesial TLE.PDF p.9, Table 6
Auditory aura; diagnostic sensitivity confidence intervalTable 6 reports a 95% confidence interval of 0.02–0.22 for sensitivity of Auditory aura.PDF p.9, Table 6
Auditory aura; sensitivity heterogeneityThe heterogeneity test for sensitivity of Auditory aura has p=0.9272.PDF p.9, Table 6
Auditory aura; diagnostic specificityTable 6 reports overall specificity 0.98 for Auditory aura in 2 studies comparing lateral with mesial TLE.PDF p.9, Table 6
Auditory aura; diagnostic specificity confidence intervalTable 6 reports a 95% confidence interval of 0.88–1.00 for specificity of Auditory aura.PDF p.9, Table 6
Auditory aura; specificity heterogeneityThe heterogeneity test for specificity of Auditory aura has p=0.8316.PDF p.9, Table 6

Reported values

5.9–9.1%Auditory auraPercentage Range · Lateral temporal epilepsy patients assessed for Auditory aura · ictalPDF p.6, Table 3
odds 0.08odds of occurrence; Auditory auraOdds · Lateral temporal epilepsy patients assessed for Auditory aura · ictalPDF p.7, Table 4; PDF p.8, Figure 2
5.9–6.7%Auditory aura; lateral TLE prevalencePercentage Range · Lateral TLE patients assessed for Auditory aura · Lateral TLE patients assessed for Auditory aura · ictalPDF p.9, Table 5
0–12.9%Auditory aura; mesial TLE prevalencePercentage Range · Mesial TLE patients assessed for Auditory aura · Mesial TLE patients assessed for Auditory aura · ictalPDF p.9, Table 5
sensitivity 0.06Auditory aura; diagnostic sensitivitySensitivity · 2 diagnostic-accuracy studies comparing lateral and mesial TLE for Auditory aura · 2 diagnostic-accuracy studies comparing lateral and mesial TLE for Auditory aura · ictal sign presencePDF p.9, Table 6
specificity 0.98Auditory aura; diagnostic specificitySpecificity · 2 diagnostic-accuracy studies comparing lateral and mesial TLE for Auditory aura · 2 diagnostic-accuracy studies comparing lateral and mesial TLE for Auditory aura · ictal sign presencePDF p.9, Table 6

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 1 finding

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

auditory aurasSimple auditory auras such as ringing or buzzing are associated with the primary auditory cortex, while complex voices, music, hallucinations, or illusions are associated with auditory association areas in the temporo-occipital cortex. Although auditory information has bilateral innervation, the contralateral ear is better represented in auditory cortex.PDF p.2, section 3.1 Auras; PDF p.2, Table 1

gibbs-clinical-features-sleep-related-hypermotor-epilepsy-2019.pdfIndependent primary study · 1 finding · 3 reported values

gibbs-clinical-features-sleep-related-hypermotor-epilepsy-2019.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

auditory and visual nonmotor manifestationsAuditory and visual manifestations were observed only in extrafrontal SHE; visual symptoms were associated with a posterior cortex SOZ, whereas auditory symptoms were associated with either a temporal or an operculoinsular SOZ.PDF p.5, section 3.3; PDF p.6, Table 2

Reported values

visual posterior 2auditory and visual nonmotor manifestationsCount · Extrafrontal SHE patients in the 115-patient semiology-analysis cohort; Table 2 lists auditory n=1 in temporal and n=1 in operculoinsular subgroups and visual n=2 in the posterior subgroup · visual manifestation; posterior SOZ · early nonmotor seizure onsetPDF p.5, section 3.3; PDF p.6, Table 2
auditory operculoinsular 1auditory and visual nonmotor manifestationsCount · Extrafrontal SHE patients in the 115-patient semiology-analysis cohort; Table 2 lists auditory n=1 in temporal and n=1 in operculoinsular subgroups and visual n=2 in the posterior subgroup · auditory manifestation; operculoinsular SOZ · early nonmotor seizure onsetPDF p.5, section 3.3; PDF p.6, Table 2
auditory temporal 1auditory and visual nonmotor manifestationsCount · Extrafrontal SHE patients in the 115-patient semiology-analysis cohort; Table 2 lists auditory n=1 in temporal and n=1 in operculoinsular subgroups and visual n=2 in the posterior subgroup · auditory manifestation; temporal SOZ · early nonmotor seizure onsetPDF p.5, section 3.3; PDF p.6, Table 2

jobst-insula-and-its-epilepsies-2019.pdfNarrative, educational, or cited context · 2 findings

jobst-insula-and-its-epilepsies-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

auditory auraAuditory auras are among the reported clinical manifestations of insular seizures.PDF p.2, Clinical Features
auditory sensation from very posteroinferior insulaAuditory sensations were evoked by stimulating the very posteroinferior part of the insula.PDF p.5, Other Insular Responses

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdfNarrative, educational, or cited context · 2 findings · 6 reported values

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Auditory auraAuditory auras are reported across populations at variable frequency, and unilateral ear plugging is described as a sign that can lateralize seizure onset to the contralateral temporal lobe auditory cortex.PDF p.3, section 2.4 Auditory auras; PDF p.3, section 2.4.1 Mechanism
Auditory auraThe Cleveland Clinic series included 18 patients with auditory auras; 15 heard bilateral sounds and 3 localized the aura to the contralateral ear, with the epileptogenic zone determined by seizure freedom after surgery in 10 and presurgical evaluation in 8.PDF p.3, section 2.4 Auditory auras

Reported values

Frequency 2-16% of patients, depending on aura type and reviewed populationAuditory auraPercentage · Patients with focal epilepsy as summarized in a review and case series · Ictal auraPDF p.3, section 2.4 Auditory auras; PDF p.3, section 2.4.1 Mechanism
Bilateral sounds 15/18Auditory auraPercentage · n/N 15/18 · 18 patients with auditory auras in the Cleveland Clinic series · Bilateral sounds · Ictal auraPDF p.3, section 2.4 Auditory auras
Patients with auditory auras n=18Auditory auraCount · 18 patients with auditory auras in the Cleveland Clinic series · Ictal auraPDF p.3, section 2.4 Auditory auras
EZ determined by seizure freedom after surgery 10/18Auditory auraPercentage · n/N 10/18 · 18 patients with auditory auras in the Cleveland Clinic series · Postoperative seizure-freedom determination · Ictal auraPDF p.3, section 2.4 Auditory auras
Contralateral-ear aura 3/18Auditory auraPercentage · n/N 3/18 · 18 patients with auditory auras in the Cleveland Clinic series · Contralateral ear · Ictal auraPDF p.3, section 2.4 Auditory auras
EZ determined by presurgical evaluation 8/18Auditory auraPercentage · n/N 8/18 · 18 patients with auditory auras in the Cleveland Clinic series · Presurgical-evaluation determination · Ictal auraPDF p.3, section 2.4 Auditory auras

luders-semiological-seizure-classification-1998.pdfNarrative, educational, or cited context · 1 finding

luders-semiological-seizure-classification-1998.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Auditory auraIsolated auditory hallucinations or illusions are auditory auras; complex auditory phenomena with broader perceptual alterations are auditory only when clearly predominant, otherwise they are psychic auras.PDF p.3, Auras, subsection Auditory auras; PDF p.2, Table 1

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdfIndependent primary study · 1 finding · 3 reported values

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdf

Independent primary study · Class II · Evidence weight 5.07 · 2 × 1.5 × 1.69

Findings

sensory hallucination or illusion (visual, auditory, vestibular)The combined category of visual, auditory, or vestibular sensory hallucination or illusion was more frequent in L than M or ML patients.PDF p.5, Table 2; PDF p.5, Semiologic analysis; PDF p.8, Sensory illusions and hallucinations

Reported values

6/18 (33.3%)sensory hallucination or illusion (visual, auditory, vestibular)Percentage · n/N 6/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · initial ictal subjective symptomPDF p.5, Table 2; PDF p.5, Semiologic analysis; PDF p.8, Sensory illusions and hallucinations
3/24 (12.5%)sensory hallucination or illusion (visual, auditory, vestibular)Percentage · n/N 3/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · initial ictal subjective symptomPDF p.5, Table 2; PDF p.5, Semiologic analysis; PDF p.8, Sensory illusions and hallucinations
11/13 (84.6%)sensory hallucination or illusion (visual, auditory, vestibular)Percentage · n/N 11/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · initial ictal subjective symptomPDF p.5, Table 2; PDF p.5, Semiologic analysis; PDF p.8, Sensory illusions and hallucinations

mazzola-electrical-stimulation-human-insula-ictal-semiology-2017.pdfNarrative, educational, or cited context · 1 finding · 9 reported values

mazzola-electrical-stimulation-human-insula-ictal-semiology-2017.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.80 · 1 × 0.9 × 2

Findings

auditory sensationsAuditory sensations occurred in 44 responses (8%) from the very posterior and inferior insula; 69.7% were unpleasant and 30.3% neutral, 81.8% (n=36) were simple auditory hallucinations, 18.2% (n=8) were more complex with ear vibration/pressure/paresthesiae, and perception was contralateral in 57.6%, bilateral in 36.4%, and ipsilateral in 6%.PDF p.3, Results; PDF p.5, Other Types of Evoked Sensations and Fig. 5C; PDF p.6, continuation

Reported values

neutral 30.3%auditory sensationsPercentage · 44 auditory responses in the 550-response series · neutral · stimulation-evoked auditory responsePDF p.3, Results; PDF p.5, Other Types of Evoked Sensations and Fig. 5C; PDF p.6, continuation
complex 18.2% (n=8)auditory sensationsPercentage · n/N 8/44 · 44 auditory responses in the 550-response series · complex ear vibration/pressure/paresthesiae · stimulation-evoked auditory responsePDF p.3, Results; PDF p.5, Other Types of Evoked Sensations and Fig. 5C; PDF p.6, continuation
unpleasant 69.7%auditory sensationsPercentage · 44 auditory responses in the 550-response series · unpleasant · stimulation-evoked auditory responsePDF p.3, Results; PDF p.5, Other Types of Evoked Sensations and Fig. 5C; PDF p.6, continuation
simple hallucination 81.8% (n=36)auditory sensationsPercentage · n/N 36/44 · 44 auditory responses in the 550-response series · simple auditory hallucination · stimulation-evoked auditory responsePDF p.3, Results; PDF p.5, Other Types of Evoked Sensations and Fig. 5C; PDF p.6, continuation
bilateral 36.4%auditory sensationsPercentage · 44 auditory responses in the 550-response series · bilateral · stimulation-evoked auditory responsePDF p.3, Results; PDF p.5, Other Types of Evoked Sensations and Fig. 5C; PDF p.6, continuation
44 responses (8%)auditory sensationsPercentage · n/N 44/550 · 44 auditory responses in the 550-response series · auditory responses · stimulation-evoked auditory responsePDF p.3, Results; PDF p.5, Other Types of Evoked Sensations and Fig. 5C; PDF p.6, continuation
contralateral 57.6%auditory sensationsPercentage · 44 auditory responses in the 550-response series · contralateral · stimulation-evoked auditory responsePDF p.3, Results; PDF p.5, Other Types of Evoked Sensations and Fig. 5C; PDF p.6, continuation
OR=0.81 for y-coordinate locationauditory sensationsOdds ratio · 44 auditory responses in the 550-response series · stimulation-evoked auditory responsePDF p.3, Results; PDF p.5, Other Types of Evoked Sensations and Fig. 5C; PDF p.6, continuation
ipsilateral 6%auditory sensationsPercentage · 44 auditory responses in the 550-response series · ipsilateral · stimulation-evoked auditory responsePDF p.3, Results; PDF p.5, Other Types of Evoked Sensations and Fig. 5C; PDF p.6, continuation

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 1 finding

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

temporal plus epilepsy; gustatory; vestibular; auditory; contraversive eyes/head; piloerection; ipsilateral tonic motor; postictal dysphoriaThe source describes temporal-plus semiology as more often including gustatory, vestibular, or auditory symptoms, contraversive eye or head manifestations, piloerection, ipsilateral tonic motor signs, and a more dysphoric postictal phase.PDF p.2, Introduction

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdfNarrative, educational, or cited context · 1 finding

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

stimulation-evoked somatosensory, auditory, vestibular, olfactory, gustatory, and viscerosensory symptomsThe chapter reports that electrical stimulation studies evoked somatosensory symptoms, including pain, from the posterior two-thirds of the insula; auditory and vestibular symptoms from the posterior insula; and olfactory, gustatory, and viscerosensory symptoms, including laryngeal constriction, from the midinsula, whereas stimulation of the most anterior portion rarely evoked symptoms unless a larger network seizure was elicited.PDF p.3, insular functional differentiation and electrical cortical stimulation

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdfNarrative, educational, or cited context · 1 finding

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

auditory aurasThe review describes simple auditory auras such as a buzz or noise as arising from Heschl's gyrus in the superior temporal gyrus and states that perceived sound laterality is not reliable for lateralizing the epilepsy, even when the patient perceives the sound on one side.PDF p.2, Auditory auras

17 contributing manuscripts; source-reported values remain separate and are not pooled.

Ictal contralateral tonic eye deviationSource terms: Ictal eye deviation; Ictal tonic eye deviationReported: ContralateralAlso reported: IpsilateralAlso reported: Left hemisphereAlso reported: Right hemisphereNo single reliable side17 manuscripts · 75 findings · 110 reported values

Weighted evidence supportevidence weight 34.78 across 17 manuscripts · 3 manuscript weight pending · 4 independent primary study · 3 structured design not resolved · 5 narrative, educational, or cited context · 2 systematic review or meta-analysis · 3 case report or observation

The cited discussion does not establish a reliable lateralizing direction for forceful head turning. ATLP was usually on the same side as version, with one complex two-direction version exception; the head was midline or returning to midline when ATLP appeared. The authors hypothesize that initial or primary MST involvement would produce initial ipsilateral conjugate eye deviation. Aggregate eye-deviation direction is not reported. Source reports contralateral limb posturing in a sequential occipital-onset phenotype. No lateralizing direction is reported for the visual-aura sequence. The source describes visual aura followed by head-eye deviation and contralateral tonic posturing as activity propagates through dorsal parietal nodes toward premotor areas. The seizure contains a leftward head/eye deviation, preserved as a body-side observation without cerebral lateralization inference. Table 2 records rightward head, eye, and body deviation in a case with source-reported right occipital onset. Eye deviation was contralateral in 13/20 eye-deviation seizures (65%) and ipsilateral in 7/20 (35%), but the directional difference was not statistically significant. Eye version direction was not reported, so the frontal cohort data cannot support a lateralizing direction. The review lists eye deviation as contralateral to the seizure focus and usually accompanied by forced head turning in the same direction. The temporal-plus description preserves contraversive eye/head and ipsilateral tonic-motor relations without assigning a left/right cerebral hemisphere. No lateralization axis information is reported for the 41% head-and-eye-deviation frequency. This educational statement supplies no lateralizing direction. Both tables list forced eye version as contralateral. The adapted review table lists eye version as contralateral. The current paper restates that version has high positive predictive value for the side of ictal onset without specifying a left/right or ipsi/contra direction. Patient 9 had forced tonic head-and-eye deviation to the right, but the onset hemisphere is not supplied. The primary comparison reports no lateralization; head and/or eye deviation over the whole seizure course did not differ significantly across M, ML, and L temporal-onset groups. No head/eye direction relative to the seizure hemisphere is reported. The primary result reports no lateralization; late head and/or eye deviation did not differ significantly across M, ML, and L temporal-onset groups. The review states that forced sustained eye version before secondary generalization is reliably contralateral, whereas without generalization it may be ipsilateral or contralateral depending on the activated region. This finding provides no lateralization information. Frequency only; no lateralization is reported. No lateralization axis information is reported for the 0–50% head-eye-deviation range. No lateralization axis information is reported for the moderate head-eye-deviation association grade. No lateralization is reported. The source reports head and eye deviation in 14% of patients and describes it as contralateral to seizure onset. No seizure lateralization is reported. No directional head-eye side or hemisphere is reported. No lateralization axis information is reported for head-eye deviation versus affective/autonomic aura. No lateralization axis information is reported for head-eye deviation versus autonomic signs. This record provides no seizure lateralization. No hemisphere or body-side direction is reported. No lateralization evidence is reported. Figure 6 reports OR 7.7 for Affective/autonomic aura relative to Head-eye deviation, with no hemisphere or lateralization direction. Figure 6 reports OR 5.7 for Autonomic signs relative to Head-eye deviation, with no hemisphere or lateralization direction. No lateralizing direction is reported. No lateralizing semiology is reported for the tonic-clonic versus head-eye-deviation odds comparison. No lateralizing semiology is reported for the reciprocal head-eye-deviation versus tonic-clonic odds comparison. In Case 1, forced right eye deviation and right head turning were ipsilateral to the right temporo-occipital focus, while later left-leg tonic posturing and left version were contralateral during seizure progression. The Figure 5 caption reports absolute left eye version, but it does not state whether that direction is ipsilateral or contralateral to the seizure side and conflicts with the same case's rightward narrative description. In Case 2, initial forced right eye deviation was ipsilateral to the right temporal epileptogenic region, whereas later left-arm tonic posturing and left facial clonia were contralateral motor signs. In Case 2, the epileptogenic/ictal region was right-sided and the initial eye deviation was ipsilateral to it. The report restates cited direct-stimulation studies in which posterior inferior temporal sulcus stimulation induced constant ipsilateral eye deviation. The current report restates a cited right temporo-occipital case with forced ipsilateral eye deviation and homodromous head turning. No independent lateralization axis record is present; the card concerns the timing of contraversive movement relative to onset region. Cited reports found ipsiversion in 50% and 48% of seizures with head/eye turning and concluded that forced turning at onset had no localizing or lateralizing value. The cited study reports 4/16 ipsiversion in a selected series; no cerebral reference frame is resolved. The cited series reported ipsiversion incidence of 3% in a larger series and 4/16 (25%) in a selected series. No source lateralization is reported. The cited stereo-EEG series reported ocular deviation contralateral to the ictal discharge in all 16 patients. The cited series reports contraversive head and eye movements in 29% of 55 patients without a resolved cerebral reference frame. Both depth-studied patients had contralateral head and eye deviation. The review restates that late forced head and eye version can be ipsilateral when initial contraversion ends during generalization, but can remain contralateral when initial contraversion persists. In the cited Wyllie series, late deviation was contralateral when initial contraversion persisted and ipsilateral when initial contraversion ended. The cited series reports late ipsiversion after an initial contraversive movement in 6 of 38 selected patients, always ipsilateral to the epilepsy focus.

Source-defined result groups 30

Localization: TemporalObserved proportion 33.3%M · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: L onset subtype / M onset subtype / ML onset subtypeObserved proportion 22.2%ML · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / Ipsilateral / Does not lateralizeObserved proportion 65.0%Contralateral to seizure focus · Ipsilateral to seizure focus · eye-deviation seizure1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 37.5%M · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: OccipitalObserved proportion 100.0%All reported · seizure spread beyond occipital lobe · cases1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Right hemisphere / IpsilateralSource-defined values retained separatelyAll reported · ATLP side versus version side and EEG laterality · instance1 manuscript · 1 reported value · not pooled

Localization: L onset subtype / M onset subtype / ML onset subtypeObserved proportion 12.5%M · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / Ipsilateral / Does not lateralizeObserved proportion 35.0%Ipsilateral to seizure focus · Contralateral to seizure focus · eye-deviation seizure1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 0.0%initial semiology · Initial semiology versus combined set-of-semiology · individual1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / Ipsilateral / Does not lateralizeSource-defined values retained separatelyContralateral to seizure focus · Ipsilateral to seizure focus · all analyzed seizures1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Right hemisphere / IpsilateralSource-defined values retained separatelyGroup II with ATLP and version · ATLP side versus version side and EEG laterality · patient1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / Ipsilateral / Does not lateralizeSource-defined values retained separatelyIpsilateral to seizure focus · Contralateral to seizure focus · all analyzed seizures1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 33.3%ML · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · seizure/ictal SEEG recording1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 23.1%L · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: L onset subtype / M onset subtype / ML onset subtypeObserved proportion 23.1%L · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 6.6%combined set-of-semiology · Initial semiology versus combined set-of-semiology · individual1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / Ipsilateral / Left hemisphere / Right hemisphereObserved proportion 33.3%All reported · seizure1 manuscript · 2 reported values · not pooled

Localization: TemporalObserved proportion 50.0%ML · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 100.0%All reported · seizure spread beyond occipital lobe · cases1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 38.5%L · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: FrontalSource-defined values retained separatelyFacial expression change · pairwise symptom-occurrence comparison1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 17

Alphabetical by manuscript.

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfCase report or observation · 1 finding

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

patient 9 forced right head/eye deviationHead and eyes forced tonic deviation to the right was listed for patient 9.PDF p.4, Figure 3

blair-temporal-lobe-epilepsy-semiology-2012.pdfNarrative, educational, or cited context · 1 finding

blair-temporal-lobe-epilepsy-semiology-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Eye deviationEye deviation is listed as contralateral to the seizure focus and is usually associated with forced head turning in the same direction; version occurs in temporal and extratemporal onset seizures.PDF p.4, Table 2; PDF p.4, section 4 Lateralizing Features in Temporal Lobe Epilepsy

chassoux-ictal-semiology-anterior-cingulate-epilepsy-systematic-review-2025.pdfSystematic review or meta-analysis · 34 findings · 31 reported values

chassoux-ictal-semiology-anterior-cingulate-epilepsy-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

dystonic posturing; head-eye deviation; tonic-clonic manifestationsThe review links dystonic posturing, head/eye deviation, and tonic-clonic manifestations to propagation rather than the earliest seizure phase.PDF p.11, Anatomical and clinical correlations
head-eye deviationThe source reports a frequency of 14% for head-eye deviation.PDF p.13, Table 3
head-eye deviation; reported frequency rangeThe source reports a frequency range of 0–50% for head-eye deviation.PDF p.13, Table 3
head-eye deviation; ACC association gradeTable 3 assigns the source's Moderate overall association grade to head-eye deviation.PDF p.13, Table 3
head-eye deviation; Figure 4 rateFigure 4 displays a 14% rate for head-eye deviation.PDF p.10, Figure 4
head-eye deviation; contralateral to seizure onsetHead and eye deviation occurred in 14% of patients and was contralateral to seizure onset.PDF p.9, Objective symptomatology
pairwise OR: Head-eye deviation relative to Vocalization/verbalizationFigure 6 reports an odds ratio of 0.1 for Head-eye deviation relative to Vocalization/verbalization.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of 0.1 for Head-eye deviation relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Affective/autonomic auraFigure 6 reports an odds ratio of 0.1 for Head-eye deviation relative to Affective/autonomic aura.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Autonomic signsFigure 6 reports an odds ratio of 0.2 for Head-eye deviation relative to Autonomic signs.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Facial expression changeFigure 6 reports an odds ratio of 0.2 for Head-eye deviation relative to Facial expression change.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 0.2 for Head-eye deviation relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Loss of consciousnessFigure 6 reports an odds ratio of 0.3 for Head-eye deviation relative to Loss of consciousness.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Post-ictal confusion/behavior change disinhibitionFigure 6 reports an odds ratio of 0.4 for Head-eye deviation relative to Post-ictal confusion/behavior change disinhibition.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Chapeau de gendarmeFigure 6 reports an odds ratio of 0.6 for Head-eye deviation relative to Chapeau de gendarme.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Dystonic posturingFigure 6 reports an odds ratio of 0.7 for Head-eye deviation relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Vocalization/verbalization relative to Head-eye deviationFigure 6 reports an odds ratio of 9.6 for Vocalization/verbalization relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to Head-eye deviationFigure 6 reports an odds ratio of 9.1 for Hypermotor-complex motor behavior relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Affective/autonomic aura relative to Head-eye deviationFigure 6 reports an odds ratio of 7.7 for Affective/autonomic aura relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Autonomic signs relative to Head-eye deviationFigure 6 reports an odds ratio of 5.7 for Autonomic signs relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Facial expression change relative to Head-eye deviationFigure 6 reports an odds ratio of 5.2 for Facial expression change relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to Head-eye deviationFigure 6 reports an odds ratio of 4.6 for Motor (gestural) automatisms relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Loss of consciousness relative to Head-eye deviationFigure 6 reports an odds ratio of 3.4 for Loss of consciousness relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Post-ictal confusion/behavior change disinhibition relative to Head-eye deviationFigure 6 reports an odds ratio of 2.7 for Post-ictal confusion/behavior change disinhibition relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Chapeau de gendarme relative to Head-eye deviationFigure 6 reports an odds ratio of 1.6 for Chapeau de gendarme relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to Head-eye deviationFigure 6 reports an odds ratio of 1.5 for Dystonic posturing relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Laughter relative to Head-eye deviationFigure 6 reports an odds ratio of 0.9 for Laughter relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to Head-eye deviationFigure 6 reports an odds ratio of 0.6 for Oro-alimentary automatisms relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Tonic-clonic relative to Head-eye deviationFigure 6 reports an odds ratio of 0.6 for Tonic-clonic relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: F to BTC relative to Head-eye deviationFigure 6 reports an odds ratio of 0.4 for F to BTC relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to LaughterFigure 6 reports an odds ratio of 1.5 for Head-eye deviation relative to Laughter.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 1.7 for Head-eye deviation relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Tonic-clonicFigure 6 reports an odds ratio of 2.8 for Head-eye deviation relative to Tonic-clonic.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to F to BTCFigure 6 reports an odds ratio of 2.8 for Head-eye deviation relative to F to BTC.PDF p.12, Figure 6

Reported values

14% (frequency range 0–50%)head-eye deviationPercentage · Reviewed ACC seizure cases with reported semiology · ictal propagationPDF p.13, Table 3
14%head-eye deviation; Figure 4 ratePercentage · Reviewed ACC seizure cases with reported semiology · ictal propagationPDF p.10, Figure 4
14%head-eye deviation; contralateral to seizure onsetPercentage · Reviewed ACC seizure cases with reported semiology · Reviewed ACC seizure casesPDF p.9, Objective symptomatology
OR 0.1pairwise OR: Head-eye deviation relative to Vocalization/verbalizationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.1pairwise OR: Head-eye deviation relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.1pairwise OR: Head-eye deviation relative to Affective/autonomic auraOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.2pairwise OR: Head-eye deviation relative to Autonomic signsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.2pairwise OR: Head-eye deviation relative to Facial expression changeOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.2pairwise OR: Head-eye deviation relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.3pairwise OR: Head-eye deviation relative to Loss of consciousnessOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.4pairwise OR: Head-eye deviation relative to Post-ictal confusion/behavior change disinhibitionOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.6pairwise OR: Head-eye deviation relative to Chapeau de gendarmeOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.7pairwise OR: Head-eye deviation relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 9.6pairwise OR: Vocalization/verbalization relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 9.1pairwise OR: Hypermotor-complex motor behavior relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 7.7pairwise OR: Affective/autonomic aura relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 5.7pairwise OR: Autonomic signs relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 5.2pairwise OR: Facial expression change relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 4.6pairwise OR: Motor (gestural) automatisms relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 3.4pairwise OR: Loss of consciousness relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 2.7pairwise OR: Post-ictal confusion/behavior change disinhibition relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.6pairwise OR: Chapeau de gendarme relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.5pairwise OR: Dystonic posturing relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.7pairwise OR: Laughter relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.6pairwise OR: Oro-alimentary automatisms relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.4pairwise OR: Tonic-clonic relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.4pairwise OR: F to BTC relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.5pairwise OR: Head-eye deviation relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.7pairwise OR: Head-eye deviation relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 2.8pairwise OR: Head-eye deviation relative to Tonic-clonicOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 2.8pairwise OR: Head-eye deviation relative to F to BTCOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6

epilepsy-fellowship-handbook-semiologyreferences.pdfNarrative, educational, or cited context · 1 finding

epilepsy-fellowship-handbook-semiologyreferences.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Forced eye versionBoth tables list Forced eye version as Contralateral.PDF p.2, Lateralizing signs/Localization table row "Forced eye version" (printed p.7); PDF p.3, Lateralizing signs/Localization table row "Forced eye version" (printed p.5)

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 1 finding

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

eye versionEye version is a forced, sustained conjugate deviation that usually accompanies head version and reliably lateralizes to the contralateral hemisphere before secondary generalization. Without generalization it may be ipsilateral or contralateral to the epileptogenic lesion depending on whether occipital or frontal regions are activated.PDF p.5, section 4 Lateralizing motor signs in complex motor seizures; PDF p.5, Table 2

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdfIndependent primary study · 1 finding · 2 reported values

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdf

Independent primary study · Class II · Evidence weight 5.11 · 2 × 1.35 × 1.893

Findings

Eye versionEye-version semiology was absent as initial semiology (0/61, 0%) and occurred in 4/61 individuals (7%) in the combined set-of-semiology.PDF p.5, Table 2

Reported values

Initial 0/61 (0%)Eye versionPercentage · n/N 0/61 · 61 individuals undergoing frontal lobe epilepsy surgery · initial semiology · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2
Combined 4/61 (7%)Eye versionPercentage · n/N 4/61 · 61 individuals undergoing frontal lobe epilepsy surgery · combined set-of-semiology · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 1 finding

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Eye versionTable 3 associates eye version with frontal eye fields (BA 8) and extra-striate cortex (BA 19) and lists contralateral lateralisation.PDF p.4, Table 3

kotagal-asymmetric-tonic-limb-posturing-secondarily-generalized.pdfStructured design not resolved · 2 findings · 2 reported values

kotagal-asymmetric-tonic-limb-posturing-secondarily-generalized.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1

Findings

ATLP following head and eye versionAt the time of ATLP, the head was midline or returning to midline from version in all instances, and ATLP was on the same side as version in all but one Group II patient; the exception had left version followed by right version, right ATLP, and generalized clonic movements, with EEG higher over the left hemisphere.PDF p.3, Other characteristics of ATLP—item 2
head/eye versionThe methods section characterizes version as a well-recognized lateralizing sign with good interobserver agreement and high positive predictive value for the side of ictal onset.PDF p.2, Methods—definition and comparison of version

Reported values

Head midline or returning to midline at ATLP in all instancesATLP following head and eye versionPercentage · Group II patients with ATLP and version; one symptomatic generalized epilepsy exception is described · ATLP after version and before generalized clonic movementsPDF p.3, Other characteristics of ATLP—item 2
ATLP on same side as version in all but one Group II patientATLP following head and eye versionPercentage · Group II patients with ATLP and version; one symptomatic generalized epilepsy exception is described · Group II with ATLP and version · ATLP after version and before generalized clonic movementsPDF p.3, Other characteristics of ATLP—item 2

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdfNarrative, educational, or cited context · 3 findings · 6 reported values

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Late ipsiversionThe review identifies ipsilateral forced head and eye version at the end of a generalized tonic-clonic seizure as a distinct lateralizing sign, especially when an initial contraversion ends during the generalized phase; if initial contraversion persists, late version can remain contralateral.PDF p.4, section 3.2 Late ipsiversion at the end of a generalized seizure
Late ipsiversionIn Wyllie et al., a study of 61 seizures in 27 patients with version, 9 patients had a late versive movement; when initial contraversion persisted, late deviation was contralateral in 3 patients, and when initial contraversion ended, late version was ipsilateral in 6 patients.PDF p.4, section 3.2 Late ipsiversion at the end of a generalized seizure
Late ipsiversionChee et al. found late ipsiversion after an initial contraversive movement before generalization in 6 of 38 selected patients, always ipsilateral to the epilepsy focus as determined by ictal EEG.PDF p.4, section 3.2 Late ipsiversion at the end of a generalized seizure

Reported values

6 patients had ipsilateral late versionLate ipsiversionCount · 27 patients with 61 seizures and version; 9 patients with late versive movement · initial contraversion ended · End of generalized tonic-clonic seizurePDF p.4, section 3.2 Late ipsiversion at the end of a generalized seizure
3 patients had contralateral late deviationLate ipsiversionCount · 27 patients with 61 seizures and version; 9 patients with late versive movement · initial contraversion persisted · End of generalized tonic-clonic seizurePDF p.4, section 3.2 Late ipsiversion at the end of a generalized seizure
61 seizuresLate ipsiversionCount · 27 patients with 61 seizures and version; 9 patients with late versive movement · End of generalized tonic-clonic seizurePDF p.4, section 3.2 Late ipsiversion at the end of a generalized seizure
9/27 patients had late movementLate ipsiversionPercentage · n/N 9/27 · 27 patients with 61 seizures and version; 9 patients with late versive movement · late versive movement · End of generalized tonic-clonic seizurePDF p.4, section 3.2 Late ipsiversion at the end of a generalized seizure
Late ipsiversion in 6/38 patientsLate ipsiversionPercentage · n/N 6/38 · 38 selected patients with frontal and temporal lobe epilepsy; 6 with late ipsiversion · Before or at the end of generalizationPDF p.4, section 3.2 Late ipsiversion at the end of a generalized seizure
Late ipsiversion ipsilateral to epilepsy focus 6/6Late ipsiversionPercentage · n/N 6/6 · 38 selected patients with frontal and temporal lobe epilepsy; 6 with late ipsiversion · Patients with late ipsiversion · Before or at the end of generalizationPDF p.4, section 3.2 Late ipsiversion at the end of a generalized seizure

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdfIndependent primary study · 3 findings · 10 reported values

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdf

Independent primary study · Class II · Evidence weight 5.07 · 2 × 1.5 × 1.69

Findings

head and/or eyes deviationHead and/or eyes deviation over the whole seizure course did not differ significantly across M, ML, and L groups.PDF p.6, Table 3; PDF p.9, Nondifferentiating ictal characteristics
early head and/or eyes deviationEarly head and/or eyes deviation did not differ significantly across M, ML, and L groups.PDF p.6, Table 4; PDF p.6, Early features
late head and/or eyes deviationLate head and/or eyes deviation did not differ significantly across M, ML, and L groups.PDF p.7, Table 5; PDF p.7, Later features; PDF p.9, Nondifferentiating ictal characteristics

Reported values

ML=9/18 (50%)head and/or eyes deviationPercentage · n/N 9/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · ictal course, early or late combinedPDF p.6, Table 3; PDF p.9, Nondifferentiating ictal characteristics
L=5/13 (38.5%)head and/or eyes deviationPercentage · n/N 5/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · ictal course, early or late combinedPDF p.6, Table 3; PDF p.9, Nondifferentiating ictal characteristics
M=9/24 (37.5%)head and/or eyes deviationPercentage · n/N 9/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · ictal course, early or late combinedPDF p.6, Table 3; PDF p.9, Nondifferentiating ictal characteristics
p=0.69head and/or eyes deviationP value · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ictal course, early or late combinedPDF p.6, Table 3; PDF p.9, Nondifferentiating ictal characteristics
4/18 (22.2%)early head and/or eyes deviationPercentage · n/N 4/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · early ictal, first half of seizurePDF p.6, Table 4; PDF p.6, Early features
3/24 (12.5%)early head and/or eyes deviationPercentage · n/N 3/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · early ictal, first half of seizurePDF p.6, Table 4; PDF p.6, Early features
3/13 (23.1%)early head and/or eyes deviationPercentage · n/N 3/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · early ictal, first half of seizurePDF p.6, Table 4; PDF p.6, Early features
6/18 (33.3%)late head and/or eyes deviationPercentage · n/N 6/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · late ictal, second half of seizurePDF p.7, Table 5; PDF p.7, Later features; PDF p.9, Nondifferentiating ictal characteristics
8/24 (33.3%)late head and/or eyes deviationPercentage · n/N 8/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · late ictal, second half of seizurePDF p.7, Table 5; PDF p.7, Later features; PDF p.9, Nondifferentiating ictal characteristics
3/13 (23.1%)late head and/or eyes deviationPercentage · n/N 3/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · late ictal, second half of seizurePDF p.7, Table 5; PDF p.7, Later features; PDF p.9, Nondifferentiating ictal characteristics

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 1 finding

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

temporal plus epilepsy; gustatory; vestibular; auditory; contraversive eyes/head; piloerection; ipsilateral tonic motor; postictal dysphoriaThe source describes temporal-plus semiology as more often including gustatory, vestibular, or auditory symptoms, contraversive eye or head manifestations, piloerection, ipsilateral tonic motor signs, and a more dysphoric postictal phase.PDF p.2, Introduction

roh-lateralizing-value-ictal-behaviors-temporal-lobe-epilepsy-1996.pdfStructured design not resolved · 2 findings · 4 reported values

roh-lateralizing-value-ictal-behaviors-temporal-lobe-epilepsy-1996.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 2

Findings

severity of head turning and eye movementThe discussion reports that Ochs et al. (1984) and Robillard et al. (1983) found no localizing or lateralizing value for forceful head turning at clinical seizure onset, while Wyllie et al. (1986) found lateralizing significance only for very severe head and eye movements with marked sustained unnatural positioning.PDF p.5, Discussion; PDF p.6, Discussion
eye deviationEye deviation inclined toward the side contralateral to seizure origin, but the source states that this tendency was not statistically significant.PDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1

Reported values

7/20 ipsilateral eye-deviation seizures (35%)eye deviationPercentage · n/N 7/20 · 19 patients with unilateral TLE; 20 eye-deviation seizures · Ipsilateral to seizure focus · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1
Ipsilateral eye deviation in 6% of all 116 seizureseye deviationPercentage · 19 patients with unilateral TLE; 20 eye-deviation seizures · Ipsilateral to seizure focus · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1
Contralateral eye deviation in 12% of all 116 seizureseye deviationPercentage · 19 patients with unilateral TLE; 20 eye-deviation seizures · Contralateral to seizure focus · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1
13/20 contralateral eye-deviation seizures (65%)eye deviationPercentage · n/N 13/20 · 19 patients with unilateral TLE; 20 eye-deviation seizures · Contralateral to seizure focus · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdfCase report or observation · 5 findings · 5 reported values

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

ocular deviation within first 10 secondsThe source reports a cited stereo-EEG series of 16 patients with ocular deviation within the first 10 seconds of seizure onset.PDF p.20, Discussion
tonic ocular deviation in cited stereo-EEG seriesOcular deviation was tonic in 14 of the 16 cited patients.PDF p.20, Discussion
contralateral ocular deviation in cited stereo-EEG seriesOcular deviation was contralateral to the ictal discharge in all 16 patients in the cited series.PDF p.20, Discussion
contraversive head and eye movement in Ludwig and Ajmone-MarsanThe source reports contraversive head and eye movements in 29% of 55 patients in the cited Ludwig and Ajmone-Marsan series.PDF p.20, Discussion
contralateral head and eye deviation with occipital-localized seizureTwo depth-studied patients had contralateral head and eye deviation while the seizure remained localized to the occipital lobe.PDF p.6, Results, Non-visual manifestations

Reported values

16 patients with ocular deviation within 10 secondsocular deviation within first 10 secondsCount · cited stereo-EEG occipital seizure series · seizure onsetPDF p.20, Discussion
14/16 patientstonic ocular deviation in cited stereo-EEG seriesProportion · n/N 14/16 · 16 cited patients with early ocular deviation · seizure onsetPDF p.20, Discussion
16/16 patientscontralateral ocular deviation in cited stereo-EEG seriesProportion · n/N 16/16 · 16 cited patients with early ocular deviation · seizure onsetPDF p.20, Discussion
29% of 55 patientscontraversive head and eye movement in Ludwig and Ajmone-MarsanPercentage · cited Ludwig and Ajmone-Marsan occipital epilepsy series · ictal manifestationPDF p.20, Discussion
2 casescontralateral head and eye deviation with occipital-localized seizureCount · n/N 2/2 · two depth-studied cohort patients · ictal onset and early evolutionPDF p.6, Results, Non-visual manifestations

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdfIndependent primary study · 2 findings · 1 reported value

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdf

Independent primary study · Class II · Evidence weight 5.28 · 2 × 1.35 × 1.957

Findings

head and eye deviationHead and eye deviation occurred in 41% of patients.PDF p.4, Results, Other seizure characteristics
adversive head and eye movement after parietal spreadThe source suggests that adversive head and eye movements may reflect spread from the superior parietal lobule to the frontal lobe.PDF p.10, Discussion

Reported values

41%head and eye deviationPercentage · 82-patient parietal epilepsy series · ictal motor or oculomotor phasePDF p.4, Results, Other seizure characteristics

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdfIndependent primary study · 6 findings · 1 reported value

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdf

Independent primary study · Class II · Evidence weight 4.92 · 2 × 1.5 × 1.639

Findings

tonic eye deviationTonic eye deviation occurred in 11 of 19 patients (57.9%).PDF p.5, Ictal Semiology and Seizure Capture During SEEG Monitoring; PDF p.9, Figure 1
visual aura to oculomotor to evolving motor phenotypePhenotype III progresses from visual aura to head-eye deviation or eye pursuit, then to contralateral limb tonic or asymmetric tonic posturing, with some seizures evolving to GTCS.PDF p.9, Phenotype III
visual aura to head-eye deviation or pursuitIn Phenotype III, a visual aura rapidly progresses to head-eye deviation or eye pursuit.PDF p.9, Phenotype III; PDF p.13, Phenotype III discussion
dorsal parietal to premotor motor evolutionThe authors link rapid motor evolution after visual aura to propagation to dorsal parietal nodes and then premotor areas.PDF p.13, Phenotype III discussion
head and eye deviation to the leftTable 2 records head and eye deviation to the left in a seizure that followed left-upper-limb tonic posturing.PDF p.6, Table 2 Case 1 Sz1
head-eye-body deviation to the rightTable 2 records head, eye, and body deviation to the right in Case 5.PDF p.6, Table 2 Case 5

Reported values

11/19 (57.9%) tonic eye deviationtonic eye deviationPercentage · n/N 11/19 · 19 patients monitored with SEEG · ictal oculomotor semiologyPDF p.5, Ictal Semiology and Seizure Capture During SEEG Monitoring; PDF p.9, Figure 1

wyllie1986.pdfStructured design not resolved · 4 findings · 45 reported values

wyllie1986.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1

Findings

ictal events preceding contraversive head and eye movementThirty-five of 61 versive seizures (57%) began with the versive movement; these were predominantly frontal-onset (91%) and none was temporal-onset, whereas the other versive seizures were preceded by quiet staring or staring with automatisms as detailed in Table 2.PDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
ipsiversion in Ochs and Robillard seriesThe current paper reports that Ochs et al. and Robillard et al. found ipsiversion in 50% and 48%, respectively, of seizures with head and eye turning and concluded that forced head turning at clinical seizure onset had no localizing or lateralizing value.PDF p.3, discussion paragraph comparing Ochs and Robillard; PDF p.5, references 31-32
ipsiversion in Ajmone Marsan and Abraham seriesThe current paper reports that Ajmone Marsan and Abraham found ipsiversion in 4 of 16 pentylenetetrazol-induced seizures with version and lateralized ictal EEG, but cautions that the seizures were selected to illustrate other electroclinical features and the 25% incidence may not have been representative.PDF p.4, paragraph beginning “Ajmone Marsan and Abraham”; PDF p.6, reference 39
ipsiversion in Ajmone Marsan and Ralston seriesThe current paper reports a 3% incidence of ipsiversion in a larger series of pentylenetetrazol-induced seizures by Ajmone Marsan and Ralston and suggests that this may have been a more accurate assessment than the 25% incidence in the selected Ajmone Marsan and Abraham series.PDF p.4, paragraph comparing the 3% and 25% incidences; PDF p.6, reference 38

Reported values

frontal all versive seizures: 37 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · frontal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
frontal preceded by staring with automatisms: 0 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · frontal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
total preceded by staring with automatisms: 14 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · total · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
frontal all versive seizures: 10 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · frontal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
frontal preceded by quiet staring: 5 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · frontal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
temporal preceded by quiet staring: 2 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · temporal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
parietal preceded by quiet staring: 1 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · parietal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
temporal preceded by quiet staring: 2 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · temporal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
occipital preceded by quiet staring: 0 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · occipital · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
occipital preceded by staring with automatisms: 0 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · occipital · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
total all versive seizures: 27 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · total · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
occipital preceded by staring with automatisms: 0 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · occipital · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
total all versive seizures: 61 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · total · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
total version at onset 35/61 (57%)ictal events preceding contraversive head and eye movementPercentage · n/N 35/61 · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · total · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
parietal no preceding ictal event; version at onset: 1 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · parietal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
temporal no preceding ictal event; version at onset: 0 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · temporal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
total no preceding ictal event; version at onset: 12 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · total · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
total preceded by quiet staring: 8 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · total · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
parietal preceded by staring with automatisms: 0 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · parietal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
total preceded by quiet staring: 8 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · total · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
occipital preceded by quiet staring: 0 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · occipital · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
parietal preceded by quiet staring: 1 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · parietal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
frontal no preceding ictal event; version at onset: 10 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · frontal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
frontal preceded by quiet staring: 5 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · frontal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
occipital no preceding ictal event; version at onset: 1 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · occipital · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
parietal no preceding ictal event; version at onset: 1 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · parietal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
total preceded by staring with automatisms: 18 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · total · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
temporal all versive seizures: 20 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · temporal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
parietal all versive seizures: 2 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · parietal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
parietal preceded by staring with automatisms: 0 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · parietal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
occipital all versive seizures: 1 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · occipital · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
occipital no preceding ictal event; version at onset: 2 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · occipital · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
parietal all versive seizures: 2 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · parietal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
temporal all versive seizures: 14 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · temporal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
frontal version at onset 32/37 (91%)ictal events preceding contraversive head and eye movementPercentage · n/N 32/37 · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · frontal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
temporal no preceding ictal event; version at onset: 0 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · temporal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
temporal preceded by staring with automatisms: 18 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · temporal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
frontal preceded by staring with automatisms: 0 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · frontal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
temporal preceded by staring with automatisms: 14 patientsictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · temporal · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
occipital all versive seizures: 2 seizuresictal events preceding contraversive head and eye movementCount · 27 patients; 61 versive seizures categorized by frontal, temporal, parietal, or occipital onset · occipital · Pre-contraversion ictal phase and onset of versive movementPDF p.2, Table 2; PDF p.2, paragraph beginning “Thirty-five (57%)”; PDF p.5, conclusion
50%ipsiversion in Ochs and Robillard seriesPercentage · Seizures with head and eye turning in the cited Ochs report; cohort details not reported here · Ochs et al. · Head turning at clinical seizure onsetPDF p.3, discussion paragraph comparing Ochs and Robillard; PDF p.5, references 31-32
48%ipsiversion in Ochs and Robillard seriesPercentage · Seizures with head and eye turning in the cited Robillard report; cohort details not reported here · Robillard et al. · Head turning at clinical seizure onsetPDF p.3, discussion paragraph comparing Ochs and Robillard; PDF p.5, references 31-32
Ipsiversion 4 of 16 seizures (25%)ipsiversion in Ajmone Marsan and Abraham seriesPercentage · n/N 4/16 · Pentylenetetrazol-induced seizures selected to illustrate other electroclinical features in the cited series · Ictal head and eye turningPDF p.4, paragraph beginning “Ajmone Marsan and Abraham”; PDF p.6, reference 39
Ipsiversion incidence 3% in larger cited seriesipsiversion in Ajmone Marsan and Ralston seriesPercentage · Larger pentylenetetrazol-induced seizure series cited by the current paper · Larger Ajmone Marsan and Ralston series · Ictal head and eye turningPDF p.4, paragraph comparing the 3% and 25% incidences; PDF p.6, reference 38
Ipsiversion incidence 4/16 (25%) in selected cited seriesipsiversion in Ajmone Marsan and Ralston seriesPercentage · n/N 4/16 · Larger pentylenetetrazol-induced seizure series cited by the current paper · Selected Ajmone Marsan and Abraham series · Ictal head and eye turningPDF p.4, paragraph comparing the 3% and 25% incidences; PDF p.6, reference 38

zhang-ipsiversive-ictal-eye-deviation-temporal-epilepsy-2017.pdfCase report or observation · 7 findings · 3 reported values

zhang-ipsiversive-ictal-eye-deviation-temporal-epilepsy-2017.pdf

Case report or observation · Class III · Evidence weight 1.50 · 1 × 1.5 × 1

Findings

Authors’ proposed MST/smooth-pursuit mechanism for ipsiversive deviationThe authors hypothesize that lateralization of eye deviation during temporo-occipital seizures depends on whether MST is involved initially or primarily; they state that seizures originating from or primarily involving posterior ITG or the anterior bank of AOS, identified as human MST, would probably induce initial ipsilateral conjugate eye deviation.PDF p.1, Abstract; PDF p.9, Discussion and Conclusion
Case-1 forced eye deviation and head turningIn the Case-1 habitual seizure chronology, forced eye deviation to the right was followed by right-sided head turning, left-leg tonic posturing, left version, and GTCS in the described sequence.PDF p.2, Case-1 case presentation; PDF p.2, Fig. 1 caption
Case-1 Fig. 5 initial eyes left versionThe Fig. 5 caption for a Case-1 first-implantation ictal SEEG trace states that seizure onset was on G’12-13 and L’12-13, exploring the posterior inferior temporal area, and that the initial eyes showed left version.PDF p.4, Fig. 5 caption
Case-2 forced right eye deviation with left motor signsIn Case-2, the reported habitual seizure chronology was eyes open and staring followed by forced deviation to the right, proximal left-arm tonic posturing with a clenched left fist, and left facial clonia in one seizure; the episodes included loss of consciousness.PDF p.5, Case-2 case presentation; PDF p.8-9, Discussion
Case-2 posterior inferior temporal/AOS ictal localization preceding ipsiversive eye deviationIn Case-2, the source states that ictal SEEG confirmed the putative lesion as epileptogenic and that the most posterior cortical part of the inferior temporal gyrus, occupying the anterior bank of AOS, was involved by ictal discharges within 5 s before the initial clinical sign, identified as the ipsilateral eye deviation.PDF p.5, Case-2 case presentation; PDF p.6, Case-2 SEEG results
Cited direct-stimulation association of posterior inferior temporal sulcus with ipsilateral eye deviationThe current report states that comparative studies found the vicinity of the posterior branch of the inferior temporal sulcus to be motion-sensitive and that direct stimulation of this area induces constant ipsilateral eye deviation.PDF p.2, Background
Cited Kaplan case with ipsiversive eye deviation and right temporo-occipital onsetThe authors state that the ipsiversive eye deviation with homodromous head turning in their cases is similar to the case reported by Kaplan and that the cited case’s epileptic seizure originated from the right temporo-occipital cortex.PDF p.9, Discussion

Reported values

left facial clonia occurred in 1 of 3 captured habitual seizuresCase-2 forced right eye deviation with left motor signsCount · n/N 1/3 · Case-2; three habitual seizures were captured on video-EEG, but the source does not state that every listed component occurred in all three · ictal onset and progressionPDF p.5, Case-2 case presentation; PDF p.8-9, Discussion
Qualitative semiologic sequenceCase-2 forced right eye deviation with left motor signsCount · n/N 1/3 · Case-2; three habitual seizures were captured on video-EEG, but the source does not state that every listed component occurred in all three · ictal onset and progressionPDF p.5, Case-2 case presentation; PDF p.8-9, Discussion
Ictal discharge involvement within 5 s before initial ipsilateral eye deviationCase-2 posterior inferior temporal/AOS ictal localization preceding ipsiversive eye deviationCount · Case-2 · ictal activity immediately before the initial clinical signPDF p.5, Case-2 case presentation; PDF p.6, Case-2 SEEG results

17 contributing manuscripts; source-reported values remain separate and are not pooled.

AuraReported: Left hemisphereAlso reported: Right hemisphereNo single reliable side16 manuscripts · 51 findings · 34 reported values

Weighted evidence supportevidence weight 34.55 across 16 manuscripts · 2 manuscript weight pending · 4 independent primary study · 2 systematic review or meta-analysis · 7 narrative, educational, or cited context · 2 structured design not resolved · 1 case report or observation

A right middle frontal gyrus lesion case had left-face/left-arm clonic spread and fencing posture, with semiology and ictal EEG interpreted as right frontocentral onset. The source explicitly reports a left temporal pole lesion; the right-ear siren is retained as an auditory-side description without a hemisphere inference. The source explicitly reports a left temporal-pole lesion for the patient with the the source's own stomach-turning aura description. The source explicitly reports a right temporal-pole lesion for the patient with the the source's own clicking-and-intense-fear aura description. The source explicitly reports a right temporal-pole lesion for the patient with the the source's own anxiety and deja-vu aura description. The source explicitly reports a right temporal-pole lesion for the patient with the the source's own tunnel-vision, nausea, and deja-vu aura description. The source explicitly reports a right temporal-pole lesion for the patient with the the source's own fear and indescribable-feeling aura description. The review describes selected auras as relatively specific for temporal-lobe epilepsy but generally lacking useful lateralizing value. The review reports that auras are more common with right temporal than bitemporal epilepsy and that viscerosensory or experiential auras trend toward right temporal association. The paper restates that auras, especially epigastric sensations, were more frequent before RTL than LTL seizures. The cited study reported no significant overall aura lateralization while experiential auras tended to occur more often in right temporal lobe seizures. The source text does not provide a hemisphere direction, but the prefilled lateralization value says right. The review says auras may provide lateralizing information but reports no specific lateralizing direction here. No side direction is reported for auras in aggregate. No seizure lateralization is reported. No lateralizing direction is reported for ability to warn at seizure onset. No source-supported hemispheric or body-side lateralization is reported. No lateralizing direction is reported for the aura comparison. No lateralizing direction is reported for the aura count. No cerebral hemisphere or body-side direction is reported. No source-supported lateralizing direction is reported for the frontal-subgroup auras. No lateralizing direction is reported.

Source-defined result groups 8

Localization: ParietalObserved proportion 72.2%All reported · patients1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 41.7%12 patients with EZ in the prefrontal operculum · precentral Rolandic operculum group (N=9) · patients in the prefrontal operculum group1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 66.7%All reported · prefrontal operculum versus precentral Rolandic operculum · all included patients1 manuscript · 1 reported value · not pooled

Localization: OFC-involving epileptogenic zone / orbitofrontal cortex (OFC)Source-defined values retained separatelyEntire OFC-involving group · patients with aura1 manuscript · 1 reported value · not pooled

Localization: ParietalObserved proportion 93.9%All reported · no aura · patients1 manuscript · 1 reported value · not pooled

Localization: OFC-restricted epileptogenic zone / orbitofrontal cortex (OFC)Observed proportion 19.2%OFC-restricted EZN group · patients with aura1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 100.0%9 patients with EZ in the precentral Rolandic operculum · prefrontal operculum group (N=12) · patients in the precentral Rolandic operculum group1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 16

Alphabetical by manuscript.

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfStructured design not resolved · 3 findings · 3 reported values

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.389

Findings

typical anterior auraAuras were reported in three of six typical anterior cases.PDF p.3, Clinical Presentation
posterior cingulate auraAuras were reported in all four posterior cingulate patients.PDF p.5, Posterior Cingulate Epilepsy
posterior cingulate multiple aurasTwo posterior cingulate patients had multiple auras.PDF p.5, Clinical Presentation

Reported values

3/6 (50%) with auratypical anterior auraPercentage · n/N 3/6 · 6 typical anterior cingulate cases · auraPDF p.3, Clinical Presentation
4/4 (100%) with auraposterior cingulate auraPercentage · n/N 4/4 · 4 posterior cingulate cases · auraPDF p.5, Posterior Cingulate Epilepsy
2/4 with multiple aurasposterior cingulate multiple aurasProportion · n/N 2/4 · 4 posterior cingulate cases · auraPDF p.5, Clinical Presentation

asadollahi-drug-resistant-parietal-lobe-epilepsy-clinical-manifestations-surgery-outcome-2017.pdfIndependent primary study · 8 findings · 8 reported values

asadollahi-drug-resistant-parietal-lobe-epilepsy-clinical-manifestations-surgery-outcome-2017.pdf

Independent primary study · Class II · Evidence weight 3.91 · 2 × 1.2 × 1.628

Findings

aurasThirteen of 18 patients described auras.PDF p.1, Abstract; PDF p.2, Results; PDF p.4, Discussion
Bartolomei et al. 2011 auraTable 1 reports 82% aura in the cited Bartolomei et al. 2011 cohort.PDF p.3, Table 1
Salanova et al. 1995a auraTable 1 reports 94% aura in the cited Salanova et al. 1995a cohort.PDF p.3, Table 1
Salanova et al. 1995b auraTable 1 reports 79% aura in the cited Salanova et al. 1995b cohort.PDF p.3, Table 1
Kim et al. 2004b auraTable 1 reports 67.5% aura in the cited Kim et al. 2004b cohort.PDF p.3, Table 1
Kim et al. 2004a auraTable 1 reports 78.9% aura in the cited Kim et al. 2004a cohort.PDF p.3, Table 1
Francione et al. 2015 auraTable 1 reports 80% aura in the cited Francione et al. 2015 cohort.PDF p.3, Table 1
Asadollahi et al. 2017 (this study) auraTable 1 reports 72% aura in the cited Asadollahi et al. 2017 (this study) cohort.PDF p.3, Table 1

Reported values

13/18 (72%) patients with aurasaurasPercentage · n/N 13/18 · 18-patient drug-resistant parietal lobe epilepsy cohort · preoperative ictal symptom historyPDF p.1, Abstract; PDF p.2, Results; PDF p.4, Discussion
82% auraBartolomei et al. 2011 auraPercentage · Bartolomei et al. 2011 cohort · auraPDF p.3, Table 1
94% auraSalanova et al. 1995a auraPercentage · Salanova et al. 1995a cohort · auraPDF p.3, Table 1
79% auraSalanova et al. 1995b auraPercentage · Salanova et al. 1995b cohort · auraPDF p.3, Table 1
67.5% auraKim et al. 2004b auraPercentage · Kim et al. 2004b cohort · auraPDF p.3, Table 1
78.9% auraKim et al. 2004a auraPercentage · Kim et al. 2004a cohort · auraPDF p.3, Table 1
80% auraFrancione et al. 2015 auraPercentage · Francione et al. 2015 cohort · auraPDF p.3, Table 1
72% auraAsadollahi et al. 2017 (this study) auraPercentage · Asadollahi et al. 2017 (this study) cohort · auraPDF p.3, Table 1

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 2 findings · 4 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 5.86 · 2 × 1.5 × 1.952

Findings

auraAuras of varying types were reported in 71 of 80 analyzed seizures (88.7%).PDF p.5, Seizure clinical semiology
ability to warn at seizure onset auraThe ability to warn at seizure onset was more frequent in TL than T+ seizures.PDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.8, Ability to warn at seizure onset

Reported values

71/80 seizures (88.7%) with an auraauraPercentage · n/N 71/80 · 80 analyzed seizures, one typical seizure per patient · ictal onsetPDF p.5, Seizure clinical semiology
T+ 43.5%ability to warn at seizure onset auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.8, Ability to warn at seizure onset
TL 78%ability to warn at seizure onset auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.8, Ability to warn at seizure onset
P=0.003ability to warn at seizure onset auraP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictal onsetPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.8, Ability to warn at seizure onset

blair-temporal-lobe-epilepsy-semiology-2012.pdfNarrative, educational, or cited context · 3 findings · 1 reported value

blair-temporal-lobe-epilepsy-semiology-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Aura phenomena and localizing versus lateralizing valueThe review reports that rising epigastric sensation, fear, déjà vu, jamais vu, visceral or auditory illusions, complex auditory or visual hallucinations, gustatory or olfactory hallucinations, and elementary auditory hallucinations may correlate with temporal-lobe seizure onset or be relatively specific for TLE, while auras often have localizing value but usually lack lateralizing significance.PDF p.1, abstract; PDF p.2, section 2.2 Aura
Aura occurrence and durationAuras are described as simple partial seizures that can occur in isolation, occur in the majority of patients at the onset of a CPS, and can last from seconds to 1–2 minutes before consciousness is lost.PDF p.1, abstract; PDF p.2, section 2.2 Aura
Aura as spread pattern versus seizure-onset markerThe review states that reciprocal mesial and neocortical temporal connections may be activated to produce an aura and suggests that aura type may indicate the pattern of seizure spread more than the site of seizure onset.PDF p.3, final paragraph of section 3

Reported values

seconds to 1–2 minutesAura occurrence and durationRange · Patients with TLE or CPSs as discussed by the review; no single cohort reported. · Pre-consciousness ictal onsetPDF p.1, abstract; PDF p.2, section 2.2 Aura

chassoux-ictal-semiology-anterior-cingulate-epilepsy-systematic-review-2025.pdfSystematic review or meta-analysis · 4 findings · 2 reported values

chassoux-ictal-semiology-anterior-cingulate-epilepsy-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

auraThe source reports a frequency of 58% for aura.PDF p.13, Table 3
aura; reported frequency rangeThe source reports a frequency range of 0–96% for aura.PDF p.13, Table 3
aura; ACC association gradeTable 3 assigns the source's High overall association grade to aura.PDF p.13, Table 3
aura; Figure 4 rateFigure 4 displays a 58.1% rate for aura.PDF p.10, Figure 4

Reported values

58% (frequency range 0–96%)auraPercentage · Reviewed ACC seizure cases with reported semiology · ictal onsetPDF p.13, Table 3
58.1%aura; Figure 4 ratePercentage · Reviewed ACC seizure cases with reported semiology · ictal onsetPDF p.10, Figure 4

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfCase report or observation · 1 finding

chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

aura; behavioural arrest; left-face clonic activity; fencing postureIn an illustrative 50-year-old man with a right middle frontal gyrus cystic lesion, a seizure evolved from an aura to behavioural arrest, left-face clonic movements spreading over the left arm, and left-arm extension in a fencing posture before secondary generalisation; the authors state that the semiology and ictal EEG supported right frontocentral onset.PDF p.3, Video case 1 and Figure 1; PDF p.3, Figure 2 caption

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdfNarrative, educational, or cited context · 9 findings · 8 reported values

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.58 · 1 × 0.9 × 1.759

Findings

OFC + group (EZN extending beyond OFC); aura; oro-alimentary automatisms; gestural automatismsThe source characterizes EZN extending beyond the OFC as having richer semiological profiles, with temporal extension more often associated with aura, oro-alimentary automatisms, and sleep.PDF p.6, Semiological profile; PDF p.7, Conclusion
aura; OFC-extended EZNAuras were reported in 11 of 33 OFC-extended cases.PDF p.3, Aura
aura; OFC-restricted EZNAuras were reported in five of 26 OFC-restricted cases.PDF p.3, Aura
aura; entire OFC-involving groupAcross the entire 87-case group, aura was documented in 30% of cases.PDF p.3, Aura
aura; Chibane cited cohortChibane et al. were reported as having a 43.8% aura prevalence in their cohort.PDF p.3, Aura
aura; temporal OFC-extended subgroupAuras were reported in 58% of the temporal subgroup of OFC-extended cases.PDF p.3, Aura
aura; frontal OFC-extended subgroupAuras were reported in 18% of the frontal subgroup of OFC-extended cases.PDF p.3, Aura
aura; insular OFC-extended subgroupTwo patients in the insular subgroup had reported auras.PDF p.3, Aura
aura; frontal OFC-extended subgroupTwo patients in the frontal subgroup had reported auras.PDF p.3, Aura

Reported values

11/33 (33%)aura; OFC-extended EZNPercentage · n/N 11/33 · OFC-extended EZN group · OFC-extended EZN group · ictal auraPDF p.3, Aura
5/26 (19%)aura; OFC-restricted EZNPercentage · n/N 5/26 · OFC-restricted EZN group · OFC-restricted EZN group · ictal auraPDF p.3, Aura
30%aura; entire OFC-involving groupPercentage · Entire OFC-involving group · Entire OFC-involving group · ictal auraPDF p.3, Aura
43.8%aura; Chibane cited cohortPercentage · Chibane cited cohort · Chibane cited cohort · ictal auraPDF p.3, Aura
58%aura; temporal OFC-extended subgroupPercentage · Temporal subgroup of OFC-extended EZN · Temporal subgroup of OFC-extended EZN · ictal auraPDF p.3, Aura
18%aura; frontal OFC-extended subgroupPercentage · Frontal subgroup of OFC-extended EZN · Frontal subgroup of OFC-extended EZN · ictal auraPDF p.3, Aura
2 patientsaura; insular OFC-extended subgroupCount · n/N 2/10 · Insular subgroup of OFC-extended EZN · Insular subgroup of OFC-extended EZN · ictal auraPDF p.3, Aura
2 patientsaura; frontal OFC-extended subgroupCount · n/N 2/11 · Frontal subgroup of OFC-extended EZN · Frontal subgroup of OFC-extended EZN · ictal auraPDF p.3, Aura

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdfNarrative, educational, or cited context · 2 findings

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Aura lateralization in cited studiesThe current paper states that its finding of more frequent auras, especially epigastric sensations, before RTL seizures concurred with Gupta et al. (1983) and Taylor and Lochery (1987).PDF p.5, Discussion, aura paragraph
Aura lateralization in a cited study with null resultThe current paper reports that Palmini and Gloor (1992) did not detect a statistically significant lateralizing value for auras, although experiential auras with complex visual and auditory hallucinations tended to originate more frequently in RTL.PDF p.5, Discussion, aura paragraph

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 1 finding

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

aurasAs first ictal symptoms, auras provide important localizing and lateralizing information about the relationship between the symptomatogenic and epileptogenic zones. They are reported by most patients with temporal and parieto-occipital epilepsies, are associated with favorable outcome after temporal lobectomy, and were reported to localize the most likely lobe of origin as well as EEG and imaging.PDF p.2, section 3.1 Auras; PDF p.2, Table 1

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdfSystematic review or meta-analysis · 5 findings · 3 reported values

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

aura; unique type of sensationIn the included patients, auras were described as mostly a unique type of sensation rather than mixed symptoms.PDF p.6, Anatomical and clinical correlations
AuraTable 2 reports 14/21 (67%) for Aura; timing is onset, and the source's overall agreement that the sign is suggestive of fronto-opercular epilepsy is graded High.PDF p.7, Table 2
AuraTable 2 reports 5/12 patients with Aura in the prefrontal operculum group.PDF p.7, Table 2
AuraTable 2 reports 9/9 patients with Aura in the precentral Rolandic operculum group.PDF p.7, Table 2
AuraFisher's exact comparison of Aura between the prefrontal and precentral Rolandic operculum groups has p=0.007.PDF p.7, Table 2

Reported values

14/21 (67%)AuraPercentage · n/N 14/21 · 21 included fronto-opercular epilepsy patients · OnsetPDF p.7, Table 2
5/12 patientsAuraProportion · n/N 5/12 · 12 patients with EZ in the prefrontal operculum · 12 patients with EZ in the prefrontal operculum · OnsetPDF p.7, Table 2
9/9 patientsAuraProportion · n/N 9/9 · 9 patients with EZ in the precentral Rolandic operculum · 9 patients with EZ in the precentral Rolandic operculum · OnsetPDF p.7, Table 2

jobst-insula-and-its-epilepsies-2019.pdfNarrative, educational, or cited context · 1 finding

jobst-insula-and-its-epilepsies-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

auras not visible on videoMost auras in insular seizures cannot be appreciated on video.PDF p.3, Video EEG

luders-semiological-seizure-classification-1998.pdfNarrative, educational, or cited context · 1 finding

luders-semiological-seizure-classification-1998.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

AuraAuras consist exclusively of subjective ictal symptoms, usually occur at the beginning of a seizure, are generally brief, and may occur in isolation; their epileptic nature can be documented objectively when they consistently evolve into a dialeptic or motor seizure or when EEG monitoring shows an EEG seizure pattern during the aura.PDF p.2, Auras; PDF p.3, Auras

misulis-sonmezturk-ess-abou-khalil-atlas-eeg-seizure-semiology-management-3e-2022.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

misulis-sonmezturk-ess-abou-khalil-atlas-eeg-seizure-semiology-management-3e-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

temporal aurasIn a selected group with proven mesial temporal origin, more than 90% of patients reported an aura; auras were more common with right than bitemporal epilepsy, epigastric aura was most common, and viscerosensory or experiential auras strongly supported temporal involvement with a trend toward right temporal association, whereas absent aura was more common with bitemporal epilepsy.PDF p.49

Reported values

>90% reported aura in the selected proven mesial temporal grouptemporal aurasPercentage · selected patients with proven mesial temporal origin and broader temporal lobe epilepsy teaching groups · preictal and early ictal auraPDF p.49

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdfIndependent primary study · 1 finding · 1 reported value

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdf

Independent primary study · Class II · Evidence weight 5.28 · 2 × 1.35 × 1.957

Findings

presence of auraeAurae were present in 77 of 82 patients.PDF p.3, Results, Aurae; PDF p.4, Table 1

Reported values

77/82 (94%) patientspresence of auraePercentage · n/N 77/82 · 82 patients with nontumoural parietal lobe epilepsy treated surgically · aura or seizure onsetPDF p.3, Results, Aurae; PDF p.4, Table 1

wang-hypermotor-seizures-temporal-pole-lesions-2008.pdfStructured design not resolved · 8 findings · 2 reported values

wang-hypermotor-seizures-temporal-pole-lesions-2008.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1

Findings

patient 2 auraTable 1 reports patient 2 with the the source's own aura description: hears a siren in the right ear.PDF p.3, Table 1
patient 3 auraTable 1 reports patient 3 with the the source's own aura description: funny feeling in stomach, like stomach is turning in circles.PDF p.3, Table 1
patient 4 auraTable 1 reports patient 4 with the the source's own aura description: something clicks in mind and intense fear.PDF p.3, Table 1
patient 5 auraTable 1 reports patient 5 with the the source's own aura description: anxiety; deja-vu.PDF p.3, Table 1
patient 7 auraTable 1 reports patient 7 with the the source's own aura description: tunnel vision, nausea and deja vu.PDF p.3, Table 1
patient 8 auraTable 1 reports patient 8 with the the source's own aura description: fear; indescribable feeling (rare).PDF p.3, Table 1
auras in temporal pole lesion cohortSix of eight patients reported an aura before seizures.PDF p.2, Results
auras among hypermotor patientsTwo of four patients with hypermotor seizures reported auras.PDF p.4, Seizure semiology on video-EEG recording

Reported values

6/8 patients with auraauras in temporal pole lesion cohortProportion · n/N 6/8 · 8-patient temporal pole lesion cohort · preoperative auraPDF p.2, Results
2/4 hypermotor patients with auraauras among hypermotor patientsProportion · n/N 2/4 · 4 patients with hypermotor seizure semiology · auraPDF p.4, Seizure semiology on video-EEG recording

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdfIndependent primary study · 1 finding · 1 reported value

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdf

Independent primary study · Class II · Evidence weight 4.92 · 2 × 1.5 × 1.639

Findings

ictal aurasAuras occurred in 10 of 19 patients (52.6%).PDF p.5, Ictal Semiology and Seizure Capture During SEEG Monitoring; PDF p.9, Figure 1

Reported values

10/19 (52.6%) aurasictal aurasPercentage · n/N 10/19 · 19 patients monitored with SEEG · aura/ictal semiologyPDF p.5, Ictal Semiology and Seizure Capture During SEEG Monitoring; PDF p.9, Figure 1

16 contributing manuscripts; source-reported values remain separate and are not pooled.

Ictal impaired awarenessReported: Left hemisphereAlso reported: Non-dominant hemisphereAlso reported: Right hemisphere14 manuscripts · 58 findings · 46 reported values

Weighted evidence supportevidence weight 34.12 across 14 manuscripts · 4 independent primary study · 6 narrative, educational, or cited context · 4 systematic review or meta-analysis

The cited study reports greater impairment with bitemporal or left-temporal seizures and more preserved consciousness with nondominant-temporal seizures. Whole-course loss of contact occurred in 74% of left and 62% of right temporal seizures, with no statistically significant side difference. Initial loss of contact occurred in 28% of left and 19% of right temporal seizures, without a statistically significant side difference. The narrative reports impaired consciousness during propagation without any left/right hemisphere direction. The 35% impaired-consciousness narrative reports no hemisphere or body-side direction. No hemisphere or body-side direction is reported. The temporal lobe distribution estimate for dialeptic/LOA semiology contains no hemisphere or body-side direction. The frontal lobe distribution estimate for dialeptic/LOA semiology contains no hemisphere or body-side direction. The occipital lobe distribution estimate for dialeptic/LOA semiology contains no hemisphere or body-side direction. The parietal lobe distribution estimate for dialeptic/LOA semiology contains no hemisphere or body-side direction. The cited network-coupling summary reports no hemisphere or body-side direction. The alternate-source summary reports no hemisphere or body-side association for impaired consciousness. The alternate-source synchrony summary provides no hemisphere or body-side direction. The cited study summary reports no side or hemisphere association. No hemisphere or body-side association is reported. Wake versus sleep/stupor at seizure onset provides no hemisphere or body-side direction.

Source-defined result groups 26

Localization: hypothalamusSource-defined values retained separatelyregional localization distribution · localizing data point1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelybasal temporal localization relative to all other semiologies · localizing data point1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 53.8%L · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 38.1%All reported · prefrontal operculum versus precentral Rolandic operculum · all included patients1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelytemporal localization given LOA/dialeptic semiology · localizing data point1 manuscript · 1 reported value · not pooled

Localization: cingulateSource-defined values retained separatelycingulate localization · localizing data point1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 70.8%M · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: OccipitalSource-defined values retained separatelyoccipital localization relative to all other semiologies · localizing data point1 manuscript · 1 reported value · not pooled

Localization: OFC-restricted EZNObserved proportion 23.1%OFC-restricted EZN cases · patients1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Right hemisphereSource-defined values retained separatelyleft temporal lobe · right temporal lobe · seizure; exact denominator not reported1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 41.0%combined set-of-semiology · Initial semiology versus combined set-of-semiology · individual1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 69.2%L · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Right hemisphereSource-defined values retained separatelyleft temporal lobe · seizure; exact source unit not further specified1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyposterior temporal localization relative to all other semiologies · localizing data point1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 72.2%ML · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyregional localization distribution · localizing data point1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Right hemisphereSource-defined values retained separatelyright temporal lobe · left temporal lobe · seizure; exact denominator not reported1 manuscript · 1 reported value · not pooled

Localization: OccipitalSource-defined values retained separatelyregional localization distribution · localizing data point1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Right hemisphereSource-defined values retained separatelyright temporal lobe · seizure; exact source unit not further specified1 manuscript · 1 reported value · not pooled

Localization: FrontalSource-defined values retained separatelyfrontal localization given LOA/dialeptic semiology · localizing data point1 manuscript · 1 reported value · not pooled

Localization: ParietalSource-defined values retained separatelyregional localization distribution · localizing data point1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 0.0%M · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 19.7%initial semiology · Initial semiology versus combined set-of-semiology · individual1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 38.9%ML · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 14

Alphabetical by manuscript.

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdfSystematic review or meta-analysis · 29 findings · 15 reported values

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

dialeptic-LOA-LOCTable 1 defines or exemplifies the the source's own semiology category “dialeptic-LOA-LOC” as Blank stare, loss of awareness, loss of contact, psychomotor arrest, distant gaze, dreamy state, loss of consciousness excluding generalized seizures, or dyscognitive states.PDF p.7, Table 1 Semiology descriptions and frequencies
dialeptic-LOA-LOCDialeptic-LOA-LOC comprised 8.3% of non-topological data.PDF p.7, Table 1 Semiology descriptions and frequencies
dialeptic/LOA; Figure 3 all-data subsetFigure 3 reports N = 753 for the all-data dialeptic/LOA panel.PDF p.9, Figure 3 and caption
dialeptic/LOA; Figure 3 non-topological subsetFigure 3 reports N = 291 for the non-topological dialeptic/LOA panel.PDF p.9, Figure 3 and caption
dialeptic/LOA; temporal lobeLoss-of-awareness/dialeptic semiology was temporal in origin in 42%.PDF p.8, Seizure semiology localizing values
dialeptic/LOA; temporal lobeThe 95% CI for dialeptic/LOA; temporal lobe was 36%–49%.PDF p.8, Seizure semiology localizing values
dialeptic/LOA; frontal lobeLoss-of-awareness/dialeptic semiology was frontal in origin in 28%.PDF p.8, Seizure semiology localizing values
dialeptic/LOA; frontal lobeThe 95% CI for dialeptic/LOA; frontal lobe was 23%–34%.PDF p.8, Seizure semiology localizing values
dialeptic/LOA; cingulatedialeptic/LOA semiology was cingulate in 3%.PDF p.8, Seizure semiology localizing values
dialeptic/LOA; cingulateThe 95% CI for dialeptic/LOA; cingulate was 1%–4%.PDF p.8, Seizure semiology localizing values
loss of awareness; occipital lobeLoss of awareness had an intrinsic localizing OR of 2.9 for occipital localization.PDF p.8, Relative localizing values of semiologies
loss of awareness; occipital lobeThe 95% CI for loss of awareness; occipital lobe was 1.8–4.6.PDF p.8, Relative localizing values of semiologies
loss of awareness; posterior temporalLoss of awareness had an intrinsic localizing OR of 2.0 for posterior temporal localization.PDF p.8, Relative localizing values of semiologies
loss of awareness; posterior temporalThe 95% CI for loss of awareness; posterior temporal was 1.0–3.6.PDF p.8, Relative localizing values of semiologies
loss of awareness; basal temporalLoss of awareness had an intrinsic localizing OR of 5.8 for basal temporal localization.PDF p.8, Relative localizing values of semiologies
loss of awareness; basal temporalThe 95% CI for loss of awareness; basal temporal was 2.4–14.3.PDF p.8, Relative localizing values of semiologies
dialeptic/LOA; occipital lobedialeptic/LOA localizing distribution included occipital lobe at 9%.PDF p.12, Relative localizing values; PDF p.12, Discussion
dialeptic/LOA; occipital lobeThe 95% CI for the occipital lobe dialeptic/LOA distribution was 6%–11%.PDF p.12, Relative localizing values; PDF p.12, Discussion
dialeptic/LOA; parietal lobedialeptic/LOA localizing distribution included parietal lobe at 8%.PDF p.12, Relative localizing values; PDF p.12, Discussion
dialeptic/LOA; parietal lobeThe 95% CI for the parietal lobe dialeptic/LOA distribution was 5%–11%.PDF p.12, Relative localizing values; PDF p.12, Discussion
dialeptic/LOA; hypothalamusdialeptic/LOA localizing distribution included hypothalamus at 8%.PDF p.12, Relative localizing values; PDF p.12, Discussion
dialeptic/LOA; hypothalamusThe 95% CI for the hypothalamus dialeptic/LOA distribution was 5%–10%.PDF p.12, Relative localizing values; PDF p.12, Discussion
dialeptic/LOA; cingulatedialeptic/LOA localizing distribution included cingulate at under 5%.PDF p.12, Relative localizing values; PDF p.12, Discussion
dialeptic/LOA; cingulateThe 95% CI for the cingulate dialeptic/LOA distribution was 1%–4%.PDF p.12, Relative localizing values; PDF p.12, Discussion
dialeptic/LOA; insuladialeptic/LOA localizing distribution included insula at under 5%.PDF p.12, Relative localizing values; PDF p.12, Discussion
dialeptic/LOA; insulaThe 95% CI for the insula dialeptic/LOA distribution was 1%–4%.PDF p.12, Relative localizing values; PDF p.12, Discussion
dialeptic/LOA; temporal cited resultA cited study is restated as reporting 35% of cases with dialeptic/altered-consciousness seizures involving the temporal region.PDF p.12, Localizing probabilities
dialeptic/LOA; frontal cited resultA cited study is restated as reporting 16% of cases with dialeptic/altered-consciousness seizures involving the frontal region.PDF p.12, Localizing probabilities
dialeptic/LOA; parieto-occipital cited resultA cited study is restated as reporting 5% of cases with dialeptic/altered-consciousness seizures involving the parieto-occipital region.PDF p.12, Localizing probabilities

Reported values

dialeptic-LOA-LOC 8.3%dialeptic-LOA-LOCPercentage · non-topological Semio2Brain dataPDF p.7, Table 1 Semiology descriptions and frequencies
dialeptic/LOA; temporal lobe 42%dialeptic/LOA; temporal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
dialeptic/LOA; frontal lobe 28%dialeptic/LOA; frontal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
dialeptic/LOA; cingulate 3%dialeptic/LOA; cingulatePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
OR 2.9loss of awareness; occipital lobeOdds ratio · non-topological Semio2Brain data unless otherwise statedPDF p.8, Relative localizing values of semiologies
OR 2.0loss of awareness; posterior temporalOdds ratio · non-topological Semio2Brain data unless otherwise statedPDF p.8, Relative localizing values of semiologies
OR 5.8loss of awareness; basal temporalOdds ratio · non-topological Semio2Brain data unless otherwise statedPDF p.8, Relative localizing values of semiologies
dialeptic/LOA; occipital lobe 9%dialeptic/LOA; occipital lobePercentage · dialeptic/LOA localizing dataPDF p.12, Relative localizing values; PDF p.12, Discussion
dialeptic/LOA; parietal lobe 8%dialeptic/LOA; parietal lobePercentage · dialeptic/LOA localizing dataPDF p.12, Relative localizing values; PDF p.12, Discussion
dialeptic/LOA; hypothalamus 8%dialeptic/LOA; hypothalamusPercentage · dialeptic/LOA localizing dataPDF p.12, Relative localizing values; PDF p.12, Discussion
dialeptic/LOA; cingulate under 5%dialeptic/LOA; cingulatePercentage · dialeptic/LOA localizing dataPDF p.12, Relative localizing values; PDF p.12, Discussion
dialeptic/LOA; insula under 5%dialeptic/LOA; insulaPercentage · dialeptic/LOA localizing dataPDF p.12, Relative localizing values; PDF p.12, Discussion
temporal localization 35%dialeptic/LOA; temporal cited resultPercentage · cited altered-consciousness seizure cohortPDF p.12, Localizing probabilities
frontal localization 16%dialeptic/LOA; frontal cited resultPercentage · cited altered-consciousness seizure cohortPDF p.12, Localizing probabilities
parieto-occipital localization 5%dialeptic/LOA; parieto-occipital cited resultPercentage · cited altered-consciousness seizure cohortPDF p.12, Localizing probabilities

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfNarrative, educational, or cited context · 1 finding

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

loss of contact during temporal lobe seizuresThe source reports a previous suggestion that loss of contact in TL epilepsy is a consequence of discharge extending outside the temporal lobe.PDF p.8, Ability to warn at seizure onset

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfSystematic review or meta-analysis · 1 finding · 1 reported value

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

Loss of awareness (Table 4)In the 60 high/very-high-confidence cases, Table 4 reports loss of awareness in 27 cases (45%).PDF p.7, Table 4

Reported values

27/60 (45%)Loss of awareness (Table 4)Percentage · n/N 27/60 · 60 basal temporal seizure cases with high or very-high EZ confidence · ictalPDF p.7, Table 4

chauvel-mcgonigal-emergence-semiology-epileptic-seizures-2014.pdfNarrative, educational, or cited context · 1 finding

chauvel-mcgonigal-emergence-semiology-epileptic-seizures-2014.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

impaired consciousness and long-distance synchronizationIn temporal seizures, impairment of consciousness is not constant and may appear at different times depending on spread; a cited quantification study found synchronization indices for extra-temporal interactions significantly increased in seizures with loss of consciousness compared with seizures without loss, only from the middle of the seizure to its end, involving posterior supra-sylvian areas and posterior thalamus (pulvinar).PDF p.6, section 7

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdfNarrative, educational, or cited context · 3 findings · 1 reported value

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.54 · 1 × 0.9 × 1.707

Findings

impairment of consciousnessIn the source's application of the proposed ILAE framework, impairment of consciousness is treated as a major criterion for classifying focal seizures.PDF p.2, Semiology patterns of seizures with EZN restricted to the OFC
impairment of consciousness; focal seizure classificationSix restricted-OFC cases met the source's impairment-of-consciousness criterion.PDF p.2, Semiology patterns of seizures with EZN restricted to the OFC
impairment of consciousness; unspecifiedFor 20 restricted-OFC cases, the authors did not specify whether the impairment-of-consciousness criterion was met.PDF p.2, Semiology patterns of seizures with EZN restricted to the OFC

Reported values

6/26 patientsimpairment of consciousness; focal seizure classificationCount · n/N 6/26 · OFC-restricted EZN cases · OFC-restricted EZN cases · ictalPDF p.2, Semiology patterns of seizures with EZN restricted to the OFC

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdfSystematic review or meta-analysis · 6 findings · 4 reported values

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

impaired consciousness during seizure propagationDuring seizure propagation, impaired consciousness was observed in three patients.PDF p.6, Anatomical and clinical correlations
impaired consciousness during seizure propagationDuring seizure propagation, the source reports impaired consciousness in 35% of patients.PDF p.6, Anatomical and clinical correlations
Impaired consciousnessTable 2 reports 8/21 (38%) for Impaired consciousness; timing is late, and the source's overall agreement that the sign is suggestive of fronto-opercular epilepsy is graded Low.PDF p.7, Table 2
Impaired consciousnessTable 2 reports 4/12 patients with Impaired consciousness in the prefrontal operculum group.PDF p.7, Table 2
Impaired consciousnessTable 2 reports 4/9 patients with Impaired consciousness in the precentral Rolandic operculum group.PDF p.7, Table 2
Impaired consciousnessFisher's exact comparison of Impaired consciousness between the prefrontal and precentral Rolandic operculum groups has p=0.673.PDF p.7, Table 2

Reported values

3 patients (35%)impaired consciousness during seizure propagationPercentage · Included fronto-opercular epilepsy patients with propagation data · Included fronto-opercular epilepsy patients with propagation data · ictal propagationPDF p.6, Anatomical and clinical correlations
8/21 (38%)Impaired consciousnessPercentage · n/N 8/21 · 21 included fronto-opercular epilepsy patients · LatePDF p.7, Table 2
4/12 patientsImpaired consciousnessProportion · n/N 4/12 · 12 patients with EZ in the prefrontal operculum · 12 patients with EZ in the prefrontal operculum · LatePDF p.7, Table 2
4/9 patientsImpaired consciousnessProportion · n/N 4/9 · 9 patients with EZ in the precentral Rolandic operculum · 9 patients with EZ in the precentral Rolandic operculum · LatePDF p.7, Table 2

jobst-insula-and-its-epilepsies-2019.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

jobst-insula-and-its-epilepsies-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

loss of awareness in MORTEMUS insular near-SUDEP casesBoth MORTEMUS insular near-SUDEP cases had loss of awareness during the associated seizures.PDF p.8, Is SUDEP Risk Increased in Insular Epilepsy?

Reported values

loss of awareness in both casesloss of awareness in MORTEMUS insular near-SUDEP casesProportion · n/N 2/2 · 2 MORTEMUS insular near-SUDEP cases · ictal/peri-ictal periodPDF p.8, Is SUDEP Risk Increased in Insular Epilepsy?

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdfIndependent primary study · 1 finding · 2 reported values

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdf

Independent primary study · Class II · Evidence weight 5.11 · 2 × 1.35 × 1.893

Findings

Impaired awarenessImpaired awareness was the most common initial semiology, occurring in 12/61 individuals (20%), and occurred in 25/61 (41%) in the combined set-of-semiology.PDF p.3, Results; PDF p.5, Table 2

Reported values

Initial 12/61 (20%)Impaired awarenessPercentage · n/N 12/61 · 61 individuals undergoing frontal lobe epilepsy surgery · initial semiology · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.3, Results; PDF p.5, Table 2
Combined 25/61 (41%)Impaired awarenessPercentage · n/N 25/61 · 61 individuals undergoing frontal lobe epilepsy surgery · combined set-of-semiology · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.3, Results; PDF p.5, Table 2

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 1 finding

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Impaired or spared consciousnessA further cited study found consciousness was most commonly impaired in bitemporal or left temporal seizures and more frequently spared in non-dominant temporal lobe seizures.PDF p.3, section 1.3

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdfIndependent primary study · 5 findings · 11 reported values

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdf

Independent primary study · Class II · Evidence weight 5.07 · 2 × 1.5 × 1.69

Findings

ictal loss of contact by temporal sideAcross the whole seizure course, loss of contact occurred in 74% of left and 62% of right temporal lobe seizures, without statistical significance.PDF p.6, General ictal characteristics
initial loss of contact by temporal sideInitial loss of contact occurred in 28% of left and 19% of right temporal seizures without a statistically significant side difference, regardless of seizure subtype.PDF p.6, Early features
initial or secondary loss of contactWhen loss of contact was counted regardless of timing, its frequency did not differ across M, ML, and L groups.PDF p.6, Table 3; PDF p.6, General ictal characteristics
initial loss of contactLoss of contact during the first 10 seconds was more frequent in L and ML than M patients, and the authors interpret initial loss of contact as reflecting early temporal-neocortical involvement in pure L or ML networks.PDF p.6, Table 4; PDF p.6, Early features; PDF p.8, Initial loss of contact
late loss of contact in MTLSThe discussion reports that late loss of contact in medial temporal lobe seizures was frequent, had a mean delay of 43.9 seconds, and was temporally correlated with secondary propagation of the discharge to neocortex.PDF p.8, Initial loss of contact

Reported values

62%ictal loss of contact by temporal sidePercentage · left and right temporal lobe seizures in the 55-patient cohort; denominators not reported · right temporal lobe · whole ictal course, regardless of timingPDF p.6, General ictal characteristics
74%ictal loss of contact by temporal sidePercentage · left and right temporal lobe seizures in the 55-patient cohort; denominators not reported · left temporal lobe · whole ictal course, regardless of timingPDF p.6, General ictal characteristics
28%initial loss of contact by temporal sidePercentage · left and right temporal seizures in the 55-patient cohort; denominators not reported · left temporal lobe · initial ictal phase, first 10 secondsPDF p.6, Early features
19%initial loss of contact by temporal sidePercentage · left and right temporal seizures in the 55-patient cohort; denominators not reported · right temporal lobe · initial ictal phase, first 10 secondsPDF p.6, Early features
L 9/13 (69.2%)initial or secondary loss of contactPercentage · n/N 9/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · whole ictal course, regardless of timingPDF p.6, Table 3; PDF p.6, General ictal characteristics
M 17/24 (70.8%)initial or secondary loss of contactPercentage · n/N 17/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · whole ictal course, regardless of timingPDF p.6, Table 3; PDF p.6, General ictal characteristics
ML 13/18 (72.2%)initial or secondary loss of contactPercentage · n/N 13/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · whole ictal course, regardless of timingPDF p.6, Table 3; PDF p.6, General ictal characteristics
M 0/24 (0%)initial loss of contactPercentage · n/N 0/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · initial ictal phase, first 10 secondsPDF p.6, Table 4; PDF p.6, Early features; PDF p.8, Initial loss of contact
L 7/13 (53.8%)initial loss of contactPercentage · n/N 7/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · initial ictal phase, first 10 secondsPDF p.6, Table 4; PDF p.6, Early features; PDF p.8, Initial loss of contact
ML 7/18 (38.9%)initial loss of contactPercentage · n/N 7/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · initial ictal phase, first 10 secondsPDF p.6, Table 4; PDF p.6, Early features; PDF p.8, Initial loss of contact
Mean delay 43.9 slate loss of contact in MTLSCount · medial temporal lobe seizures; denominator not reported · late ictal loss of contact after initial dischargePDF p.8, Initial loss of contact

mcgonigal-on-seizure-semiology-2021-5ba29d.pdfNarrative, educational, or cited context · 6 findings · 7 reported values

mcgonigal-on-seizure-semiology-2021-5ba29d.pdf; mcgonigal-on-seizure-semiology-2021-9127f2.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

impaired consciousnessThe review reports that Arthuis et al. (2009) found excessive synchrony, expressed as h2 functional coupling, between temporal and extra-temporal structures, notably parietal cortex and thalamus, in temporal-lobe seizures with marked alteration of consciousness.PDF p.4, Table 1, Impaired consciousness row, 2009
impaired consciousnessThe review reports that Lambert et al. (2012) found increased synchrony associated with progressively greater altered responsiveness in parietal-lobe seizures and a statistically significant nonlinear relationship between h2 values and degree of alteration of consciousness, suggesting a threshold effect.PDF p.4, Table 1, Impaired consciousness row, 2012
impaired consciousnessThe review reports that Bonini et al. (2016) found the highest synchrony in frontal-lobe seizures with marked altered consciousness and significant correlations between consciousness scores and h2 values in prefrontal and parietal regions but not the premotor cortex.PDF p.4, Table 1, Impaired consciousness row, 2016
impaired consciousnessIn the summarized Arthuis et al. study, temporal-lobe seizures with marked alteration of consciousness showed excessive synchrony or functional coupling between temporal and extra-temporal structures, notably parietal cortex and thalamus.PDF p.4, Table 1, Arthuis et al. 2009 row; PDF p.11, mechanism 2
impaired consciousnessIn the summarized Lambert et al. study of parietal seizures, increased synchrony was associated with progressively greater altered responsiveness and a statistically significant nonlinear relationship was found between h2 values and degree of alteration of consciousness, suggesting a threshold effect.PDF p.4, Table 1, Lambert et al. 2012 row
impaired consciousnessIn the summarized Bonini et al. study of frontal seizures, marked altered consciousness was associated with the highest synchrony, and consciousness scores correlated significantly with h2 values in prefrontal and parietal regions but not in the premotor cortex.PDF p.4, Table 1, Bonini et al. 2016 row; PDF p.11, mechanism 2

Reported values

n=12 subjectsimpaired consciousnessCount · 12 subjects with temporal-lobe epilepsy · Period of semiologic expressionPDF p.4, Table 1, Impaired consciousness row, 2009
increased synchrony and statistically significant nonlinear h2 relationship with alteration of consciousnessimpaired consciousnessCount · 10 subjects with parietal-lobe epilepsy · Period of semiologic expressionPDF p.4, Table 1, Impaired consciousness row, 2012
n=10 subjectsimpaired consciousnessCount · 10 subjects with parietal-lobe epilepsy · Period of semiologic expressionPDF p.4, Table 1, Impaired consciousness row, 2012
24 subjectsimpaired consciousnessCount · 24 subjects with frontal-lobe epilepsy · frontal-lobe epilepsy study · Period of semiologic expressionPDF p.4, Table 1, Impaired consciousness row, 2016
12 subjectsimpaired consciousnessCount · 12 subjects with temporal-lobe epilepsy; number of seizures Not reported · ictal, during altered consciousnessPDF p.4, Table 1, Arthuis et al. 2009 row; PDF p.11, mechanism 2
Subjects in 3-T fMRI humming study n=10impaired consciousnessCount · 10 subjects with parietal-lobe epilepsy; number of seizures Not reported · ictal, during altered responsivenessPDF p.4, Table 1, Lambert et al. 2012 row
24 subjectsimpaired consciousnessCount · 24 subjects with frontal-lobe epilepsy; number of seizures Not reported · Bonini et al. frontal-lobe epilepsy study · ictal, during altered consciousnessPDF p.4, Table 1, Bonini et al. 2016 row; PDF p.11, mechanism 2

meletti-persistent-postictal-central-apnea-focal-seizures-2025.pdfIndependent primary study · 1 finding · 4 reported values

meletti-persistent-postictal-central-apnea-focal-seizures-2025.pdf

Independent primary study · Class II · Evidence weight 2.40 · 2 × 1.2 × 1

Consecutive patients older than 13 years admitted to the Epilepsy Monitoring Unit at Baggiovara Civil Hospital, Modena Academic Hospital, Italy, from April 2020 through December 2023 were studied with long-term video-EEG and cardiorespiratory polygraphy; 71 met inclusion, 2 were discarded for technical artifact, 5 focal seizures with bilateral tonic-clonic evolution were excluded, and the final analysis comprised 69 patients and 406 focal-onset seizures. MRI analyses included 22 patients with ICA/PICA, 31 patients without seizure-related breathing disorders, and 30 healthy controls; analyses adjusted for age, sex, and intracranial volume and used false-discovery-rate correction.

Findings

level of vigilance at seizure onsetPICA occurrence was not associated with wake versus sleep/stupor at seizure onset.PDF p.6, Table 2, Level of vigilance at seizure onset; PDF p.6, Awareness of Apnea in the Postictal Period

Reported values

ICA-only; sleep/stupor 25 (53%)level of vigilance at seizure onsetPercentage · Patients with seizure-related disordered breathing; Table 2 row labeled 69 seizures, comparing PICA with ICA-only seizures · ICA-only; sleep/stupor · seizure onset and postictal outcomePDF p.6, Table 2, Level of vigilance at seizure onset; PDF p.6, Awareness of Apnea in the Postictal Period
ICA-only; wake 22 (47%)level of vigilance at seizure onsetPercentage · Patients with seizure-related disordered breathing; Table 2 row labeled 69 seizures, comparing PICA with ICA-only seizures · ICA-only; wake · seizure onset and postictal outcomePDF p.6, Table 2, Level of vigilance at seizure onset; PDF p.6, Awareness of Apnea in the Postictal Period
PICA; sleep/stupor 10 (45%)level of vigilance at seizure onsetPercentage · Patients with seizure-related disordered breathing; Table 2 row labeled 69 seizures, comparing PICA with ICA-only seizures · PICA; sleep/stupor · seizure onset and postictal outcomePDF p.6, Table 2, Level of vigilance at seizure onset; PDF p.6, Awareness of Apnea in the Postictal Period
PICA; wake 12 (55%)level of vigilance at seizure onsetPercentage · Patients with seizure-related disordered breathing; Table 2 row labeled 69 seizures, comparing PICA with ICA-only seizures · PICA; wake · seizure onset and postictal outcomePDF p.6, Table 2, Level of vigilance at seizure onset; PDF p.6, Awareness of Apnea in the Postictal Period

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdfSystematic review or meta-analysis · 1 finding

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

initial loss of contactThe source states that initial loss of contact is shared with lateral temporal seizures.PDF p.5, Discussion

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdfIndependent primary study · 1 finding

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

TPOJ and PCC-PCu early synchronizationEarly engagement of TPOJ and PCC/PCu is described as driving widespread network synchronization, early impaired consciousness, and secondary generalization.PDF p.14, Key Hubs Act as Accelerators and Switches

14 contributing manuscripts; source-reported values remain separate and are not pooled.

Postictal aphasia / language disturbanceSource terms: Postictal aphasiaReported: BilateralAlso reported: ContralateralAlso reported: Dominant hemisphereAlso reported: IpsilateralAlso reported: Left hemisphereAlso reported: Non-dominant hemisphereAlso reported: Right hemisphereNo single reliable side16 manuscripts · 27 findings · 34 reported values

Weighted evidence supportevidence weight 32.3 across 16 manuscripts · 2 manuscript weight pending · 4 independent primary study · 2 systematic review or meta-analysis · 7 narrative, educational, or cited context · 1 case report or observation · 2 structured design not resolved

The review states that anarthria alone is insufficient for hemispheric lateralization. The educational statement says dominant-hemisphere seizures can produce the same phonatory symptoms as non-dominant seizures, with dysphasia additionally possible in dominant-hemisphere seizures. The review is subtype-dependent: ictal speech arrest is not reliably lateralizing, whereas selected ictal language and postictal aphasia patterns are associated with dominant, usually right nondominant, or left dominant temporal language networks. The case observation records left parietotemporal EEG abnormalities with right facial twitching and is normalized by the card as bilateral laterality context. The review describes ictal or postictal dys/aphasia as having approximately 90% lateralisation value but gives no direction and says its localisation value is poor. Dysphasia was much more frequent in dominant-origin temporal-lobe seizures (27 seizures in 12 patients) than in nondominant-origin seizures (3 seizures in 2 patients), with all nondominant events being isolated paraphasias. The review distinguishes dominant-hemisphere dysphasia, nondominant ictal speech or preserved awareness, contralateral RINCH motions, and nonlateralizing speech arrest. The review links ictal or postictal dysphasia to the dominant hemisphere, formed nonsensical ictal speech to the nondominant hemisphere, and explicitly describes speech arrest as non-lateralising. The review describes postictal aphasia as a predominantly dominant-hemisphere lateralizing sign and reports 80–90% reliability. The review associates postictal aphasia with the dominant hemisphere in temporal-lobe seizures. Both handbook tables list postictal aphasia as indicating the dominant hemisphere. Prolonged postictal language delay was reported in dominant-hemisphere frontal seizures, especially when frontal onset spread to the dominant temporal lobe. The cited result reports prolonged postictal language delay with a structural lesion only in nondominant temporal complex partial seizures. The review states that postictal aphasia almost always indicates dominant-hemisphere involvement. The review states that language recovery is related to hemisphere of onset but does not specify a direction. The review states that postictal aphasia lateralizes to the language-dominant hemisphere and that delayed language recovery is particularly associated with left temporal epilepsy; ipsilateral temporal extension modifies the frontal comparison. Postictal dysphasia predominantly followed dominant-temporal seizures (12/13), with one nondominant exception. Postictal dysphasia strongly favored left-temporal seizures: 24 of 26 affected patients were left-sided, with two right-sided exceptions. Postictal aphasia occurred after 37 left-temporal seizures and no right-temporal seizures in this cohort. The current paper reports that several cited studies found postictal dysphasia to lateralize seizure origin to the dominant hemisphere. The review assigns postictal verbal-memory impairment and aphasia to dominant-hemisphere suggestion and visual-memory impairment to nondominant-hemisphere suggestion. The review reports that postictal aphasia or dysphasia points to the language-dominant hemisphere, with cited PPVs of 80-100%. The review restates that 92% of patients with postictal dysphasia had the presumed epileptogenic zone in the language-dominant hemisphere. The finding reports no cerebral lateralization. The M, ML, and L onset-subtype comparison does not report a lateralization direction.

Source-defined result groups 19

Lateralization: Dominant hemisphere / Left hemisphereObserved proportion 0.0%RTL; all analyzed seizures · LTL · seizure1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 23.1%L · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Right hemisphereObserved proportion 92.3%left temporal seizures · right temporal seizures · patient with postictal dysphasia1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Right hemisphereSource-defined values retained separatelyleft temporal lobe · right temporal lobe · temporal seizure/patient; exact denominator not reported1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 50.0%M · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 61.1%ML · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphere / Non-dominant hemisphereObserved proportion 7.7%nondominant temporal-lobe origin · dominant origin · patient1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphere / Left hemisphereObserved proportion 50.7%LTL; all analyzed seizures · RTL · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphere / Left hemisphereObserved proportion 59.3%LTL CPS · RTL versus LTL · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphere / Left hemisphereObserved proportion 26.3%LTL PE · RTL versus LTL · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphere / Non-dominant hemisphereObserved proportion 92.3%dominant temporal-lobe origin · nondominant origin · patient1 manuscript · 1 reported value · not pooled

Localization: T+ group / TL groupSource-defined values retained separatelyTL group · TL group versus T+ group · seizures1 manuscript · 1 reported value · not pooled

Localization: T+ group / TL groupSource-defined values retained separatelyT+ group · TL group versus T+ group · seizures1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Right hemisphereSource-defined values retained separatelyright temporal lobe · left temporal lobe · temporal seizure/patient; exact denominator not reported1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 16

Alphabetical by manuscript.

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 1 finding · 3 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

post-ictal language deficitPost-ictal language deficit did not differ significantly between TL and T+ groups.PDF p.6, Table 2; PDF p.9, Post-ictal signs

Reported values

P=0.78post-ictal language deficitP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · post-ictalPDF p.6, Table 2; PDF p.9, Post-ictal signs
TL 42.4%post-ictal language deficitPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · post-ictalPDF p.6, Table 2; PDF p.9, Post-ictal signs
T+ 39.1%post-ictal language deficitPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · post-ictalPDF p.6, Table 2; PDF p.9, Post-ictal signs

blair-temporal-lobe-epilepsy-semiology-2012.pdfNarrative, educational, or cited context · 2 findings · 2 reported values

blair-temporal-lobe-epilepsy-semiology-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Postictal aphasiaThe review's differential table reports postictal aphasia as common in temporal seizures involving the dominant hemisphere and rare in frontal seizures unless they spread to the temporal lobe; the narrative later calls postictal aphasia a very reliable lateralizing sign with 80–90% reliability.PDF p.2, Table 1; PDF p.4, Table 2; PDF p.5, language paragraph
Postictal aphasia as a lateralizing signPostictal aphasia is described as a very reliable lateralizing sign with 80–90% reliability and as implying dominant-hemisphere temporal seizure origin.PDF p.2, Table 1; PDF p.4, Table 2; PDF p.5, language-disturbances paragraph

Reported values

80–90% reliability reported in narrativePostictal aphasiaPercentage · Temporal versus frontal seizures; dominant-hemisphere temporal seizures; the cited reliability denominator is not reported. · PostictalPDF p.2, Table 1; PDF p.4, Table 2; PDF p.5, language paragraph
80–90% reliabilityPostictal aphasia as a lateralizing signPercentage · Temporal lobe seizures evaluated with postictal language testing; denominator not reported. · PostictalPDF p.2, Table 1; PDF p.4, Table 2; PDF p.5, language-disturbances paragraph

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 2 findings

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdf; chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

ictal/postictal dysphasia; ictal speech; preserved awareness; RINCH motionsIctal or postictal dysphasia lateralises to the dominant hemisphere but has poor localising value and must be distinguished from non-lateralising speech arrest; formed nonsensical ictal speech and preserved awareness during ictal automatisms point to the nondominant hemisphere, while rhythmic ictal non-clonic hand motions may be contralateral in temporal lobe epilepsy and peri-ictal drinking, spitting, vomiting, or urge to urinate point to a nondominant focus.PDF p.10, Lateralising signs
ictal/postictal dysphasia; speech arrest; ictal speechIctal or postictal dysphasia lateralises to the dominant hemisphere but has poor localising value; speech arrest is described as non-lateralising, whereas ictal speech consisting of formed nonsensical phrases is a non-dominant sign.PDF p.10, Lateralising signs

epilepsy-fellowship-handbook-semiologyreferences.pdfNarrative, educational, or cited context · 1 finding

epilepsy-fellowship-handbook-semiologyreferences.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Postictal aphasiaBoth tables list Postictal aphasia as Dominant hemisphere.PDF p.2, Lateralizing signs/Localization table row "Postictal aphasia" (printed p.7); PDF p.3, Lateralizing signs/Localization table row "Postictal aphasia" (printed p.5)

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdfStructured design not resolved · 2 findings · 4 reported values

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.932

Findings

Postictal aphasiaPostictal aphasia occurred only after LTL seizures and was statistically more common in LTL than RTL seizures; it was recorded after 32 LTL CPS and 5 LTL PE seizures.PDF p.1, Summary; PDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.5, Discussion
Postictal dysphasia and dominant hemisphere in cited studiesThe current paper states that several cited studies showed postictal dysphasia to lateralize seizure origin to the dominant hemisphere.PDF p.5, Discussion, postictal-aphasia paragraph

Reported values

RTL seizures with postictal aphasia 0/54Postictal aphasiaPercentage · n/N 0/54 · RTL seizure group, n=54, versus LTL seizure group, n=73; LTL subgroup includes 54 CPS and 19 PE seizures · RTL; all analyzed seizures · PostictalPDF p.1, Summary; PDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.5, Discussion
LTL PE seizures with postictal aphasia 5/19Postictal aphasiaPercentage · n/N 5/19 · RTL seizure group, n=54, versus LTL seizure group, n=73; LTL subgroup includes 54 CPS and 19 PE seizures · LTL PE · PostictalPDF p.1, Summary; PDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.5, Discussion
LTL CPS with postictal aphasia 32/54 (59%)Postictal aphasiaPercentage · n/N 32/54 · RTL seizure group, n=54, versus LTL seizure group, n=73; LTL subgroup includes 54 CPS and 19 PE seizures · LTL CPS · PostictalPDF p.1, Summary; PDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.5, Discussion
LTL seizures with postictal aphasia 37/73 (51%)Postictal aphasiaPercentage · n/N 37/73 · RTL seizure group, n=54, versus LTL seizure group, n=73; LTL subgroup includes 54 CPS and 19 PE seizures · LTL; all analyzed seizures · PostictalPDF p.1, Summary; PDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.5, Discussion

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdfNarrative, educational, or cited context · 1 finding

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

postictal verbal and visual memory impairment and postictal aphasiaPostictal verbal memory impairment is suggestive of a dominant-hemisphere temporal focus, visual memory impairment of a nondominant-hemisphere focus, and postictal aphasia strongly suggests a dominant-hemisphere focus.PDF p.9, Postictal state

gabr-speech-manifestations-lateralization-temporal-lobe-seizures-1989.pdfStructured design not resolved · 2 findings · 10 reported values

gabr-speech-manifestations-lateralization-temporal-lobe-seizures-1989.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 2

Findings

dysphasiasDysphasias occurred in 30 seizures in 14 patients: 27 seizures in 12 patients with dominant-origin seizures and 3 seizures in 2 patients with nondominant-origin seizures; all three nondominant dysphasias were isolated paraphasias, one patient had 2 ictal seizures, the second had 1 postictal seizure, and all other dysphasias were postictal and arose from the dominant hemisphere.PDF p.3, Table 3 and Results; PDF p.4, Table 5 and Results; PDF p.5, Discussion
postictal dysphasiaAmong 13 patients with postictal dysphasia, 12 (92%) had seizures originating from the dominant temporal lobe and 1 from the nondominant temporal lobe; the association was statistically significant.PDF p.1, abstract; PDF p.4, Table 6 and Results; PDF p.5, Discussion and conclusion

Reported values

27 dominant-origin seizuresdysphasiasCount · 14 patients and 30 dysphasia seizures within the 35-patient temporal-lobe epilepsy cohort · dominant-origin · mixed; 2 ictal seizures in one patient and 1 postictal seizure in a second nondominant-origin patient, with all other dysphasias postictalPDF p.3, Table 3 and Results; PDF p.4, Table 5 and Results; PDF p.5, Discussion
2 ictal nondominant dysphasia seizuresdysphasiasCount · 14 patients and 30 dysphasia seizures within the 35-patient temporal-lobe epilepsy cohort · nondominant-origin; first patient · mixed; 2 ictal seizures in one patient and 1 postictal seizure in a second nondominant-origin patient, with all other dysphasias postictalPDF p.3, Table 3 and Results; PDF p.4, Table 5 and Results; PDF p.5, Discussion
14 patients with dysphasiadysphasiasCount · 14 patients and 30 dysphasia seizures within the 35-patient temporal-lobe epilepsy cohort · mixed; 2 ictal seizures in one patient and 1 postictal seizure in a second nondominant-origin patient, with all other dysphasias postictalPDF p.3, Table 3 and Results; PDF p.4, Table 5 and Results; PDF p.5, Discussion
3 nondominant-origin seizuresdysphasiasCount · 14 patients and 30 dysphasia seizures within the 35-patient temporal-lobe epilepsy cohort · nondominant-origin · mixed; 2 ictal seizures in one patient and 1 postictal seizure in a second nondominant-origin patient, with all other dysphasias postictalPDF p.3, Table 3 and Results; PDF p.4, Table 5 and Results; PDF p.5, Discussion
2 nondominant-origin patientsdysphasiasCount · 14 patients and 30 dysphasia seizures within the 35-patient temporal-lobe epilepsy cohort · nondominant-origin · mixed; 2 ictal seizures in one patient and 1 postictal seizure in a second nondominant-origin patient, with all other dysphasias postictalPDF p.3, Table 3 and Results; PDF p.4, Table 5 and Results; PDF p.5, Discussion
1 postictal nondominant dysphasia seizuredysphasiasCount · 14 patients and 30 dysphasia seizures within the 35-patient temporal-lobe epilepsy cohort · nondominant-origin; second patient · mixed; 2 ictal seizures in one patient and 1 postictal seizure in a second nondominant-origin patient, with all other dysphasias postictalPDF p.3, Table 3 and Results; PDF p.4, Table 5 and Results; PDF p.5, Discussion
12 dominant-origin patientsdysphasiasCount · 14 patients and 30 dysphasia seizures within the 35-patient temporal-lobe epilepsy cohort · dominant-origin · mixed; 2 ictal seizures in one patient and 1 postictal seizure in a second nondominant-origin patient, with all other dysphasias postictalPDF p.3, Table 3 and Results; PDF p.4, Table 5 and Results; PDF p.5, Discussion
30 dysphasia seizuresdysphasiasCount · 14 patients and 30 dysphasia seizures within the 35-patient temporal-lobe epilepsy cohort · mixed; 2 ictal seizures in one patient and 1 postictal seizure in a second nondominant-origin patient, with all other dysphasias postictalPDF p.3, Table 3 and Results; PDF p.4, Table 5 and Results; PDF p.5, Discussion
1/13postictal dysphasiaPercentage · n/N 1/13 · 13 patients with postictal dysphasia in the 35-patient temporal-lobe epilepsy cohort · nondominant temporal-lobe origin · postictalPDF p.1, abstract; PDF p.4, Table 6 and Results; PDF p.5, Discussion and conclusion
12/13 (92%)postictal dysphasiaPercentage · n/N 12/13 · 13 patients with postictal dysphasia in the 35-patient temporal-lobe epilepsy cohort · dominant temporal-lobe origin · postictalPDF p.1, abstract; PDF p.4, Table 6 and Results; PDF p.5, Discussion and conclusion

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdfSystematic review or meta-analysis · 2 findings

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

speech arrest; anarthria; dysarthria; dysphasiaThe source states that speech arrest, including anarthria or dysarthria, can be the first sign of seizures starting from the frontal operculum, while anarthria alone is not sufficient to assign hemispheric lateralization.PDF p.9, Discussion
dominant hemisphere; non-dominant hemisphere; dysphasia; postictal language disorderThe source states that seizures in dominant and non-dominant hemispheres can produce the same phonatory symptoms, while dominant-hemisphere seizures may additionally produce dysphasia that can persist postictally.PDF p.9, Discussion

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 3 findings · 2 reported values

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Ictal or postictal dys/aphasiaThe review describes ictal or postictal dys/aphasia as a valuable finding with approximately 90% lateralisation value, while stating that its localisation value is poor.PDF p.5, section 1.9
Postictal aphasia/dysphasiaThe review states that postictal aphasia almost always indicates dominant-hemisphere involvement, occurs in 12% of temporal-lobe epilepsy cases, and had no lobar preference in the cited series of postictal dysphasia.PDF p.5, section 1.9
Postictal dysphasia recoveryThe review states that the duration of postictal dysphasia is unclear from published cases, while language recovery is related to structural etiology and hemisphere of onset.PDF p.6, section 1.9

Reported values

Approximately 90% lateralisation valueIctal or postictal dys/aphasiaPercentage · Video-EEG seizure literature; exact population not reported · ictal or postictalPDF p.5, section 1.9
12% of temporal-lobe epilepsy casesPostictal aphasia/dysphasiaPercentage · Temporal-lobe epilepsy cases and cited seizure series; exact denominators not reported · postictalPDF p.5, section 1.9

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdfNarrative, educational, or cited context · 2 findings · 2 reported values

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

postictal aphasia and dysphasiaPostictal aphasia or dysphasia lateralizes to the language-dominant hemisphere, and delayed language recovery may be predictive.PDF p.10, section 5.3
postictal dysphasiaGabr et al. found the presumed epileptogenic zone in the language-dominant hemisphere in 92% of patients with postictal dysphasia.PDF p.10, section 5.3

Reported values

positive predictive values reported between 80% and 100%postictal aphasia and dysphasiaPercentage · patients with postictal language dysfunction · postictalPDF p.10, section 5.3
92%postictal dysphasiaPercentage · patients with postictal dysphasia, all tested for language dominance by Wada · postictalPDF p.10, section 5.3

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdfIndependent primary study · 2 findings · 6 reported values

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdf

Independent primary study · Class II · Evidence weight 5.12 · 2 × 1.5 × 1.707

Findings

postictal dysphasia and temporal sidePostictal dysphasia was more frequent in left than right temporal lobe seizures, and 24 of the 26 patients with postictal dysphasia had left temporal seizures.PDF p.7, Postictal behavior
postictal dysphasiaPostictal dysphasia did not differ significantly across M, ML, and L onset subtypes when grouped by electrophysiologic subtype.PDF p.6, Table 3; PDF p.7, Postictal behavior

Reported values

12.5%postictal dysphasia and temporal sidePercentage · 26 patients with postictal dysphasia within the 55-patient cohort; side-specific comparison denominators not reported · right temporal lobe · postictalPDF p.7, Postictal behavior
24/26 (92%)postictal dysphasia and temporal sidePercentage · n/N 24/26 · 26 patients with postictal dysphasia within the 55-patient cohort; side-specific comparison denominators not reported · left temporal seizures · postictalPDF p.7, Postictal behavior
61.5%postictal dysphasia and temporal sidePercentage · 26 patients with postictal dysphasia within the 55-patient cohort; side-specific comparison denominators not reported · left temporal lobe · postictalPDF p.7, Postictal behavior
ML 11/18 (61.1%)postictal dysphasiaPercentage · n/N 11/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · postictalPDF p.6, Table 3; PDF p.7, Postictal behavior
M 12/24 (50%)postictal dysphasiaPercentage · n/N 12/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · postictalPDF p.6, Table 3; PDF p.7, Postictal behavior
L 3/13 (23.1%)postictal dysphasiaPercentage · n/N 3/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · postictalPDF p.6, Table 3; PDF p.7, Postictal behavior

misulis-sonmezturk-ess-abou-khalil-atlas-eeg-seizure-semiology-management-3e-2022.pdfNarrative, educational, or cited context · 1 finding

misulis-sonmezturk-ess-abou-khalil-atlas-eeg-seizure-semiology-management-3e-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

ictal language and postictal aphasiaIctal speech arrest is not reliably lateralizing; focal aware speech arrest may represent dominant temporal aphasia, well-formed ictal language strongly suggests a nondominant, usually right, temporal lobe, ictal jargon is associated with dominant temporal involvement, and postictal aphasia strongly supports left dominant temporal localization.PDF p.50; PDF p.51; PDF p.52

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdfIndependent primary study · 1 finding · 1 reported value

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdf

Independent primary study · Class II · Evidence weight 4.89 · 2 × 1.35 × 1.812

Findings

post-ictal dysphasiaPost-ictal dysphasia occurred in six of 42 patients.PDF p.6, Results, Non-visual manifestations

Reported values

6/42 (14%) patientspost-ictal dysphasiaPercentage · n/N 6/42 · 42 medically refractory patients with source-defined occipital lobe epilepsy · post-ictalPDF p.6, Results, Non-visual manifestations

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdfIndependent primary study · 1 finding · 1 reported value

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdf

Independent primary study · Class II · Evidence weight 5.28 · 2 × 1.35 × 1.957

Findings

post-ictal dysphasiaPost-ictal dysphasia occurred in 7% of patients.PDF p.4, Results, Other seizure characteristics; PDF p.5, Table 2

Reported values

7%post-ictal dysphasiaPercentage · 82-patient parietal epilepsy series · post-ictalPDF p.4, Results, Other seizure characteristics; PDF p.5, Table 2

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

post-ictal aphasiaThe review states that postictal aphasia lateralizes temporal-lobe epilepsy to the language-dominant hemisphere and that language recovery after the ictal EEG stops is significantly more delayed in left temporal lobe epilepsy. Postictal language delay is described as less affected in frontal-lobe epilepsy unless seizure activity extends to the ipsilateral temporal lobe. The review requires a cooperative patient who tries to understand and speak, continuous testing, and slow progressive recovery over 10-20 minutes.PDF p.6, Post ictal aphasia

Reported values

Progressive language recovery over 10-20 minutes as a diagnostic contextpost-ictal aphasiaCount · Cooperative patients with temporal lobe epilepsy compared with frontal lobe epilepsy; no cohort reported · Postictal, after the ictal EEG pattern has stoppedPDF p.6, Post ictal aphasia

unterberger-epileptic-aphasia-critical-appraisal-2021.pdfCase report or observation · 3 findings · 2 reported values

unterberger-epileptic-aphasia-critical-appraisal-2021.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

aphasia with left parietotemporal periodic/rhythmic sharp wavesFigure 3 shows a 58-year-old male with an acute symptomatic focal to bilateral tonic-clonic seizure followed by Epilepsia partialis continua with aphasia and right facial twitching due to a left middle cerebral artery stroke; ongoing aphasia is shown with left parietotemporal periodic and rhythmic sharp waves, and an otherwise identical record without motor symptoms shows lateralized periodic discharges turning into ictal rhythmic discharges pronounced over C3.PDF p.4, Fig.3a–b caption and EEG rendering
prolonged postictal language delay after frontal CPSThe review reports prolonged postictal language delay in 7% of frontal complex partial seizures confined to the dominant frontal lobe compared with 91% of complex partial seizures that started as frontal and spread to the dominant temporal lobe.PDF p.5, §6
structural lesion and postictal language delay in temporal CPSThe review reports that the presence of a structural lesion significantly prolonged postictal language delay only in patients with non-dominant temporal complex partial seizures, supporting an interaction between seizure origin and patterns of seizure spread.PDF p.5, §6

Reported values

91%prolonged postictal language delay after frontal CPSPercentage · Patients with frontal complex partial seizures · frontal-onset seizures spreading to the dominant temporal lobe · postictalPDF p.5, §6
7%prolonged postictal language delay after frontal CPSPercentage · Patients with frontal complex partial seizures · seizures confined to the dominant frontal lobe · postictalPDF p.5, §6

16 contributing manuscripts; source-reported values remain separate and are not pooled.

Olfactory aura (uncinate fit)Source terms: Olfactory auraReported: Left hemisphereNo single reliable side15 manuscripts · 42 findings · 23 reported values

Weighted evidence supportevidence weight 31.35 across 15 manuscripts · 2 independent primary study · 8 narrative, educational, or cited context · 4 systematic review or meta-analysis · 1 case report or observation

Insular stimulation-evoked olfactory sensations were perceived in the nasal cavity and were not lateralized. Right-sided motor manifestations accompanied a case interpreted as left mesial temporal epilepsy. The cited table describes olfactory aura as non-lateralising. The review states that olfactory auras have no lateralizing value. Olfactory and gustatory auras are summarized as generally nonlateralizing. The TL-versus-T+ comparison provides no lateralizing direction. No lateralizing direction is reported. No hemispheric lateralization is reported. The cited stimulation prevalence provides no hemispheric direction. The mesial-versus-lateral temporal comparison provides no hemispheric direction. The study-count record provides no hemispheric direction. This lateral-versus-mesial temporal statistic provides no hemispheric lateralization. The lateral-temporal prevalence result provides no hemispheric direction. The occurrence odds provide no hemispheric direction. The lateral-TLE prevalence result provides no hemispheric direction. The mesial-TLE prevalence range provides no hemispheric direction. This record provides no seizure lateralization. This record provides no hemispheric lateralization. No seizure lateralization is reported.

Source-defined result groups 17

Localization: TemporalSource-defined values retained separatelyAll reported · reported sign prevalence across included studies1 manuscript · 1 reported value · not pooled

Localization: ParietalSource-defined values retained separatelyparietal localization given olfactory aura · localizing data point1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTL · T+ 4.3% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyinsular localization given olfactory aura · localizing data point1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyunpleasant or indefinable odors · evoked olfactory response1 manuscript · 1 reported value · not pooled

Localization: InsularObserved proportion 1.1%olfactory responses · evoked olfactory response1 manuscript · 1 reported value · not pooled

Localization: ParietalSource-defined values retained separatelyparietal localization relative to all other semiologies · localizing data point1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyinsular localization relative to all other semiologies · localizing data point1 manuscript · 1 reported value · not pooled

Localization: FrontalSource-defined values retained separatelyfrontal localization given olfactory aura · localizing data point1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelytemporal localization given olfactory aura · localizing data point1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyT+ · TL 1.7% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 15

Alphabetical by manuscript.

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdfSystematic review or meta-analysis · 15 findings · 7 reported values

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

olfactoryTable 1 defines or exemplifies the the source's own semiology category “olfactory” as Any kind of ictal smell, for example burning.PDF p.7, Table 1 Semiology descriptions and frequencies
olfactoryOlfactory semiology comprised 4.6% of non-topological data.PDF p.7, Table 1 Semiology descriptions and frequencies
olfactory; Figure 3 all-data subsetFigure 3 reports N = 980 for the all-data olfactory panel.PDF p.9, Figure 3 and caption
olfactory; Figure 3 non-topological subsetFigure 3 reports N = 161 for the non-topological olfactory panel.PDF p.9, Figure 3 and caption
olfactory aura; frontal lobeOlfactory auras were frontal in 21% of the estimate.PDF p.8, Seizure semiology localizing values
olfactory aura; frontal lobeThe 95% CI for olfactory aura; frontal lobe was 15%–28%.PDF p.8, Seizure semiology localizing values
olfactory aura; parietal lobeOlfactory auras were parietal in 28% of the estimate.PDF p.8, Seizure semiology localizing values
olfactory aura; parietal lobeThe 95% CI for olfactory aura; parietal lobe was 20%–35%.PDF p.8, Seizure semiology localizing values
olfactory aura; temporal lobeOlfactory auras were temporal in 40% of the estimate.PDF p.8, Seizure semiology localizing values
olfactory aura; temporal lobeThe 95% CI for olfactory aura; temporal lobe was 31%–49%.PDF p.8, Seizure semiology localizing values
olfactory aura; insulaolfactory aura indicated insular localization in 44%.PDF p.8, Seizure semiology localizing values
olfactory aura; parietal lobeOlfactory auras had an intrinsic localizing OR of 4.6 for parietal localization.PDF p.8, Relative localizing values of semiologies
olfactory aura; parietal lobeThe 95% CI for olfactory aura; parietal lobe was 3.2–6.5.PDF p.8, Relative localizing values of semiologies
olfactory aura; insulaOlfactory auras had an intrinsic localizing OR of 3.8 for insular localization.PDF p.8, Relative localizing values of semiologies
olfactory aura; insulaThe 95% CI for olfactory aura; insula was 2.1–6.9.PDF p.8, Relative localizing values of semiologies

Reported values

olfactory 4.6%olfactoryPercentage · non-topological Semio2Brain dataPDF p.7, Table 1 Semiology descriptions and frequencies
olfactory aura; frontal lobe 21%olfactory aura; frontal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
olfactory aura; parietal lobe 28%olfactory aura; parietal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
olfactory aura; temporal lobe 40%olfactory aura; temporal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
olfactory aura; insula 44%olfactory aura; insulaPercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
OR 4.6olfactory aura; parietal lobeOdds ratio · non-topological Semio2Brain data unless otherwise statedPDF p.8, Relative localizing values of semiologies
OR 3.8olfactory aura; insulaOdds ratio · non-topological Semio2Brain data unless otherwise statedPDF p.8, Relative localizing values of semiologies

asadollahi-drug-resistant-parietal-lobe-epilepsy-clinical-manifestations-surgery-outcome-2017.pdfIndependent primary study · 1 finding · 1 reported value

asadollahi-drug-resistant-parietal-lobe-epilepsy-clinical-manifestations-surgery-outcome-2017.pdf

Independent primary study · Class II · Evidence weight 3.91 · 2 × 1.2 × 1.628

Findings

olfactory auraOne patient had an olfactory aura.PDF p.2, Results

Reported values

1/18 (5.5%) olfactory auraolfactory auraPercentage · n/N 1/18 · 18-patient drug-resistant parietal lobe epilepsy cohort · auraPDF p.2, Results

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 1 finding · 3 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 5.65 · 2 × 1.5 × 1.882

Findings

olfactory hallucinationOlfactory hallucinations did not differ significantly between TL and T+ groups.PDF p.6, Table 2

Reported values

TL 1.7%olfactory hallucinationPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictal onsetPDF p.6, Table 2
T+ 4.3%olfactory hallucinationPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictal onsetPDF p.6, Table 2
P=0.48olfactory hallucinationP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictal onsetPDF p.6, Table 2

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfSystematic review or meta-analysis · 2 findings · 2 reported values

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

Olfactory (Table 3)Table 3 reports olfactory symptoms in 1 case (1%), more at seizure onset.PDF p.6, Table 3
Olfactory (Table 4)In the 60 high/very-high-confidence cases, Table 4 reports olfactory symptoms in 1 case (2%).PDF p.7, Table 4

Reported values

1 case (1%)Olfactory (Table 3)Percentage · Table 3 basal temporal seizure cases · onsetPDF p.6, Table 3
1/60 (2%)Olfactory (Table 4)Percentage · n/N 1/60 · 60 basal temporal seizure cases with high or very-high EZ confidence · ictalPDF p.7, Table 4

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 1 finding

chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

gustatory; olfactory; vestibular; autonomic auraTable 3 maps gustatory aura to insula or mesiotemporal regions, olfactory aura to insula, mesiotemporal, or orbitofrontal regions, vestibular aura to posterior temporal or parietal regions, and autonomic aura to insula, amygdala, or cingulate regions.PDF p.10, Table 3; PDF p.3, Figure 1

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdfSystematic review or meta-analysis · 12 findings · 4 reported values

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

epigastric aura; olfactory/gustatory auraThe source states that absence of epigastric or olfactory/gustatory auras may be more indicative of lateral than mesial temporal seizures, whereas their presence points toward mesial rather than lateral onset.PDF p.7, Discussion; PDF p.10, Conclusions
Olfactory/gustatory auraTable 3 reports 3 studies assessing Olfactory/gustatory aura.PDF p.6, Table 3
Olfactory/gustatory auraTable 3 reports 42 patients assessed for Olfactory/gustatory aura.PDF p.6, Table 3
Olfactory/gustatory auraTable 3 reports 0% as the percentage range or value for Olfactory/gustatory aura; the overall association grade is Low.PDF p.6, Table 3
odds of occurrence; Olfactory/gustatory auraTable 4 reports overall odds of 0.04 for occurrence of Olfactory/gustatory aura in lateral TLE.PDF p.7, Table 4; PDF p.8, Figure 2
odds confidence interval; Olfactory/gustatory auraTable 4 reports a 95% confidence interval of 0.01–0.19 for the overall odds of Olfactory/gustatory aura.PDF p.7, Table 4; PDF p.8, Figure 2
heterogeneity test; Olfactory/gustatory auraThe heterogeneity test for the Table 4 odds estimate for Olfactory/gustatory aura has p=0.9159.PDF p.7, Table 4
Olfactory/gustatory aura; lateral versus mesial comparisonTable 5 reports 3 studies comparing Olfactory/gustatory aura in lateral and mesial TLE.PDF p.9, Table 5
Olfactory/gustatory aura; lateral TLE patient denominatorTable 5 reports 42 lateral-TLE patients assessed for Olfactory/gustatory aura.PDF p.9, Table 5
Olfactory/gustatory aura; mesial TLE patient denominatorTable 5 reports 67 mesial-TLE patients assessed for Olfactory/gustatory aura.PDF p.9, Table 5
Olfactory/gustatory aura; lateral TLE prevalenceTable 5 reports a lateral-TLE percentage of 0% for Olfactory/gustatory aura.PDF p.9, Table 5
Olfactory/gustatory aura; mesial TLE prevalenceTable 5 reports a mesial-TLE percentage of 0–18.8% for Olfactory/gustatory aura.PDF p.9, Table 5

Reported values

0%Olfactory/gustatory auraPercentage · Lateral temporal epilepsy patients assessed for Olfactory/gustatory aura · ictalPDF p.6, Table 3
odds 0.04odds of occurrence; Olfactory/gustatory auraOdds · Lateral temporal epilepsy patients assessed for Olfactory/gustatory aura · ictalPDF p.7, Table 4; PDF p.8, Figure 2
0%Olfactory/gustatory aura; lateral TLE prevalencePercentage · Lateral TLE patients assessed for Olfactory/gustatory aura · Lateral TLE patients assessed for Olfactory/gustatory aura · ictalPDF p.9, Table 5
0–18.8%Olfactory/gustatory aura; mesial TLE prevalencePercentage Range · Mesial TLE patients assessed for Olfactory/gustatory aura · Mesial TLE patients assessed for Olfactory/gustatory aura · ictalPDF p.9, Table 5

foldvary-focal-epilepsy-surgical-evaluation-comprehensive-clinical-neurophysiology-2000.pdfCase report or observation · 1 finding · 3 reported values

foldvary-focal-epilepsy-surgical-evaluation-comprehensive-clinical-neurophysiology-2000.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Case Study 1 olfactory aura, dystonic posturing, and left temporal findingsIn Case Study 1, a right-handed woman had recurrent unusual-odor auras without initial loss of consciousness, later seizures with loss of awareness, oral/manual automatisms, unintelligible speech, left-hand automatisms, right-arm dystonic posturing, and head version to the right. Interictal sharp waves were maximal at the left sphenoidal electrode in 90% of the source-defined observations versus 5% at the left anterior temporal and 5% at the right sphenoidal electrode, and ictal rhythmic delta followed by repetitive spiking was maximal in the left temporal region; the chapter's discussion interpreted the combined history and testing as left mesial temporal lobe epilepsy.PDF p.12, Case Study 1, history and seizure description; PDF p.12, Case Study 1, interictal and ictal EEG paragraph; PDF p.12, Case Study 1, Discussion

Reported values

5% right sphenoidalCase Study 1 olfactory aura, dystonic posturing, and left temporal findingsPercentage · Single illustrative case, 31-year-old right-handed woman with poorly controlled seizures · right sphenoidal · aura, ictal, and interictalPDF p.12, Case Study 1, history and seizure description; PDF p.12, Case Study 1, interictal and ictal EEG paragraph; PDF p.12, Case Study 1, Discussion
90% left sphenoidalCase Study 1 olfactory aura, dystonic posturing, and left temporal findingsPercentage · Single illustrative case, 31-year-old right-handed woman with poorly controlled seizures · left sphenoidal · aura, ictal, and interictalPDF p.12, Case Study 1, history and seizure description; PDF p.12, Case Study 1, interictal and ictal EEG paragraph; PDF p.12, Case Study 1, Discussion
5% left anterior temporalCase Study 1 olfactory aura, dystonic posturing, and left temporal findingsPercentage · Single illustrative case, 31-year-old right-handed woman with poorly controlled seizures · left anterior temporal · aura, ictal, and interictalPDF p.12, Case Study 1, history and seizure description; PDF p.12, Case Study 1, interictal and ictal EEG paragraph; PDF p.12, Case Study 1, Discussion

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 1 finding

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

olfactory and gustatory aurasOlfactory auras are typically unpleasant and often associated with gustatory phenomena; stimulation of the amygdala, olfactory bulb, insula, or posterior orbitofrontal region can produce olfactory sensations or illusions. Gustatory auras can be difficult to distinguish from olfactory disturbances, and stimulation of the parietal operculum or mesiobasal temporal regions can produce gustatory hallucinations.PDF p.2, section 3.1 Auras; PDF p.2, Table 1

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdfNarrative, educational, or cited context · 1 finding

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

olfactory and gustatory hallucinationsUnpleasant olfactory and gustatory hallucinations can result from seizures involving mesial temporal structures, particularly the amygdala, but are not pathognomonic because gustatory symptoms with hypersalivation and olfactory symptoms have also been reported with opercular and orbitofrontal seizures, respectively.PDF p.8, Focal sensory seizures; PDF p.10, Temporal plus epilepsy

jobst-insula-and-its-epilepsies-2019.pdfNarrative, educational, or cited context · 2 findings · 1 reported value

jobst-insula-and-its-epilepsies-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

olfactory auraOlfactory auras are among the reported clinical manifestations of insular seizures.PDF p.2, Clinical Features
olfactory stimulation responsesOlfactory sensations represented 1% of all responses in the cited insular stimulation series.PDF p.5, Other Insular Responses; PDF p.5, Figure 4 panel 5

Reported values

1% olfactory responsesolfactory stimulation responsesPercentage · all responses in the cited insular stimulation series · stimulation-evoked semiologyPDF p.5, Other Insular Responses; PDF p.5, Figure 4 panel 5

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 1 finding

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Olfactory auraTable 2 associates olfactory aura with orbitofrontal cortex, amygdala (uncinate), and insula and describes it as non-lateralising.PDF p.3, Table 2

luders-semiological-seizure-classification-1998.pdfNarrative, educational, or cited context · 1 finding

luders-semiological-seizure-classification-1998.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Olfactory auraPerception of a smell as an epileptic phenomenon is an olfactory aura; when complex perceptual alterations coexist, the episode is psychic unless the olfactory aura is clearly predominant.PDF p.3, Auras, subsection Olfactory auras; PDF p.2, Table 1

mazzola-electrical-stimulation-human-insula-ictal-semiology-2017.pdfNarrative, educational, or cited context · 1 finding · 2 reported values

mazzola-electrical-stimulation-human-insula-ictal-semiology-2017.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.80 · 1 × 0.9 × 2

Findings

olfactory sensationsSix olfactory responses (1%) were evoked from the insula; odors were unpleasant or indefinable in the remaining three cases described by the source, were located in the nasal cavity, and were not lateralized.PDF p.3, Results and Table 1; PDF p.5, Other Types of Evoked Sensations and Fig. 5A

Reported values

6 olfactory responses (1%)olfactory sensationsPercentage · n/N 6/550 · 6 olfactory responses in the 550-response series · olfactory responses · stimulation-evoked olfactory sensationPDF p.3, Results and Table 1; PDF p.5, Other Types of Evoked Sensations and Fig. 5A
three other described casesolfactory sensationsCount · 6 olfactory responses in the 550-response series · unpleasant or indefinable odors · stimulation-evoked olfactory sensationPDF p.3, Results and Table 1; PDF p.5, Other Types of Evoked Sensations and Fig. 5A

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdfNarrative, educational, or cited context · 1 finding

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

stimulation-evoked somatosensory, auditory, vestibular, olfactory, gustatory, and viscerosensory symptomsThe chapter reports that electrical stimulation studies evoked somatosensory symptoms, including pain, from the posterior two-thirds of the insula; auditory and vestibular symptoms from the posterior insula; and olfactory, gustatory, and viscerosensory symptoms, including laryngeal constriction, from the midinsula, whereas stimulation of the most anterior portion rarely evoked symptoms unless a larger network seizure was elicited.PDF p.3, insular functional differentiation and electrical cortical stimulation

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdfNarrative, educational, or cited context · 1 finding

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

olfactory aurasThe review states that olfactory auras are usually unpleasant smells, have no lateralizing value, and are most frequently seen in mesial temporal lobe epilepsy; it also reports that a relatively high percentage of these patients have neoplasms involving the amygdala.PDF p.2, Olfactory auras

15 contributing manuscripts; source-reported values remain separate and are not pooled.

Visual auraReported: BilateralAlso reported: ContralateralNo single reliable side13 manuscripts · 35 findings · 30 reported values

Weighted evidence supportevidence weight 31.31 across 13 manuscripts · 5 independent primary study · 6 narrative, educational, or cited context · 2 systematic review or meta-analysis

Source-defined result groups 17

Localization: TemporalSource-defined values retained separatelyT+ group · TL group versus T+ group · seizures1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyMesial TLE patients assessed for Visual aura · lateral TLE percentage shown separately · reported mesial-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTL group · TL group versus T+ group · seizures1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 12.5%M · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 33.3%ML · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTL group · TL group versus T+ group · seizures1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 84.6%L · other M/ML/L subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · reported sign prevalence across included studies1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTL group · TL group versus T+ group · seizures1 manuscript · 1 reported value · not pooled

Localization: OccipitalObserved proportion 73.8%All reported · no visual aura · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyT+ group · TL group versus T+ group · seizures1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyLateral TLE patients assessed for Visual aura · mesial TLE percentage shown separately · reported lateral-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 13

Alphabetical by manuscript.

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 1 finding · 8 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

visual auraVisual auras did not differ significantly overall between TL and T+ groups, although the table reports a significant subcategory P value for visual illusions and not for visual hallucinations.PDF p.6, Table 2

Reported values

T+ 13%visual auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictal onsetPDF p.6, Table 2
TL visual illusions 5.1%visual auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictal onsetPDF p.6, Table 2
T+ visual illusions 13%visual auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictal onsetPDF p.6, Table 2
T+ visual hallucinations 4.3%visual auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictal onsetPDF p.6, Table 2
TL 6.8%visual auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictal onsetPDF p.6, Table 2
P=0.36visual auraP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictal onsetPDF p.6, Table 2
P=0.02visual auraP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictal onsetPDF p.6, Table 2
TL visual hallucinations 1.7%visual auraPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictal onsetPDF p.6, Table 2

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfSystematic review or meta-analysis · 3 findings · 3 reported values

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

visual sensationsVisual sensations accounted for 5% of the sensory manifestations in the narrative summary.PDF p.4, Semiology and clinical features; PDF p.6, Table 3
Visual (Table 3)Table 3 reports visual symptoms in 4 cases (5%), more at seizure onset.PDF p.6, Table 3
Visual (Table 4)In the 60 high/very-high-confidence cases, Table 4 reports visual symptoms in 2 cases (3%).PDF p.7, Table 4

Reported values

5% visual sensationsvisual sensationsPercentage · reviewed basal temporal seizure cases · ictal onset in Table 3PDF p.4, Semiology and clinical features; PDF p.6, Table 3
4 cases (5%)Visual (Table 3)Percentage · Table 3 basal temporal seizure cases · onsetPDF p.6, Table 3
2/60 (3%)Visual (Table 4)Percentage · n/N 2/60 · 60 basal temporal seizure cases with high or very-high EZ confidence · ictalPDF p.7, Table 4

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

occipital lobe seizure; visual auraOccipital lobe seizures are usually characterized by visual aura in 40%–75% of patients, with oculomotor features such as eye deviation, blinking, or nystagmus less commonly reported.PDF p.7, Occipital lobe seizures

Reported values

visual aura 40%–75%occipital lobe seizure; visual auraPercentage Range · patients with occipital lobe epilepsy · ictal aura/early manifestationPDF p.7, Occipital lobe seizures

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.35 · 1 × 0.9 × 1.5

Findings

visual aura; insular subgroupOne insular-subgroup patient had a visual aura.PDF p.3, Aura

Reported values

1 patientvisual aura; insular subgroupCount · n/N 1/10 · Insular subgroup of OFC-extended EZN · Insular subgroup of OFC-extended EZN · ictal auraPDF p.3, Aura

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdfSystematic review or meta-analysis · 11 findings · 4 reported values

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

Visual auraTable 3 reports 3 studies assessing Visual aura.PDF p.6, Table 3
Visual auraTable 3 reports 54 patients assessed for Visual aura.PDF p.6, Table 3
Visual auraTable 3 reports 0–6.7% as the percentage range or value for Visual aura; the overall association grade is Low.PDF p.6, Table 3
odds of occurrence; Visual auraTable 4 reports overall odds of 0.05 for occurrence of Visual aura in lateral TLE.PDF p.7, Table 4; PDF p.8, Figure 2
odds confidence interval; Visual auraTable 4 reports a 95% confidence interval of 0.01–0.18 for the overall odds of Visual aura.PDF p.7, Table 4; PDF p.8, Figure 2
heterogeneity test; Visual auraThe heterogeneity test for the Table 4 odds estimate for Visual aura has p=0.8723.PDF p.7, Table 4
Visual aura; lateral versus mesial comparisonTable 5 reports 2 studies comparing Visual aura in lateral and mesial TLE.PDF p.9, Table 5
Visual aura; lateral TLE patient denominatorTable 5 reports 32 lateral-TLE patients assessed for Visual aura.PDF p.9, Table 5
Visual aura; mesial TLE patient denominatorTable 5 reports 51 mesial-TLE patients assessed for Visual aura.PDF p.9, Table 5
Visual aura; lateral TLE prevalenceTable 5 reports a lateral-TLE percentage of 0–6.7% for Visual aura.PDF p.9, Table 5
Visual aura; mesial TLE prevalenceTable 5 reports a mesial-TLE percentage of 0–5% for Visual aura.PDF p.9, Table 5

Reported values

0–6.7%Visual auraPercentage Range · Lateral temporal epilepsy patients assessed for Visual aura · ictalPDF p.6, Table 3
odds 0.05odds of occurrence; Visual auraOdds · Lateral temporal epilepsy patients assessed for Visual aura · ictalPDF p.7, Table 4; PDF p.8, Figure 2
0–6.7%Visual aura; lateral TLE prevalencePercentage Range · Lateral TLE patients assessed for Visual aura · Lateral TLE patients assessed for Visual aura · ictalPDF p.9, Table 5
0–5%Visual aura; mesial TLE prevalencePercentage Range · Mesial TLE patients assessed for Visual aura · Mesial TLE patients assessed for Visual aura · ictalPDF p.9, Table 5

gibbs-clinical-features-sleep-related-hypermotor-epilepsy-2019.pdfIndependent primary study · 1 finding · 3 reported values

gibbs-clinical-features-sleep-related-hypermotor-epilepsy-2019.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

auditory and visual nonmotor manifestationsAuditory and visual manifestations were observed only in extrafrontal SHE; visual symptoms were associated with a posterior cortex SOZ, whereas auditory symptoms were associated with either a temporal or an operculoinsular SOZ.PDF p.5, section 3.3; PDF p.6, Table 2

Reported values

visual posterior 2auditory and visual nonmotor manifestationsCount · Extrafrontal SHE patients in the 115-patient semiology-analysis cohort; Table 2 lists auditory n=1 in temporal and n=1 in operculoinsular subgroups and visual n=2 in the posterior subgroup · visual manifestation; posterior SOZ · early nonmotor seizure onsetPDF p.5, section 3.3; PDF p.6, Table 2
auditory operculoinsular 1auditory and visual nonmotor manifestationsCount · Extrafrontal SHE patients in the 115-patient semiology-analysis cohort; Table 2 lists auditory n=1 in temporal and n=1 in operculoinsular subgroups and visual n=2 in the posterior subgroup · auditory manifestation; operculoinsular SOZ · early nonmotor seizure onsetPDF p.5, section 3.3; PDF p.6, Table 2
auditory temporal 1auditory and visual nonmotor manifestationsCount · Extrafrontal SHE patients in the 115-patient semiology-analysis cohort; Table 2 lists auditory n=1 in temporal and n=1 in operculoinsular subgroups and visual n=2 in the posterior subgroup · auditory manifestation; temporal SOZ · early nonmotor seizure onsetPDF p.5, section 3.3; PDF p.6, Table 2

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Visual aura prevalence in occipital lobe seizuresThe review reports that visual auras occur in approximately more than 70% of series reporting occipital-lobe seizures.PDF p.6, section 1.12

Reported values

Approximately >70% of occipital-lobe seizure seriesVisual aura prevalence in occipital lobe seizuresPercentage · Series reporting occipital-lobe seizures · ictalPDF p.6, section 1.12

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdfNarrative, educational, or cited context · 1 finding · 2 reported values

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Visual aura and homonymous hemifield auraThe review states that homonymous hemifield defects and auras lateralize the seizure focus to the contralateral hemisphere; simple visual auras are linked to contralateral areas 17-19, while more complex visual auras may involve the temporo-parieto-occipital junction.PDF p.3, section 2.5 Visual auras; PDF p.3, section 2.5.1 Mechanism; PDF p.12, Table 1

Reported values

28.6% of occipital-lobe epilepsy patientsVisual aura and homonymous hemifield auraPercentage · Patients with occipital or other focal epilepsy with visual manifestations · occipital-lobe epilepsy · Ictal auraPDF p.3, section 2.5 Visual auras; PDF p.3, section 2.5.1 Mechanism; PDF p.12, Table 1
100% contralateralVisual aura and homonymous hemifield auraPercentage · Patients with occipital or other focal epilepsy with visual manifestations · patients with hemifield visual aura · Ictal auraPDF p.3, section 2.5 Visual auras; PDF p.3, section 2.5.1 Mechanism; PDF p.12, Table 1

luders-semiological-seizure-classification-1998.pdfNarrative, educational, or cited context · 1 finding

luders-semiological-seizure-classification-1998.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Visual auraIsolated visual hallucinations or illusions are visual auras; when visual phenomena occur with complex perceptual distortions they remain visual only if clearly predominant for a significant part of the aura, otherwise they are psychic auras, while poorly defined blurry vision is unclassifiable.PDF p.3, Auras, subsection Visual auras; PDF p.2, Table 1

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdfIndependent primary study · 1 finding · 3 reported values

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdf

Independent primary study · Class II · Evidence weight 5.07 · 2 × 1.5 × 1.69

Findings

sensory hallucination or illusion (visual, auditory, vestibular)The combined category of visual, auditory, or vestibular sensory hallucination or illusion was more frequent in L than M or ML patients.PDF p.5, Table 2; PDF p.5, Semiologic analysis; PDF p.8, Sensory illusions and hallucinations

Reported values

6/18 (33.3%)sensory hallucination or illusion (visual, auditory, vestibular)Percentage · n/N 6/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · initial ictal subjective symptomPDF p.5, Table 2; PDF p.5, Semiologic analysis; PDF p.8, Sensory illusions and hallucinations
3/24 (12.5%)sensory hallucination or illusion (visual, auditory, vestibular)Percentage · n/N 3/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · initial ictal subjective symptomPDF p.5, Table 2; PDF p.5, Semiologic analysis; PDF p.8, Sensory illusions and hallucinations
11/13 (84.6%)sensory hallucination or illusion (visual, auditory, vestibular)Percentage · n/N 11/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · initial ictal subjective symptomPDF p.5, Table 2; PDF p.5, Semiologic analysis; PDF p.8, Sensory illusions and hallucinations

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdfIndependent primary study · 5 findings · 4 reported values

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdf

Independent primary study · Class II · Evidence weight 4.89 · 2 × 1.35 × 1.812

Findings

visual auras in Ludwig and Ajmone-MarsanThe source reports that visual auras occurred in 47% of Ludwig and Ajmone-Marsan’s patients.PDF p.20, Discussion
visual auras in Blume et al.The source reports that visual auras occurred in 68% of Blume et al.’s patients.PDF p.20, Discussion
Gowers ocular and visual warningsThe source recounts Gowers’ five the source's own categories of ocular and visual warnings: sensation in the eyeball, diplopia, apparent increase or diminution in object size, loss of sight, and distinct elementary visual sensations.PDF p.2, Introduction
visual sensations in focal epilepsyPenfield and Kristiansen reported visual sensations as the initial seizure manifestation in 11 of 222 surgically treated patients with focal epilepsy, with each seizure originating in the occipital lobe.PDF p.2, Introduction
visual auraVisual auras occurred in 31 of 42 patients.PDF p.4, Results, Visual auras

Reported values

47%visual auras in Ludwig and Ajmone-MarsanPercentage · cited Ludwig and Ajmone-Marsan occipital epilepsy series · aura or seizure onsetPDF p.20, Discussion
68%visual auras in Blume et al.Percentage · cited Blume et al. posterior-cortex surgery series · aura or seizure onsetPDF p.20, Discussion
11/222 patients with visual sensations as initial manifestationvisual sensations in focal epilepsyProportion · n/N 11/222 · Penfield and Kristiansen cited surgical series · seizure onsetPDF p.2, Introduction
31/42 (73%) patientsvisual auraPercentage · n/N 31/42 · 42 medically refractory patients with source-defined occipital lobe epilepsy · aura or seizure onsetPDF p.4, Results, Visual auras

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdfNarrative, educational, or cited context · 1 finding

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

visual aurasThe review states that visual auras are often perceived in front of both eyes without clear lateralization, but may occasionally be lateralized to one visual field contralateral to the symptomatogenic zone and may be localized to an upper or lower field; simple visual hallucinations are assigned to Brodmann areas 17 and 18, while complex hallucinations or illusions more likely involve parieto-temporal association cortex or adjacent lobes. During or after amaurosis, flashing lights may appear over the blind field.PDF p.2, Visual auras

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdfIndependent primary study · 7 findings

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

visual aura to oculomotor to evolving motor phenotypePhenotype III progresses from visual aura to head-eye deviation or eye pursuit, then to contralateral limb tonic or asymmetric tonic posturing, with some seizures evolving to GTCS.PDF p.9, Phenotype III
dorsal parietal to premotor motor evolutionThe authors link rapid motor evolution after visual aura to propagation to dorsal parietal nodes and then premotor areas.PDF p.13, Phenotype III discussion
pure visual phenotypePhenotype I is defined by exclusive subjective visual auras, including elementary visual hallucinations, amaurosis, or visual obscuration, without objective motor or autonomic progression.PDF p.9, Phenotype I
visual aura to automatism phenotypePhenotype II is characterized primarily by oropharyngeal, limb, or verbal automatisms, with or without a preceding visual aura.PDF p.9, Phenotype II
Pattern I pure visual signsPattern I seizures presented pure visual auras without objective motor or autonomic symptoms.PDF p.9, Pattern I
absent or overshadowed visual aura in temporal-like semiologyOccipital seizure semiology may closely resemble temporal-lobe epilepsy when visual auras are absent, brief, or overshadowed.PDF p.13, Phenotype II discussion
visual aura to head-eye deviation or pursuitIn Phenotype III, a visual aura rapidly progresses to head-eye deviation or eye pursuit.PDF p.9, Phenotype III; PDF p.13, Phenotype III discussion

13 contributing manuscripts; source-reported values remain separate and are not pooled.

Tonic motor phenomenonReported: BilateralAlso reported: ContralateralAlso reported: IpsilateralAlso reported: Right hemisphere15 manuscripts · 46 findings · 49 reported values

Weighted evidence supportevidence weight 31.3 across 15 manuscripts · 1 manuscript weight pending · 4 independent primary study · 1 structured design not resolved · 3 systematic review or meta-analysis · 6 narrative, educational, or cited context · 1 case report or observation

The source describes visual aura followed by head-eye deviation and contralateral tonic posturing as activity propagates through dorsal parietal nodes toward premotor areas. Ipsilateral tonic motor signs were associated with T+ seizures at P=0.05, but the side reference is not defined and the overall tonic-motor comparison did not differ significantly. In the unilateral TLE cohort, tonic posture occurred only contralateral to the EEG seizure-onset focus in 17 seizures from 12 patients. The review describes early upper-limb and orofacial elementary motor signs as mainly contralateral tonic, clonic, or dystonic manifestations. At onset, 8/21 fronto-opercular epilepsy patients had contralateral brachial tonic, clonic, or dystonic posturing. Four of 12 prefrontal-operculum patients had contralateral brachial tonic, clonic, or dystonic posturing at onset. Four of nine precentral Rolandic-operculum patients had contralateral brachial tonic, clonic, or dystonic posturing at onset. This row restates the Fisher exact test for the contralateral brachial combined-sign comparison. The cited table lists tonic semiology as contralateral if unilateral. The cited table associates tonic posturing with contralateral lateralisation. The review states that clearly unilateral tonic activity points toward the contralateral seizure-onset side, while bilateral/asymmetric patterns and cohort distributions remain context-dependent. The patient-level observation reports bilateral tonic activity with right arm extension. The review says tonic seizures often involve bilateral proximal contraction, while clearly unilateral tonic seizures strongly support contralateral seizure origin. Version-first and version-plus-tonic sequence counts are reported, with correct EZ lateralization in 3/4 tonic-start/asymmetric-clonic sequences and 1/1 M2e-to-clonic sequence, but no direction is stated. The review describes head/eye deviation as suggesting an ipsilateral focus and other listed unilateral motor signs as usually indicating a contralateral focus. No seizure-hemisphere lateralization is reported; bilateral refers to tonic body distribution. No lateralization relationship is reported. No lateralizing information is supplied. No lateralization information is reported. No lateralization is reported. No lateralizing direction is reported for the the source's own tonic category. No lateralizing semiology is reported; this row is a figure-panel sample-size label for tonic data. No lateralizing semiology is reported; this row is a figure-panel sample-size label for the non-topological tonic data. The tonic estimate reports localization only. No lateralizing direction is reported for the tonic cingulate estimate. No lateralizing direction is reported for the tonic-cingulate percentage. No lateralizing direction is reported for the tonic-seizure frontal-lobe association. No lateralizing direction is reported for the tonic-to-clonic propagation description.

Source-defined result groups 16

Lateralization: ContralateralSource-defined values retained separatelyipsilateral · ipsilateral versus contralateral to EEG focus · seizure, with patient count in parentheses1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 14.7%contralateral · ipsilateral versus contralateral to EEG focus · seizure, with patient count in parentheses1 manuscript · 1 reported value · not pooled

Localization: cingulateSource-defined values retained separatelycingulate localization · localizing data point1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelycontralateral · ipsilateral versus contralateral to EEG focus · seizure, with patient count in parentheses1 manuscript · 1 reported value · not pooled

Localization: ParietalObserved proportion 60.9%All reported · tonic-posturing patients without superior parietal involvement · patients with tonic posturing1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 38.1%All reported · prefrontal operculum versus precentral Rolandic operculum · all included patients1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 42.9%All reported · prefrontal operculum versus precentral Rolandic operculum · all included patients1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 15

Alphabetical by manuscript.

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdfSystematic review or meta-analysis · 18 findings · 8 reported values

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

tonicTable 1 defines or exemplifies the the source's own semiology category “tonic” as Stiff posturing of one or more limbs or torso.PDF p.7, Table 1 Semiology descriptions and frequencies
tonicTonic semiology comprised 9.8% of non-topological data.PDF p.7, Table 1 Semiology descriptions and frequencies
tonic; Figure 3 all-data subsetFigure 3 reports N = 971 for the all-data tonic panel.PDF p.9, Figure 3 and caption
tonic; Figure 3 non-topological subsetFigure 3 reports N = 345 for the non-topological tonic panel.PDF p.9, Figure 3 and caption
tonic; temporal lobe; all dataTonic semiology localized to the temporal lobe in 48% of all-data estimates.PDF p.7, Seizure semiology localizing values
tonic; temporal lobe; all dataThe 95% CI for the all-data temporal-lobe estimate for tonic semiology was 44%–53%.PDF p.7, Seizure semiology localizing values
tonic; temporal lobe; non-topologicalTonic semiology localized to the temporal lobe in 20% of the non-topological estimate.PDF p.7, Seizure semiology localizing values
tonic; temporal lobe; non-topologicalThe 95% CI for the non-topological temporal-lobe estimate for tonic semiology was 15%–24%.PDF p.7, Seizure semiology localizing values
tonic; frontal lobe; non-topologicalTonic semiology localized to the frontal lobe in 54% of the non-topological estimate.PDF p.8, Seizure semiology localizing values
tonic; frontal lobe; non-topologicalThe 95% CI for the non-topological frontal-lobe estimate for tonic semiology was 47%–61%.PDF p.8, Seizure semiology localizing values
tonic; frontal lobe; all dataTonic semiology localized to the frontal lobe in 29% of the all-data estimate.PDF p.8, Seizure semiology localizing values
tonic; frontal lobe; all dataThe 95% CI for the all-data frontal-lobe estimate for tonic semiology was 26%–32%.PDF p.8, Seizure semiology localizing values
tonic; frontal lobeTonic seizures originated mainly from the frontal lobe in 54%.PDF p.8, Seizure semiology localizing values
tonic; frontal lobeThe 95% CI for tonic; frontal lobe was 47%–61%.PDF p.8, Seizure semiology localizing values
tonic; cingulatetonic semiology was cingulate in 7%.PDF p.8, Seizure semiology localizing values
tonic; cingulateThe 95% CI for tonic; cingulate was 4%–9%.PDF p.8, Seizure semiology localizing values
tonic seizures; frontal lobeTonic seizures had an intrinsic localizing OR of 3.0 for frontal-lobe onset.PDF p.8, Relative localizing values of semiologies
tonic seizures; frontal lobeThe 95% CI for tonic seizures; frontal lobe was 2.4–3.7.PDF p.8, Relative localizing values of semiologies

Reported values

tonic 9.8%tonicPercentage · non-topological Semio2Brain dataPDF p.7, Table 1 Semiology descriptions and frequencies
tonic; temporal lobe; all data 48%tonic; temporal lobe; all dataPercentage · non-topological localizing data points unless otherwise statedPDF p.7, Seizure semiology localizing values
tonic; temporal lobe; non-topological 20%tonic; temporal lobe; non-topologicalPercentage · non-topological localizing data points unless otherwise statedPDF p.7, Seizure semiology localizing values
tonic; frontal lobe; non-topological 54%tonic; frontal lobe; non-topologicalPercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
tonic; frontal lobe; all data 29%tonic; frontal lobe; all dataPercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
tonic; frontal lobe 54%tonic; frontal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
tonic; cingulate 7%tonic; cingulatePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
OR 3.0tonic seizures; frontal lobeOdds ratio · non-topological Semio2Brain data unless otherwise statedPDF p.8, Relative localizing values of semiologies

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfCase report or observation · 1 finding

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

patient 2 bilateral tonic right-arm extensionBilateral tonic activity with right arm extension was listed for patient 2.PDF p.4, Figure 3

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 2 findings · 11 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

tonic motor signsTonic motor signs did not differ significantly overall between TL and T+ groups, but the ipsilateral tonic subtype was associated with T+ seizures.PDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
tonic motor signsSimple motor signs were common and most often consisted of tonic motor signs, reported in 48.7% of analyzed seizures.PDF p.5, Seizure clinical semiology

Reported values

TL ipsilateral 25.4%tonic motor signsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
P=0.13tonic motor signsP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
TL bilateral 25.4%tonic motor signsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
TL contralateral 37.3%tonic motor signsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
T+ ipsilateral 47.8%tonic motor signsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
T+ tonic motor 60.9%tonic motor signsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
TL tonic motor 37.3%tonic motor signsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
T+ bilateral 39.1%tonic motor signsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
T+ contralateral 52.2%tonic motor signsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
P=0.05tonic motor signsP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictalPDF p.1, abstract; PDF p.5, Seizure clinical semiology; PDF p.6, Table 2; PDF p.7, Table 3; PDF p.8, Motor signs
tonic motor signs 48.7%tonic motor signsPercentage · 80 analyzed seizures, one typical seizure per patient · ictalPDF p.5, Seizure clinical semiology

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 1 finding

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

tonic posturing; clonic jerksThe source describes clonic jerks following focal tonic manifestations as likely reflecting propagation from the SMA to the primary motor area.PDF p.7, Discussion

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

tonic seizuresTonic seizures involve sustained contraction with posturing; although proximal muscles are often affected bilaterally, clearly unilateral tonic seizures strongly support seizure origin in the contralateral hemisphere.PDF p.3, section 3.2 Simple motor seizures; PDF p.2, Table 1

Reported values

Tonic contraction lasts at least 3 secondstonic seizuresCount · patients with focal epilepsy · ictal motorPDF p.3, section 3.2 Simple motor seizures; PDF p.2, Table 1

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdfNarrative, educational, or cited context · 1 finding

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

unilateral dystonic posturing, head/eye deviation, clonic or tonic movements, and hypokinesiaSecondary motor signs related to propagation outside the temporal lobe may lateralize the seizure-onset zone: unilateral dystonic posturing is usually contralateral to the focus, head or eye deviation suggests an ipsilateral focus, and other unilateral clonic or tonic movements or limb immobility usually indicate a contralateral focus.PDF p.8, Focal impaired awareness seizures

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdfSystematic review or meta-analysis · 9 findings · 6 reported values

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

elementary motor symptoms; orofacial; brachial; tonic; clonic; dystonicElementary motor symptoms were described as early, mainly involving the orofacial regions and/or arms; arm manifestations were mainly contralateral tonic, clonic, or dystonic seizures or postures.PDF p.6, Anatomical and clinical correlations; PDF p.8, Discussion
Brachial contralateral (tonic and/or clonic or dystonic posture)Table 2 reports 8/21 (38%) for Brachial contralateral (tonic and/or clonic or dystonic posture); timing is onset, and the source's overall agreement that the sign is suggestive of fronto-opercular epilepsy is graded Moderate.PDF p.7, Table 2
Brachial contralateral (tonic and/or clonic or dystonic posture)Table 2 reports 4/12 patients with Brachial contralateral (tonic and/or clonic or dystonic posture) in the prefrontal operculum group.PDF p.7, Table 2
Brachial contralateral (tonic and/or clonic or dystonic posture)Table 2 reports 4/9 patients with Brachial contralateral (tonic and/or clonic or dystonic posture) in the precentral Rolandic operculum group.PDF p.7, Table 2
Brachial contralateral (tonic and/or clonic or dystonic posture)Fisher's exact comparison of Brachial contralateral (tonic and/or clonic or dystonic posture) between the prefrontal and precentral Rolandic operculum groups has p=0.673.PDF p.7, Table 2
Elementary motor: orofacial (tonic and/or clonic, grimace)Table 2 reports 9/21 (43%) for Elementary motor: orofacial (tonic and/or clonic, grimace); timing is onset, and the source's overall agreement that the sign is suggestive of fronto-opercular epilepsy is graded High.PDF p.7, Table 2
Elementary motor: orofacial (tonic and/or clonic, grimace)Table 2 reports 4/12 patients with Elementary motor: orofacial (tonic and/or clonic, grimace) in the prefrontal operculum group.PDF p.7, Table 2
Elementary motor: orofacial (tonic and/or clonic, grimace)Table 2 reports 5/9 patients with Elementary motor: orofacial (tonic and/or clonic, grimace) in the precentral Rolandic operculum group.PDF p.7, Table 2
Elementary motor: orofacial (tonic and/or clonic, grimace)Fisher's exact comparison of Elementary motor: orofacial (tonic and/or clonic, grimace) between the prefrontal and precentral Rolandic operculum groups has p=0.396.PDF p.7, Table 2

Reported values

8/21 (38%)Brachial contralateral (tonic and/or clonic or dystonic posture)Percentage · n/N 8/21 · 21 included fronto-opercular epilepsy patients · OnsetPDF p.7, Table 2
4/12 patientsBrachial contralateral (tonic and/or clonic or dystonic posture)Proportion · n/N 4/12 · 12 patients with EZ in the prefrontal operculum · 12 patients with EZ in the prefrontal operculum · OnsetPDF p.7, Table 2
4/9 patientsBrachial contralateral (tonic and/or clonic or dystonic posture)Proportion · n/N 4/9 · 9 patients with EZ in the precentral Rolandic operculum · 9 patients with EZ in the precentral Rolandic operculum · OnsetPDF p.7, Table 2
9/21 (43%)Elementary motor: orofacial (tonic and/or clonic, grimace)Percentage · n/N 9/21 · 21 included fronto-opercular epilepsy patients · OnsetPDF p.7, Table 2
4/12 patientsElementary motor: orofacial (tonic and/or clonic, grimace)Proportion · n/N 4/12 · 12 patients with EZ in the prefrontal operculum · 12 patients with EZ in the prefrontal operculum · OnsetPDF p.7, Table 2
5/9 patientsElementary motor: orofacial (tonic and/or clonic, grimace)Proportion · n/N 5/9 · 9 patients with EZ in the precentral Rolandic operculum · 9 patients with EZ in the precentral Rolandic operculum · OnsetPDF p.7, Table 2

jobst-insula-and-its-epilepsies-2019.pdfNarrative, educational, or cited context · 2 findings

jobst-insula-and-its-epilepsies-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

tonic motor manifestationTonic motor manifestations are among the clinical manifestations reported with insular seizures.PDF p.2, Clinical Features
tonic motor sign frontal-like symptomFrontal-like insular seizures may include tonic motor signs.PDF p.2, Clinical Features

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 2 findings

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Tonic seizure patternTable 2 associates tonic semiology with primary motor cortex and SSMA and lists contralateral lateralisation if unilateral.PDF p.3, Table 2
Tonic posturingTable 3 associates tonic posturing with SSMA, basal ganglia, cingulum, and primary motor cortex (M1) and contralateral lateralisation.PDF p.4, Table 3

luders-semiological-seizure-classification-1998.pdfNarrative, educational, or cited context · 2 findings · 2 reported values

luders-semiological-seizure-classification-1998.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

tonic seizureThe source defines tonic seizures as sustained muscle contractions, usually lasting more than 3 seconds, that lead to positioning.PDF p.4, Simple motor seizures
Tonic seizureTonic seizures consist of sustained muscle contractions, usually lasting more than 3 seconds, that lead to positioning.PDF p.4, Simple motor seizures, Tonic seizures; PDF p.2, Table 1

Reported values

muscle-contraction duration usually >3 stonic seizureDuration Threshold · ictalPDF p.4, Simple motor seizures
Usually >3 s muscle-contraction durationTonic seizureCount · IctalPDF p.4, Simple motor seizures, Tonic seizures; PDF p.2, Table 1

marashly-ictal-motor-sequences-lateralization-localization-values-2016.pdfIndependent primary study · 1 finding · 13 reported values

marashly-ictal-motor-sequences-lateralization-localization-values-2016.pdf

Independent primary study · Class II · Evidence weight 4.12 · 2 × 1.15 × 1.79

Findings

version-first ictal motor sequence; version plus tonic and/or M2e progressionAmong the 38 sequence seizures, version was the first motor sign in 29/38; among those 29 version-first seizures, M2e followed in 15/29 and tonic posturing in 7/29, which the authors combine as version followed by a tonic seizure in 22/29 because they treat M2e as a special tonic form. One seizure had simultaneous version and tonic posturing as the first sign followed by secondary generalization and asymmetric clonic ending; three of the remaining non-version-first seizures showed version plus tonic activity in a different order; in total 33/38 showed version plus tonic activity in variable order. Version was absent in 5/38, four seizures started with tonic activity and ended with asymmetric clonic ending, three of those lateralized the EZ correctly, and one M2e-to-clonic sequence lateralized the EZ correctly.PDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign

Reported values

Correct EZ lateralization in M2e-to-clonic sequence 1/1version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 1/1 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Correct EZ lateralization in M2e-to-clonic sequence · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
M2e-to-clonic sequence 1/38version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 1/38 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · M2e-to-clonic sequence · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Version absent 5/38version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 5/38 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Version absent · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Version as second sign in non-version-first seizures 4/9version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 4/9 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Version as second sign in non-version-first seizures · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Non-version-first with version plus tonic in different order 3/9version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 3/9 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Non-version-first with version plus tonic in different order · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Version plus tonic in variable order 33/38version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 33/38 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Version plus tonic in variable order · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Tonic start with asymmetric clonic ending 4/38version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 4/38 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Tonic start with asymmetric clonic ending · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Tonic posturing second after version 7/29version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 7/29 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Tonic posturing second after version · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Version followed by tonic including M2e 22/29version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 22/29 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Version followed by tonic including M2e · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Version first 29/38version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 29/38 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Version first · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
M2e second after version 15/29version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 15/29 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · M2e second after version · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Simultaneous version and tonic as first sign 1/38version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 1/38 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Simultaneous version and tonic as first sign · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign
Correct EZ lateralization among tonic-start/asymmetric-clonic sequences 3/4version-first ictal motor sequence; version plus tonic and/or M2e progressionPercentage · n/N 3/4 · 38 representative sequence seizures from the 47-patient cohort; the source also uses “patients” for some of these counts · Correct EZ lateralization among tonic-start/asymmetric-clonic sequences · pre-secondary-generalization ictal motor sequencePDF p.2, Summary; PDF p.9, Results; PDF p.10, Discussion; PDF p.11, Discussion; PDF p.21, Fig. 1 captioned prevalence of individual signs as first sign

roh-lateralizing-value-ictal-behaviors-temporal-lobe-epilepsy-1996.pdfStructured design not resolved · 1 finding · 3 reported values

roh-lateralizing-value-ictal-behaviors-temporal-lobe-epilepsy-1996.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 2

Findings

tonic postureIn the unilateral TLE cohort, tonic posture occurred only on the side contralateral to the EEG seizure focus.PDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1

Reported values

12 patients with contralateral tonic posturetonic postureCount · 19 patients with unilateral TLE; tonic posture occurred in 12 patients · contralateral · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1
0 ipsilateral seizurestonic postureCount · 19 patients with unilateral TLE; tonic posture occurred in 12 patients · ipsilateral · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1
17 contralateral seizures (15% of all 116 seizures)tonic posturePercentage · n/N 17/116 · 19 patients with unilateral TLE; tonic posture occurred in 12 patients · contralateral · ictalPDF p.1, Abstract; PDF p.3, Results and Table 1; PDF p.4, Figure 1

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdfIndependent primary study · 2 findings · 2 reported values

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdf

Independent primary study · Class II · Evidence weight 5.28 · 2 × 1.35 × 1.957

Findings

tonic posturing of extremitiesTonic posturing of the extremities occurred in 28% of patients.PDF p.4, Results, Other seizure characteristics; PDF p.5, Table 2
superior parietal epileptogenic zone with tonic posturingFourteen of 23 patients with tonic posturing had epileptogenic zones including the superior parietal lobule.PDF p.4, Results, Other seizure characteristics; PDF p.6, Discussion

Reported values

28%tonic posturing of extremitiesPercentage · 82-patient parietal epilepsy series · ictal motor phasePDF p.4, Results, Other seizure characteristics; PDF p.5, Table 2
14/23 (61%) patientssuperior parietal epileptogenic zone with tonic posturingPercentage · n/N 14/23 · 23 patients with tonic posturing · ictal motor phase and seizure-onset localizationPDF p.4, Results, Other seizure characteristics; PDF p.6, Discussion

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdfNarrative, educational, or cited context · 2 findings · 3 reported values

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

tonic seizures in focal epilepsyThe review states that focal tonic seizures preferentially affect proximal muscle groups, may be unilateral or bilateral, and tend to be asymmetric; consciousness is often preserved at onset. Preserved consciousness during bilateral motor activity can localize a focus to the supplementary motor area. Tonic seizures are reported in 62.2% of frontal-lobe epilepsy and 1.7% of temporal-lobe epilepsy; temporal-lobe tonic seizures were unilateral, whereas 32% of frontal-lobe tonic seizures were bilateral. A clearly unilateral tonic seizure has high lateralizing significance toward the contralateral seizure onset.PDF p.3, Tonic seizures
tonic seizures originating from SSMAThe review states that tonic seizures originating from the SSMA may appear bilateral from onset, but careful analysis can show initiation in one body part followed by rapid movement to other limbs; less often the posture is unilateral or restricted to one limb, while proximal-limb and axial involvement remains prominent.PDF p.3, Tonic seizures; PDF p.4, Tonic seizures (continued)

Reported values

tonic seizures 62.2% in frontal-lobe epilepsytonic seizures in focal epilepsyPercentage · Patients with focal epilepsy, compared between frontal-lobe and temporal-lobe epilepsy; cohort denominators not reported · frontal-lobe epilepsy · Ictal tonic seizure, especially onsetPDF p.3, Tonic seizures
32% of frontal-lobe tonic seizures were bilateraltonic seizures in focal epilepsyPercentage · Patients with focal epilepsy, compared between frontal-lobe and temporal-lobe epilepsy; cohort denominators not reported · frontal-lobe tonic seizures · Ictal tonic seizure, especially onsetPDF p.3, Tonic seizures
tonic seizures 1.7% in temporal-lobe epilepsytonic seizures in focal epilepsyPercentage · Patients with focal epilepsy, compared between frontal-lobe and temporal-lobe epilepsy; cohort denominators not reported · temporal-lobe epilepsy · Ictal tonic seizure, especially onsetPDF p.3, Tonic seizures

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdfIndependent primary study · 1 finding

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

dorsal parietal to premotor motor evolutionThe authors link rapid motor evolution after visual aura to propagation to dorsal parietal nodes and then premotor areas.PDF p.13, Phenotype III discussion

15 contributing manuscripts; source-reported values remain separate and are not pooled.

AutomatismsReported: ContralateralAlso reported: Dominant hemisphereAlso reported: Left hemisphereAlso reported: Non-dominant hemisphereAlso reported: Right hemisphere16 manuscripts · 33 findings · 32 reported values

Weighted evidence supportevidence weight 30.6 across 16 manuscripts · 2 manuscript weight pending · 3 independent primary study · 6 narrative, educational, or cited context · 4 systematic review or meta-analysis · 2 structured design not resolved · 1 case report or observation

The review associates mesial-temporal automatisms with hand or mouth movements, ictal speech with nondominant seizures, and unilateral dystonic posturing with a contralateral seizure-onset relation. Automatisms with preserved responsiveness were reported as lateralizing to the non-dominant hemisphere, right in the described right-handed subgroup, with one left-language-dominant left temporal exception. The cited series includes delayed motor signs, including source-described contralateral dystonia, without a reported onset-side direction. The review describes automatisms with dystonia as a strong but direction-unspecified lateralisation clue and preserves the ictal/postictal distinction. The cited study is restated as associating dominant-hemisphere focal-onset seizures with automatisms with loss of awareness and nondominant seizures with retained awareness. The cited study attributes preserved responsiveness during oral or manual automatisms to nondominant temporal onset. Automatisms were more frequent in the RTL group than the LTL group: 52/54 (96%) versus 55/73 (75%), with source-reported p=0.003. The review states that automatisms with preserved responsiveness generally lateralize temporal seizures to the nondominant hemisphere, with one reported exception. The cited study restatement reports preserved-responsiveness automatisms exclusively in right nondominant temporal seizures and not in left temporal seizures. The additional case of automatisms with preserved consciousness was reported in right temporal lobe epilepsy. A case was reported with left hemispheric epilepsy and right-sided language dominance. The case reports a right temporal seizure focus with right-sided language dominance, a dominant-temporal exception to the usual nondominant pattern. The source reports no lateralizing direction for the network-propagation account of occipital-onset seizures. No lateralizing direction is reported. The review classification of ictal feature categories reports no lateralizing direction. No lateralization information is reported. No lateralizing direction is reported for the whole-group prevalence of automatisms. No lateralizing direction is reported for the whole-group automatisms cluster coefficient. No lateralizing direction is reported for the fronto-temporal subgroup automatisms coefficient. No lateralizing direction is reported for the oral or gestural automatism cohort. No hemisphere or body-side direction is reported. No source-supported lateralizing direction is reported for the cited occipital-plus organization summary. The pooled automatisms prevalence is 25%; no hemisphere or body-side direction is reported. I2 heterogeneity was 14.19% with source-reported p=0.28; no hemisphere direction is reported.

Source-defined result groups 10

Lateralization: Right hemisphereObserved proportion 75.3%LTL · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphereObserved proportion 100.0%All reported · patient1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphere / Right hemisphereObserved proportion 100.0%All reported · usual nondominant-hemisphere association · patient1 manuscript · 1 reported value · not pooled

Lateralization: Right hemisphereObserved proportion 96.3%RTL · seizure1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Non-dominant hemisphere / Right hemisphereSource-defined values retained separatelyAll reported · Lobar subgroup comparison within the surgical cohort. · Seizure and patient counts for sign occurrence; narrative subgroup includes seizures and patients.1 manuscript · 1 reported value · not pooled

Localization: Parietal / TemporalObserved proportion 78.6%All reported · automatisms without the listed extension · patients with oral or gestural automatisms1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 100.0%All reported · usual nondominant-hemisphere association · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 100.0%All reported · patient1 manuscript · 1 reported value · not pooled

Lateralization: Right hemisphereObserved proportion 100.0%All reported · patient1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Non-dominant hemisphere / Right hemisphereObserved proportion range 75.0–80.0% (median 77.5%)narrative right-handed subgroup · Lobar subgroup comparison within the surgical cohort. · Seizure and patient counts for sign occurrence; narrative subgroup includes seizures and patients.1 manuscript · 2 reported values · not pooled

Evidence by contributing manuscript 16

Alphabetical by manuscript.

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdfNarrative, educational, or cited context · 2 findings · 2 reported values

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

ictal vocalization with automatismsA cited study of 102 patients reported 91% sensitivity for detecting temporal-lobe seizures when ictal vocalizations co-occurred with automatisms.PDF p.12, Localizing probabilities
ictal vocalization with automatismsThe same cited study reported 70% specificity for detecting temporal-lobe seizures when ictal vocalizations co-occurred with automatisms.PDF p.12, Localizing probabilities

Reported values

sensitivity 91%ictal vocalization with automatismsSensitivity · 102 patients with ictal vocalizationPDF p.12, Localizing probabilities
specificity 70%ictal vocalization with automatismsSpecificity · 102 patients with ictal vocalizationPDF p.12, Localizing probabilities

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfStructured design not resolved · 2 findings · 1 reported value

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.301

Findings

atypical anterior automatismsAutomatisms were observed in one atypical anterior patient without the violent component seen in the typical group.PDF p.5, Clinical Presentation
posterior cingulate staring and automatisms cited caseThe discussion cites a lesional posterior cingulate case with seizures characterized by staring and automatisms.PDF p.7, Discussion

Reported values

1/4 automatisms without violent componentatypical anterior automatismsProportion · n/N 1/4 · 4 atypical anterior cingulate cases · ictal semiologyPDF p.5, Clinical Presentation

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfNarrative, educational, or cited context · 1 finding

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

delayed motor signs (Duchowny study)The cited Duchowny series is described as having behavioral arrest and delayed motor signs including version, contralateral dystonia, clonic jerks, and automatisms.PDF p.7, cited-study discussion

blair-temporal-lobe-epilepsy-semiology-2012.pdfNarrative, educational, or cited context · 1 finding

blair-temporal-lobe-epilepsy-semiology-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Automatisms in temporal-versus-frontal differentialTable 1 reports automatisms as common and longer in temporal lobe seizures and less common in frontal lobe seizures.PDF p.2, Table 1

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 5 findings · 2 reported values

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

automatismsThe discussion identifies automatisms as a possible early localizing sign in SMA epilepsy because they were mostly reported at seizure onset.PDF p.8, Discussion
automatismsTable 3 lists 11 patients for the the source's own ictal symptom “automatisms”; its table phase label is onset.PDF p.6, Table 3
automatismsTable 3 reports a pooled prevalence of 25% for the the source's own ictal symptom “automatisms”; its table phase label is onset.PDF p.6, Table 3
automatisms; between-study heterogeneityThe source reports I2 heterogeneity of 14.19% for pooled automatisms prevalence.PDF p.5, Results
automatisms; heterogeneity testThe source reports p = 0.28 for the between-study heterogeneity test of pooled automatisms prevalence.PDF p.5, Results

Reported values

25% pooled prevalenceautomatismsPercentage · Patients with SMA or pre-SMA epilepsy in the selected studies · onsetPDF p.6, Table 3
I2 = 14.19%automatisms; between-study heterogeneityHeterogeneity I2 · Patients with SMA or pre-SMA epilepsy in the selected studies · ictal symptom prevalence analysisPDF p.5, Results

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 1 finding

chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

mesial temporal automatisms; ictal speech; unilateral dystonic posturingMesial temporal automatisms often involve the hands or mouth; less common vocalisations and ictal speech are associated with non-dominant seizures; unilateral dystonic posturing can occur and is described as a contralateral sign.PDF p.5, Mesial temporal lobe including hippocampus

elwan-kotagal-lateralizing-localizing-seizure-semiology-2018.pdfIndependent primary study · 1 finding · 8 reported values

elwan-kotagal-lateralizing-localizing-seizure-semiology-2018.pdf

Independent primary study · Class II · Evidence weight 4.36 · 2 × 1.5 × 1.452

Findings

Automatisms with preserved responsivenessAutomatisms with preserved responsiveness were reported as lateralizing to the non-dominant hemisphere with 62% PPV and inter-observer kappa of 0.89, with a right-hemisphere pattern in the described right-handed subgroup and one left-language-dominant exception.PDF p.3, Table 1; PDF p.3, §5.1

Reported values

frontal PPV 0%Automatisms with preserved responsivenessPositive predictive value · Sign-positive occurrences included 21 seizures in 17 patients overall; temporal 15/11, frontal 2/2, parietal 1/1, and occipital 3/3. The narrative additionally describes 6/8 seizures in 4/5 right-handed patients and one left-temporal seizure with left hemispheric language dominance by fMRI. · IctalPDF p.3, Table 1; PDF p.3, §5.1
4/5 patientsAutomatisms with preserved responsivenessPercentage · n/N 4/5 · Sign-positive occurrences included 21 seizures in 17 patients overall; temporal 15/11, frontal 2/2, parietal 1/1, and occipital 3/3. The narrative additionally describes 6/8 seizures in 4/5 right-handed patients and one left-temporal seizure with left hemispheric language dominance by fMRI. · narrative right-handed subgroup · IctalPDF p.3, Table 1; PDF p.3, §5.1
6/8 seizuresAutomatisms with preserved responsivenessPercentage · n/N 6/8 · Sign-positive occurrences included 21 seizures in 17 patients overall; temporal 15/11, frontal 2/2, parietal 1/1, and occipital 3/3. The narrative additionally describes 6/8 seizures in 4/5 right-handed patients and one left-temporal seizure with left hemispheric language dominance by fMRI. · narrative right-handed subgroup · IctalPDF p.3, Table 1; PDF p.3, §5.1
overall PPV 62%Automatisms with preserved responsivenessPositive predictive value · Sign-positive occurrences included 21 seizures in 17 patients overall; temporal 15/11, frontal 2/2, parietal 1/1, and occipital 3/3. The narrative additionally describes 6/8 seizures in 4/5 right-handed patients and one left-temporal seizure with left hemispheric language dominance by fMRI. · IctalPDF p.3, Table 1; PDF p.3, §5.1
occipital PPV 100%Automatisms with preserved responsivenessPositive predictive value · Sign-positive occurrences included 21 seizures in 17 patients overall; temporal 15/11, frontal 2/2, parietal 1/1, and occipital 3/3. The narrative additionally describes 6/8 seizures in 4/5 right-handed patients and one left-temporal seizure with left hemispheric language dominance by fMRI. · IctalPDF p.3, Table 1; PDF p.3, §5.1
temporal PPV 60%Automatisms with preserved responsivenessPositive predictive value · Sign-positive occurrences included 21 seizures in 17 patients overall; temporal 15/11, frontal 2/2, parietal 1/1, and occipital 3/3. The narrative additionally describes 6/8 seizures in 4/5 right-handed patients and one left-temporal seizure with left hemispheric language dominance by fMRI. · IctalPDF p.3, Table 1; PDF p.3, §5.1
inter-observer kappa 0.89Automatisms with preserved responsivenessKappa · Sign-positive occurrences included 21 seizures in 17 patients overall; temporal 15/11, frontal 2/2, parietal 1/1, and occipital 3/3. The narrative additionally describes 6/8 seizures in 4/5 right-handed patients and one left-temporal seizure with left hemispheric language dominance by fMRI. · IctalPDF p.3, Table 1; PDF p.3, §5.1
parietal PPV 100%Automatisms with preserved responsivenessPositive predictive value · Sign-positive occurrences included 21 seizures in 17 patients overall; temporal 15/11, frontal 2/2, parietal 1/1, and occipital 3/3. The narrative additionally describes 6/8 seizures in 4/5 right-handed patients and one left-temporal seizure with left hemispheric language dominance by fMRI. · IctalPDF p.3, Table 1; PDF p.3, §5.1

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdfStructured design not resolved · 1 finding · 2 reported values

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.932

Findings

Automatisms overallAutomatisms overall were more frequent in RTL than in LTL seizures.PDF p.1, Summary; PDF p.4, numbered clinical-feature results; PDF p.4, Table 5

Reported values

55/73 (75%)Automatisms overallPercentage · n/N 55/73 · RTL seizure group, n=54, versus LTL seizure group, n=73 · LTL · IctalPDF p.1, Summary; PDF p.4, numbered clinical-feature results; PDF p.4, Table 5
52/54 (96%)Automatisms overallPercentage · n/N 52/54 · RTL seizure group, n=54, versus LTL seizure group, n=73 · RTL · IctalPDF p.1, Summary; PDF p.4, numbered clinical-feature results; PDF p.4, Table 5

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 1 finding

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

automatisms with preserved responsivenessOral or manual automatisms with preserved responsiveness reliably localize seizure onset to the nondominant temporal lobe because seizure propagation does not reach the language-dominant temporal lobe or extratemporal structures.PDF p.5, section 5 Nondominant temporal signs; PDF p.5, Table 2

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 2 findings

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Automatisms with dystoniaThe review states that automatisms may be ictal or postictal and provide strong lateralisation clues when associated with dystonia; manipulative automatisms may be more common postictally, and EEG can help distinguish ictal from postictal automatisms.PDF p.4, section 1.6
Automatisms with awarenessThe review reports that dominant-hemisphere focal-onset seizures with automatisms were associated with loss of awareness, while non-dominant seizures were associated with retained awareness.PDF p.3, section 1.3

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdfCase report or observation · 5 findings · 9 reported values

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

automatisms with preserved responsivenessAutomatisms with preserved responsiveness generally lateralize temporal lobe seizures to the nondominant hemisphere, with one reported exception.PDF p.6, section 3.10; PDF p.7, section 3.10 continuation; PDF p.12, Table 1
automatisms with preserved responsivenessEbner et al. observed automatisms with preserved responsiveness exclusively in right nondominant temporal seizures and not in left temporal seizures.PDF p.6, section 3.10; PDF p.7, section 3.10 continuation
automatisms with preserved consciousnessAn additional case of automatisms with preserved consciousness was reported in right temporal lobe epilepsy.PDF p.7, section 3.10
automatisms with preserved responsivenessA case was reported with left hemispheric epilepsy and right-sided language dominance.PDF p.7, section 3.10
automatisms with preserved responsiveness and ictal dysphasiaJanszky et al. reported a dominant-temporal exception to the usual nondominant lateralization of preserved-responsive automatisms.PDF p.7, section 3.10; PDF p.12, Table 1

Reported values

100% nondominantautomatisms with preserved responsivenessPercentage · patients with temporal lobe epilepsy · TLE with preserved-responsive automatisms · ictalPDF p.12, Table 1
5.7%automatisms with preserved responsivenessPercentage · patients with temporal lobe epilepsy · temporal lobe epilepsy · ictalPDF p.12, Table 1
one exceptionautomatisms with preserved responsivenessCount · patients with temporal lobe epilepsy · reported exception · ictalPDF p.6, section 3.10; PDF p.7, section 3.10 continuation; PDF p.12, Table 1
none observed in left temporal seizuresautomatisms with preserved responsivenessCount · 123 patients with temporal lobe epilepsy diagnosed by video/EEG and MRI · left temporal seizures · ictalPDF p.6, section 3.10; PDF p.7, section 3.10 continuation
7/123 (5.7%) overallautomatisms with preserved responsivenessPercentage · n/N 7/123 · 123 patients with temporal lobe epilepsy diagnosed by video/EEG and MRI · all TLE patients · ictalPDF p.6, section 3.10; PDF p.7, section 3.10 continuation
10% of right nondominant TLE patientsautomatisms with preserved responsivenessPercentage · 123 patients with temporal lobe epilepsy diagnosed by video/EEG and MRI · right nondominant TLE · ictalPDF p.6, section 3.10; PDF p.7, section 3.10 continuation
1 caseautomatisms with preserved consciousnessCount · n/N 1/1 · one patient with right temporal lobe epilepsy · ictalPDF p.7, section 3.10
1 caseautomatisms with preserved responsivenessCount · n/N 1/1 · one patient with left hemispheric epilepsy · ictalPDF p.7, section 3.10
1 caseautomatisms with preserved responsiveness and ictal dysphasiaCount · n/N 1/1 · one 25-year-old woman with right temporal lobe epilepsy · ictalPDF p.7, section 3.10; PDF p.12, Table 1

mcgonigal-on-seizure-semiology-2021-5ba29d.pdfNarrative, educational, or cited context · 1 finding · 2 reported values

mcgonigal-on-seizure-semiology-2021-5ba29d.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

altered conscious level; automatic motor behavior; verbal automatismsThe review reports that Marchi et al. (2016) found widespread epileptogenic-zone organization typical of occipital-plus epilepsy, with temporal and/or parietal cortex commonly involved; altered conscious level was more common with widespread posterior neocortical onset, while automatic motor behavior and/or verbal automatisms were more often seen with occipitotemporal organization.PDF p.6, Table 2, Occipital lobe row

Reported values

29 subjectsaltered conscious level; automatic motor behavior; verbal automatismsCount · 29 subjects with occipital-lobe epilepsy and 194 seizures · occipital-lobe epilepsy study · Seizure onset and semiologic expressionPDF p.6, Table 2, Occipital lobe row
194 seizuresaltered conscious level; automatic motor behavior; verbal automatismsCount · 29 subjects with occipital-lobe epilepsy and 194 seizures · occipital-lobe epilepsy study · Seizure onset and semiologic expressionPDF p.6, Table 2, Occipital lobe row

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 7 findings · 5 reported values

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

automatisms; elementary motor; hyperkinetic; autonomic; emotional; grimace; cognitive; other subjectiveThe source classifies ictal features into automatisms, elementary motor, hyperkinetic, autonomic, emotional, grimace, cognitive, and other subjective categories for the cluster and prevalence analyses.PDF p.4, Statistical analysis
emotional; autonomic; automatisms; hyperkinetic behavior; grimaceAcross groups, the source places autonomic and emotional features at seizure onset, while automatisms, hyperkinetic behavior, and grimace are associated with propagation.PDF p.2, Key points; PDF p.9, Seizure semiology
automatisms; whole groupAutomatisms were reported in 80 of 109 patients (73%) in the whole group.PDF p.5, All group
automatisms; fronto-temporal subgroupAutomatisms was reported in 88% of the fronto-temporal subgroup (33 patients).PDF p.5, Fronto-temporal subgroup
automatisms; temporo-frontal subgroupAutomatisms was reported in 67% of the temporo-frontal subgroup (76 patients).PDF p.5, Temporo-frontal subgroup
association coefficient; automatisms as isolated clusterThe source reports an association coefficient of >0.3 for automatisms as isolated cluster in the whole group.PDF p.5, All group; PDF p.10, Figure 3A
association coefficient; automatisms as isolated clusterThe source reports an association coefficient of >0.2 for automatisms as isolated cluster in the fronto-temporal subgroup.PDF p.5, Fronto-temporal subgroup; PDF p.10, Figure 3B

Reported values

80/109 (73%)automatisms; whole groupPercentage · n/N 80/109 · 109 review patients, whole group · ictal propagationPDF p.5, All group
88%automatisms; fronto-temporal subgroupPercentage · 33 patients, fronto-temporal subgroup · ictal propagationPDF p.5, Fronto-temporal subgroup
67%automatisms; temporo-frontal subgroupPercentage · 76 patients, temporo-frontal subgroup · ictal propagationPDF p.5, Temporo-frontal subgroup
association coefficient >0.3association coefficient; automatisms as isolated clusterAssociation Coefficient · 109 review patients · ictal symptom co-occurrencePDF p.5, All group; PDF p.10, Figure 3A
association coefficient >0.2association coefficient; automatisms as isolated clusterAssociation Coefficient · 33 fronto-temporal subgroup patients · ictal symptom co-occurrencePDF p.5, Fronto-temporal subgroup; PDF p.10, Figure 3B

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdfIndependent primary study · 1 finding · 1 reported value

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdf

Independent primary study · Class II · Evidence weight 4.25 · 2 × 1.35 × 1.573

Findings

inferior parietal or opercular extension with automatismsEleven of 14 patients with oral or gestural automatisms had epileptogenic zones extending into the inferior parietal lobule, parietal operculum, or superior-posterior temporal region.PDF p.4, Results, Other seizure characteristics; PDF p.6, Discussion

Reported values

11/14 (79%) patientsinferior parietal or opercular extension with automatismsPercentage · n/N 11/14 · 14 patients with oral or gestural automatisms · ictal propagation and seizure-onset localizationPDF p.4, Results, Other seizure characteristics; PDF p.6, Discussion

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdfSystematic review or meta-analysis · 1 finding

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

timing of automatisms; medio-lateral rapid-propagation groupThe source states that the only significant difference reported by Maillard was earlier timing of automatisms in the medio-lateral rapid-propagation group.PDF p.7, Discussion

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdfIndependent primary study · 1 finding

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

occipital onset with temporal-like automatism and motor expressionThe source concludes that occipital-onset seizures can produce temporal-like automatisms and frontal- or parietal-like motor symptoms through network propagation.PDF p.12, Key Findings and Phenotype-Propagation Pattern Correspondences; PDF p.14, Clinical Translation

16 contributing manuscripts; source-reported values remain separate and are not pooled.

Fear auraSource terms: Ictal fearReported: Non-dominant hemisphereAlso reported: Right hemisphereNo single reliable side17 manuscripts · 34 findings · 24 reported values

Weighted evidence supportevidence weight 30.37 across 17 manuscripts · 2 manuscript weight pending · 9 narrative, educational, or cited context · 2 structured design not resolved · 4 systematic review or meta-analysis · 2 independent primary study

The stimulation-site count contains no lateralization information. The cited stimulation response provides no hemispheric direction. This finding provides no lateralization information. The single-patient aura occurrence provides no hemispheric direction. This lateral-versus-mesial temporal statistic provides no hemispheric lateralization. The lateral-temporal prevalence range provides no hemispheric direction. The occurrence odds provide no hemispheric direction. The lateral-TLE prevalence range provides no hemispheric direction. The mesial-TLE prevalence range provides no hemispheric direction. No hemisphere or body-side direction is reported. This record provides no hemispheric lateralization. The cited prefrontal prevalence series provides no lateralizing direction. The cited fear/anxiety network account provides no lateralizing direction. The stimulation responses contain no lateralization information. This record provides no seizure lateralization. The cited table describes fear aura as non-lateralising. No lateralizing direction is reported. The cited emotional-expression statement reports no hemisphere or lateralization direction. The temporal-subtype result provides no hemispheric direction. The review table labels both fear and déjà vu/jamais vu as nonlateralizing, while noting an often-nondominant tendency only for déjà vu/jamais vu. The review places fear, auditory or gustatory hallucinations, sensory hallucinations, and vertigo between lateral and medial temporal patterns. Ictal fear has been associated with possible right-hemispheric lateralization.

Source-defined result groups 13

Localization: TemporalObserved proportion 22.2%ML · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 37.5%M · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: InsularObserved proportion 17.1%Visceral responses · viscero-psychic symptom presentations · evoked visceral response1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · reported sign prevalence across included studies1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · Table 3 point estimate 13% · Table 3 between-report frequency range1 manuscript · 1 reported value · not pooled

Localization: InsularObserved proportion 50.0%Viscero-psychic responses · viscero-psychic symptom presentations · evoked viscero-psychic response1 manuscript · 1 reported value · not pooled

Localization: orbitofrontal cortex-restricted epileptogenic-zone networkObserved proportion 3.8%OFC-restricted EZN cases · patients with affective phenomena1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyLateral TLE patients assessed for Fear aura/psychic aura · mesial TLE percentage shown separately · reported lateral-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyMesial TLE patients assessed for Fear aura/psychic aura · lateral TLE percentage shown separately · reported mesial-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Localization: InsularObserved proportion 50.0%Viscero-psychic responses · viscero-psychic symptom presentations · evoked viscero-psychic response1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 0.0%L · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 17

Alphabetical by manuscript.

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfStructured design not resolved · 3 findings · 2 reported values

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.5

Findings

typical group fear/laughter/personality patternThe abstract characterizes the typical anterior group by hypermotor seizures, infrequent generalization, and fear, laughter, or severe interictal personality changes.PDF p.1, Abstract
typical anterior fear auraFear was present in all three typical anterior cases with aura.PDF p.3, Clinical Presentation
anterior cingulate fear aura aggregateFear was seen as an aura in three anterior cingulate cases.PDF p.6, Discussion

Reported values

3/3 fear aura among aura-positive casestypical anterior fear auraProportion · n/N 3/3 · 3 typical anterior aura-positive cases · auraPDF p.3, Clinical Presentation
3/10 fear auraanterior cingulate fear aura aggregateProportion · n/N 3/10 · 10 anterior cingulate cases · auraPDF p.6, Discussion

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfSystematic review or meta-analysis · 2 findings · 2 reported values

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

Fear (Table 3)Table 3 reports fear in 1 case (1%), more at seizure onset.PDF p.6, Table 3
Fear (Table 4)In the 60 high/very-high-confidence cases, Table 4 reports fear in 4 cases (7%).PDF p.7, Table 4

Reported values

1 case (1%)Fear (Table 3)Percentage · Table 3 basal temporal seizure cases · onsetPDF p.6, Table 3
4/60 (7%)Fear (Table 4)Percentage · n/N 4/60 · 60 basal temporal seizure cases with high or very-high EZ confidence · ictalPDF p.7, Table 4

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.54 · 1 × 0.9 × 1.707

Findings

affective phenomena; fearOne restricted-OFC case described affective phenomena, specifically fear.PDF p.2, Semiology patterns of seizures with EZN restricted to the OFC

Reported values

1/26 (3.8%)affective phenomena; fearPercentage · n/N 1/26 · OFC-restricted EZN cases · OFC-restricted EZN cases · ictalPDF p.2, Semiology patterns of seizures with EZN restricted to the OFC

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdfSystematic review or meta-analysis · 11 findings · 4 reported values

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

Fear aura/psychic auraTable 3 reports 5 studies assessing Fear aura/psychic aura.PDF p.6, Table 3
Fear aura/psychic auraTable 3 reports 81 patients assessed for Fear aura/psychic aura.PDF p.6, Table 3
Fear aura/psychic auraTable 3 reports 0–40% as the percentage range or value for Fear aura/psychic aura; the overall association grade is Low.PDF p.6, Table 3
odds of occurrence; Fear aura/psychic auraTable 4 reports overall odds of 0.10 for occurrence of Fear aura/psychic aura in lateral TLE.PDF p.7, Table 4; PDF p.8, Figure 2
odds confidence interval; Fear aura/psychic auraTable 4 reports a 95% confidence interval of 0.02–0.45 for the overall odds of Fear aura/psychic aura.PDF p.7, Table 4; PDF p.8, Figure 2
heterogeneity test; Fear aura/psychic auraThe heterogeneity test for the Table 4 odds estimate for Fear aura/psychic aura has p=0.0243.PDF p.7, Table 4
Fear aura/psychic aura; lateral versus mesial comparisonTable 5 reports 4 studies comparing Fear aura/psychic aura in lateral and mesial TLE.PDF p.9, Table 5
Fear aura/psychic aura; lateral TLE patient denominatorTable 5 reports 58 lateral-TLE patients assessed for Fear aura/psychic aura.PDF p.9, Table 5
Fear aura/psychic aura; mesial TLE patient denominatorTable 5 reports 87 mesial-TLE patients assessed for Fear aura/psychic aura.PDF p.9, Table 5
Fear aura/psychic aura; lateral TLE prevalenceTable 5 reports a lateral-TLE percentage of 0–40% for Fear aura/psychic aura.PDF p.9, Table 5
Fear aura/psychic aura; mesial TLE prevalenceTable 5 reports a mesial-TLE percentage of 18.8–35.5% for Fear aura/psychic aura.PDF p.9, Table 5

Reported values

0–40%Fear aura/psychic auraPercentage Range · Lateral temporal epilepsy patients assessed for Fear aura/psychic aura · ictalPDF p.6, Table 3
odds 0.10odds of occurrence; Fear aura/psychic auraOdds · Lateral temporal epilepsy patients assessed for Fear aura/psychic aura · ictalPDF p.7, Table 4; PDF p.8, Figure 2
0–40%Fear aura/psychic aura; lateral TLE prevalencePercentage Range · Lateral TLE patients assessed for Fear aura/psychic aura · Lateral TLE patients assessed for Fear aura/psychic aura · ictalPDF p.9, Table 5
18.8–35.5%Fear aura/psychic aura; mesial TLE prevalencePercentage Range · Mesial TLE patients assessed for Fear aura/psychic aura · Mesial TLE patients assessed for Fear aura/psychic aura · ictalPDF p.9, Table 5

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 1 finding

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

fear and déjà vu or jamais vu auras in Table 1Table 1 lists fear as arising from the amygdala, hippocampus, and mesial frontal lobe and as nonlateralizing; it lists déjà vu or jamais vu as arising from the uncus, entorhinal cortex, and temporal neocortex and as nonlateralizing, often nondominant.PDF p.2, Table 1

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdfNarrative, educational, or cited context · 1 finding

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

ictal fear or anxietySudden ictal fear or anxiety resembling a panic attack may highlight an amygdala seizure onset; dysphoric, euphoric, and ultimately ecstatic feelings are also described in the mesial temporal semiology spectrum.PDF p.8, Focal emotional seizures

gibbs-clinical-features-sleep-related-hypermotor-epilepsy-2019.pdfIndependent primary study · 1 finding · 1 reported value

gibbs-clinical-features-sleep-related-hypermotor-epilepsy-2019.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

inner sensation of fear before hypermotor semiologyAn inner sensation of fear before the start of hypermotor semiology evolved into SP4 or SP3 in most SHE cases, reported as 86%.PDF p.8, section 4.3

Reported values

Percentage evolving to SP4 or SP3, 86%inner sensation of fear before hypermotor semiologyPercentage · SHE cases with an inner sensation of fear before hypermotor behavior · pre-hypermotor nonmotor symptom -> ictal SP3/SP4PDF p.8, section 4.3

jobst-insula-and-its-epilepsies-2019.pdfNarrative, educational, or cited context · 2 findings · 1 reported value

jobst-insula-and-its-epilepsies-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

viscero-psychic responsesViscero-psychic symptoms were elicited at 14 insular stimulation sites.PDF p.5, Visceral Symptoms
fear associated with viscero-psychic symptomsThoracic or abdominal heaviness was associated with a feeling of fear in viscero-psychic responses.PDF p.5, Visceral Symptoms

Reported values

14 stimulation sites with viscero-psychic symptomsviscero-psychic responsesCount · visceral responses in the cited insular stimulation series · stimulation-evoked autonomic/affective semiologyPDF p.5, Visceral Symptoms

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 1 finding

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Fear auraTable 2 associates fear aura with amygdala, hippocampus, and mesial frontal lobe (anterior cingulate) and describes it as non-lateralising.PDF p.3, Table 2

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdfNarrative, educational, or cited context · 1 finding

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

ictal fearIctal fear has been associated with possible right-hemispheric lateralization.PDF p.12, Conclusion

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdfIndependent primary study · 1 finding · 4 reported values

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdf

Independent primary study · Class II · Evidence weight 5.07 · 2 × 1.5 × 1.69

Findings

fearInitial fear was more frequent in M and ML than L patients and was absent in the L group.PDF p.5, Semiologic analysis; PDF p.5, Table 2; PDF p.7, Fear or anxiety

Reported values

ML=4/18 (22.2%)fearPercentage · n/N 4/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · initial ictal subjective symptomPDF p.5, Semiologic analysis; PDF p.5, Table 2; PDF p.7, Fear or anxiety
p=0.026fearP value · 55 patients with unilateral TLE; M=24, ML=18, L=13 · initial ictal subjective symptomPDF p.5, Semiologic analysis; PDF p.5, Table 2; PDF p.7, Fear or anxiety
M=9/24 (37.5%)fearPercentage · n/N 9/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · initial ictal subjective symptomPDF p.5, Semiologic analysis; PDF p.5, Table 2; PDF p.7, Fear or anxiety
L=0/13 (0%)fearPercentage · n/N 0/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · initial ictal subjective symptomPDF p.5, Semiologic analysis; PDF p.5, Table 2; PDF p.7, Fear or anxiety

mazzola-electrical-stimulation-human-insula-ictal-semiology-2017.pdfNarrative, educational, or cited context · 1 finding · 3 reported values

mazzola-electrical-stimulation-human-insula-ictal-semiology-2017.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.76 · 1 × 0.9 × 1.957

Findings

viscero-psychic symptomsThe 14 viscero-psychic responses combined a visceral sensation with anxiety or fear; thoracic or abdominal constriction/heaviness accompanied anxiety in 7 of 14, and anxiety ranged from mild to panic and could be isolated in 7 of 14 cases.PDF p.3, Results and Table 1; PDF p.5, Visceral Sensations and Fig. 4C

Reported values

Isolated anxiety 7/14viscero-psychic symptomsCount · n/N 7/14 · 14 viscero-psychic responses within the 82 visceral responses · Viscero-psychic responses · stimulation-evoked visceral and affective sensationPDF p.3, Results and Table 1; PDF p.5, Visceral Sensations and Fig. 4C
14 viscero-psychic responses within 82 visceral responsesviscero-psychic symptomsCount · n/N 14/82 · 14 viscero-psychic responses within the 82 visceral responses · Visceral responses · stimulation-evoked visceral and affective sensationPDF p.3, Results and Table 1; PDF p.5, Visceral Sensations and Fig. 4C
Thoracic/abdominal constriction or heaviness with anxiety 7/14viscero-psychic symptomsCount · n/N 7/14 · 14 viscero-psychic responses within the 82 visceral responses · Viscero-psychic responses · stimulation-evoked visceral and affective sensationPDF p.3, Results and Table 1; PDF p.5, Visceral Sensations and Fig. 4C

mcgonigal-frontal-lobe-seizures-overview-update-2022.pdfNarrative, educational, or cited context · 2 findings · 3 reported values

mcgonigal-frontal-lobe-seizures-overview-update-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

fear/threat-response emotional spectrum in a 42-patient prefrontal SEEG seriesThe review reports, from a 42-patient prefrontal SEEG series attributed to Singh et al. (in preparation), that around 40% had fear at seizure onset as an aura, around 20% had an anxious or fearful facial expression, and around 10% had full-blown threat-response behavior; it describes a spectrum from fearful face with or without freezing, through defense gestures, to explosive hyperkinetic escape or fight behavior.PDF p.5, Emotional semiology
fear/anxiety localizationFor prefrontal seizures with apparent fear or anxiety, the review reports a main role for ventromesial prefrontal cortex and especially posterior orbitofrontal cortex, with co-involvement of mesial temporal structures including amygdala with or without temporal pole; the described pattern includes fear feeling, fearful/anxious face, and upper-limb defense posture.PDF p.5, Emotional semiology

Reported values

around 10%fear/threat-response emotional spectrum in a 42-patient prefrontal SEEG seriesPercentage · 42 patients with prefrontal seizures explored with SEEG · full-blown threat-response behavior · Ictal onset for fear aura; ictal for objective facial expression and threat-response behaviorPDF p.5, Emotional semiology
around 40%fear/threat-response emotional spectrum in a 42-patient prefrontal SEEG seriesPercentage · 42 patients with prefrontal seizures explored with SEEG · fear at seizure onset as an aura · Ictal onset for fear aura; ictal for objective facial expression and threat-response behaviorPDF p.5, Emotional semiology
around 20%fear/threat-response emotional spectrum in a 42-patient prefrontal SEEG seriesPercentage · 42 patients with prefrontal seizures explored with SEEG · anxious or fearful facial expression · Ictal onset for fear aura; ictal for objective facial expression and threat-response behaviorPDF p.5, Emotional semiology

moser-chapeau-de-gendarme-sign-focal-epilepsy-systematic-review-2025.pdfNarrative, educational, or cited context · 1 finding

moser-chapeau-de-gendarme-sign-focal-epilepsy-systematic-review-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

affective ACC expressionStronger emotional expressions such as fear or menace, with open eyes, hypermotor, and autonomic features, were linked to the rostroventral “affective” ACC.PDF p.8, Discussion

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 1 finding

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

fear; anxiety; facial expression of fear/horror; orbitofrontal cortex; amygdalaThe source states that hyperkinetic behavior following intense fear or anxiety with facial fear/horror expression has been related to limbic imbalance, particularly decoupling between orbitofrontal cortex and amygdala.PDF p.12, Discussion

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdfSystematic review or meta-analysis · 3 findings · 2 reported values

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

fear; auditory hallucinations; gustatory hallucinations; sensory hallucinations; vertigoThe source describes fear, auditory or gustatory hallucinations, sensory hallucinations, and vertigo as intermediate features between lateral and medial temporal patterns.PDF p.5, Discussion
aura of fearTable 3 reports aura of fear in 13% of the temporo-polar synthesis (evidence grade Low).PDF p.5, Table 3
aura of fearTable 3 reports a 0–100% range for aura of fear across the temporo-polar reports (evidence grade Low).PDF p.5, Table 3

Reported values

13%aura of fearPercentage · Temporo-polar semiology synthesis represented in Table 3 · clinical onsetPDF p.5, Table 3
range 0–100%aura of fearPercentage Range · Temporo-polar semiology synthesis represented in Table 3 · clinical onsetPDF p.5, Table 3

wang-hypermotor-seizures-temporal-pole-lesions-2008.pdfStructured design not resolved · 1 finding · 1 reported value

wang-hypermotor-seizures-temporal-pole-lesions-2008.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.301

Findings

fear and indescribable feeling aura in hypermotor seizureOne hypermotor patient reported fear and an indescribable feeling as an aura.PDF p.4, Seizure semiology on video-EEG recording; PDF p.3, Table 1

Reported values

1/4 hypermotor patients with fear/indescribable-feeling aurafear and indescribable feeling aura in hypermotor seizureProportion · n/N 1/4 · 4 hypermotor patients · auraPDF p.4, Seizure semiology on video-EEG recording; PDF p.3, Table 1

17 contributing manuscripts; source-reported values remain separate and are not pooled.

Gelastic seizures (ictal mirthless laughter - pathognomonic for hypothalamic hamartoma)Source terms: Gelastic seizuresReported: BilateralAlso reported: Right hemisphere15 manuscripts · 69 findings · 56 reported values

Weighted evidence supportevidence weight 28.6 across 15 manuscripts · 2 independent primary study · 5 systematic review or meta-analysis · 7 narrative, educational, or cited context · 1 case report or observation

The cited table describes gelastic semiology as non-lateralising. The source text does not provide a hemisphere direction, but the prefilled lateralization value says right. No lateralizing direction is reported for the two discussed laughter cases. The source text reports an internal laughter-count discrepancy but no hemisphere direction, while the prefilled lateralization value says right. The review reports 6 gelastic-behavior cases; the bilateral qualifier concerns spasms, not cerebral hemisphere direction. Laughing or crying did not differ significantly between TL and T+ groups; no hemisphere or body-side direction is reported. No seizure lateralization is reported. No lateralizing direction is reported. The review associations contain no lateralization information. No lateralization information is reported for the gelastic-seizure context comparison. No lateralization information is reported. No source-supported hemispheric or body-side lateralization is reported. No lateralizing direction is reported for the other-automatisms subset. No lateralizing direction is reported for the review-table gelastic behavior result. No lateralizing direction is reported for the restricted high/very-high-confidence subset. No hemisphere or body-side direction is reported for the initial clinical semiology. The cited gelastic-seizure localization summary reports no lateralizing direction. The cited gelastic-seizure series reports no hemisphere direction. No lateralizing direction is reported for the illustrative gelastic-seizure case. Laughter frequency was reported as 10% with a source-reported 0–50% across-study range; no hemisphere direction is reported. No lateralizing direction is reported for the laughter frequency range. Laughter was reported at 9.7%; no hemisphere direction is reported. Nine patients represented 10% of reviewed cases; the denominator is not printed and the 93-patient cohort total is not substituted. Three of nine laughter-positive patients had laughter at onset or as a defining seizure feature; no hemisphere direction is reported. Six of nine laughter-positive patients had inconstant laughter or laughter at seizure end; no hemisphere direction is reported. The source reports OR <0.1 for laughter relative to vocalization/verbalization; no hemisphere direction is reported. No lateralization axis information is reported for laughter versus affective/autonomic aura. The claim states OR 0.2 for laughter relative to autonomic signs, while the supplied statistic record states OR 0.1; no hemisphere direction is reported. The claim states OR 0.2 for laughter relative to facial expression change, while the supplied statistic record states OR 0.1; no hemisphere direction is reported. No hemisphere or body-side direction is reported. This finding provides no lateralization information. Figure 6 reports OR 11.7 for Affective/autonomic aura relative to Laughter, with no hemisphere or lateralization direction. No lateralizing direction is reported for the Figure 6 laughter-versus-F-to-BTC comparison. No lateralization information is reported for the gelastic-seizure definition.

Source-defined result groups 9

Localization: FrontalObserved proportion 16.7%12 patients with EZ in the prefrontal operculum · precentral Rolandic operculum group (N=9) · patients in the prefrontal operculum group1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 14.3%All reported · prefrontal operculum versus precentral Rolandic operculum · all included patients1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 15

Alphabetical by manuscript.

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdfSystematic review or meta-analysis · 2 findings · 1 reported value

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

other automatisms; gelastic and dacrystic seizuresAmong the 108 cases categorized as other automatisms, 62 were gelastic or dacrystic seizures.PDF p.8, Seizure semiology localizing values
other automatisms; gelastic and dacrystic seizuresThe denominator for the reported gelastic/dacrystic subset was 108 other-automatisms cases.PDF p.8, Seizure semiology localizing values

Reported values

62/108 other-automatisms casesother automatisms; gelastic and dacrystic seizuresProportion · n/N 62/108 · other automatisms category · gelastic or dacrystic seizuresPDF p.8, Seizure semiology localizing values

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfNarrative, educational, or cited context · 2 findings · 1 reported value

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

typical group fear/laughter/personality patternThe abstract characterizes the typical anterior group by hypermotor seizures, infrequent generalization, and fear, laughter, or severe interictal personality changes.PDF p.1, Abstract
gelastic seizures in cingulate literatureThe discussion reports that gelastic seizures were reported in six of 16 anterior cingulate cases in the reviewed literature.PDF p.6, Discussion

Reported values

6/16 gelastic seizuresgelastic seizures in cingulate literatureProportion · n/N 6/16 · reviewed anterior cingulate epilepsy cases · ictal semiologyPDF p.6, Discussion

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 1 finding · 2 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

laughing or cryingLaughing or crying did not differ significantly between TL and T+ groups.PDF p.6, Table 2

Reported values

TL 8.5%laughing or cryingPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictalPDF p.6, Table 2
T+ 4.3%laughing or cryingPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictalPDF p.6, Table 2

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfSystematic review or meta-analysis · 4 findings · 4 reported values

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

gelastic behaviorThe review reports gelastic behavior in six cases.PDF p.4, Semiology and clinical features; PDF p.6, Table 3
Gelastic Behavior (Table 3)Table 3 reports gelastic behavior in 6 cases (7%), more during propagation.PDF p.6, Table 3
Gelastic Behavior (Table 4)In the 60 high/very-high-confidence cases, Table 4 reports gelastic behavior in 5 cases (8%).PDF p.7, Table 4
hyperkinetic/agitation plus gelastic behaviorThe co-occurrence analysis identified hyperkinetic/agitation with gelastic behavior in 22% of the 18-patient detailed-data set.PDF p.7, Figure 2 discussion

Reported values

6 cases with gelastic behaviorgelastic behaviorCount · basal temporal seizure cases; three-patient DNET subset for spasms · ictal; propagation for gelastic behavior in Table 3PDF p.4, Semiology and clinical features; PDF p.6, Table 3
6 cases (7%)Gelastic Behavior (Table 3)Percentage · Table 3 basal temporal seizure cases · propagationPDF p.6, Table 3
5/60 (8%)Gelastic Behavior (Table 4)Percentage · n/N 5/60 · 60 basal temporal seizure cases with high or very-high EZ confidence · ictalPDF p.7, Table 4
22% co-occurrencehyperkinetic/agitation plus gelastic behaviorPercentage · 18 patients with detailed semiology data · ictal; timing not otherwise reportedPDF p.7, Figure 2 discussion

blair-temporal-lobe-epilepsy-semiology-2012.pdfNarrative, educational, or cited context · 1 finding

blair-temporal-lobe-epilepsy-semiology-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Gelastic seizuresGelastic seizures are listed as localizing to temporal, hypothalamic, or frontal cingulate regions.PDF p.4, Table 2; PDF p.3, section 2.5 Automatisms

chassoux-ictal-semiology-anterior-cingulate-epilepsy-systematic-review-2025.pdfSystematic review or meta-analysis · 35 findings · 33 reported values

chassoux-ictal-semiology-anterior-cingulate-epilepsy-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

laughterThe source reports a frequency of 10% for laughter.PDF p.13, Table 3
laughter; reported frequency rangeThe source reports a frequency range of 0–50% for laughter.PDF p.13, Table 3
laughter; ACC association gradeTable 3 assigns the source's High overall association grade to laughter.PDF p.13, Table 3
laughter; Figure 4 rateFigure 4 displays a 9.7% rate for laughter.PDF p.10, Figure 4
laughterLaughter was reported in nine patients and represented 10% of the reviewed cases.PDF p.7, Objective symptomatology
laughter at onset or defining featureThree of the nine laughter cases had laughter at seizure onset or as a defining seizure feature.PDF p.7, Objective symptomatology
laughter late or inconstantSix of the nine laughter cases were inconstant or occurred at seizure end.PDF p.7, Objective symptomatology
pairwise OR: Laughter relative to Vocalization/verbalizationFigure 6 reports an odds ratio of <0.1 for Laughter relative to Vocalization/verbalization.PDF p.12, Figure 6
pairwise OR: Laughter relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of 0.1 for Laughter relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Laughter relative to Affective/autonomic auraFigure 6 reports an odds ratio of 0.1 for Laughter relative to Affective/autonomic aura.PDF p.12, Figure 6
pairwise OR: Laughter relative to Autonomic signsFigure 6 reports an odds ratio of 0.2 for Laughter relative to Autonomic signs.PDF p.12, Figure 6
pairwise OR: Laughter relative to Facial expression changeFigure 6 reports an odds ratio of 0.2 for Laughter relative to Facial expression change.PDF p.12, Figure 6
pairwise OR: Laughter relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 0.2 for Laughter relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Laughter relative to Loss of consciousnessFigure 6 reports an odds ratio of 0.3 for Laughter relative to Loss of consciousness.PDF p.12, Figure 6
pairwise OR: Laughter relative to Post-ictal confusion/behavior change disinhibitionFigure 6 reports an odds ratio of 0.3 for Laughter relative to Post-ictal confusion/behavior change disinhibition.PDF p.12, Figure 6
pairwise OR: Laughter relative to Chapeau de gendarmeFigure 6 reports an odds ratio of 0.4 for Laughter relative to Chapeau de gendarme.PDF p.12, Figure 6
pairwise OR: Laughter relative to Dystonic posturingFigure 6 reports an odds ratio of 0.6 for Laughter relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Laughter relative to Head-eye deviationFigure 6 reports an odds ratio of 0.9 for Laughter relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Vocalization/verbalization relative to LaughterFigure 6 reports an odds ratio of 14.5 for Vocalization/verbalization relative to Laughter.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to LaughterFigure 6 reports an odds ratio of 13.7 for Hypermotor-complex motor behavior relative to Laughter.PDF p.12, Figure 6
pairwise OR: Affective/autonomic aura relative to LaughterFigure 6 reports an odds ratio of 11.7 for Affective/autonomic aura relative to Laughter.PDF p.12, Figure 6
pairwise OR: Autonomic signs relative to LaughterFigure 6 reports an odds ratio of 8.6 for Autonomic signs relative to Laughter.PDF p.12, Figure 6
pairwise OR: Facial expression change relative to LaughterFigure 6 reports an odds ratio of 7.9 for Facial expression change relative to Laughter.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to LaughterFigure 6 reports an odds ratio of 7 for Motor (gestural) automatisms relative to Laughter.PDF p.12, Figure 6
pairwise OR: Loss of consciousness relative to LaughterFigure 6 reports an odds ratio of 5.1 for Loss of consciousness relative to Laughter.PDF p.12, Figure 6
pairwise OR: Post-ictal confusion/behavior change disinhibition relative to LaughterFigure 6 reports an odds ratio of 4.1 for Post-ictal confusion/behavior change disinhibition relative to Laughter.PDF p.12, Figure 6
pairwise OR: Chapeau de gendarme relative to LaughterFigure 6 reports an odds ratio of 2.4 for Chapeau de gendarme relative to Laughter.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to LaughterFigure 6 reports an odds ratio of 2.2 for Dystonic posturing relative to Laughter.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to LaughterFigure 6 reports an odds ratio of 1.5 for Head-eye deviation relative to Laughter.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to LaughterFigure 6 reports an odds ratio of 0.9 for Oro-alimentary automatisms relative to Laughter.PDF p.12, Figure 6
pairwise OR: Tonic-clonic relative to LaughterFigure 6 reports an odds ratio of 0.9 for Tonic-clonic relative to Laughter.PDF p.12, Figure 6
pairwise OR: F to BTC relative to LaughterFigure 6 reports an odds ratio of 0.5 for F to BTC relative to Laughter.PDF p.12, Figure 6
pairwise OR: Laughter relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 1.1 for Laughter relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Laughter relative to Tonic-clonicFigure 6 reports an odds ratio of 2.6 for Laughter relative to Tonic-clonic.PDF p.12, Figure 6
pairwise OR: Laughter relative to F to BTCFigure 6 reports an odds ratio of 2.6 for Laughter relative to F to BTC.PDF p.12, Figure 6

Reported values

10% (frequency range 0–50%)laughterPercentage · Reviewed ACC seizure cases with reported semiology · ictal onset and propagationPDF p.13, Table 3
9.7%laughter; Figure 4 ratePercentage · Reviewed ACC seizure cases with reported semiology · ictal onset and propagationPDF p.10, Figure 4
9 patients (10%)laughterPercentage · Reviewed ACC seizure cases with reported semiology · Reviewed ACC seizure casesPDF p.7, Objective symptomatology
3/9 laughter-positive patientslaughter at onset or defining featureProportion · n/N 3/9 · Reviewed ACC seizure cases with reported semiology · laughter-positive cases · Laughter-positive ACC casesPDF p.7, Objective symptomatology
6/9 laughter-positive patientslaughter late or inconstantProportion · n/N 6/9 · Reviewed ACC seizure cases with reported semiology · laughter-positive cases · Laughter-positive ACC casesPDF p.7, Objective symptomatology
OR <0.1pairwise OR: Laughter relative to Vocalization/verbalizationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR <0.1pairwise OR: Laughter relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR <0.1pairwise OR: Laughter relative to Affective/autonomic auraOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.1pairwise OR: Laughter relative to Autonomic signsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.1pairwise OR: Laughter relative to Facial expression changeOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.1pairwise OR: Laughter relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.2pairwise OR: Laughter relative to Loss of consciousnessOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.2pairwise OR: Laughter relative to Post-ictal confusion/behavior change disinhibitionOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.4pairwise OR: Laughter relative to Chapeau de gendarmeOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.4pairwise OR: Laughter relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.7pairwise OR: Laughter relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 14.5pairwise OR: Vocalization/verbalization relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 13.7pairwise OR: Hypermotor-complex motor behavior relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 11.7pairwise OR: Affective/autonomic aura relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 8.6pairwise OR: Autonomic signs relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 7.9pairwise OR: Facial expression change relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 7pairwise OR: Motor (gestural) automatisms relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 5.1pairwise OR: Loss of consciousness relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 4.1pairwise OR: Post-ictal confusion/behavior change disinhibition relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 2.4pairwise OR: Chapeau de gendarme relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 2.2pairwise OR: Dystonic posturing relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.5pairwise OR: Head-eye deviation relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.9pairwise OR: Oro-alimentary automatisms relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.5pairwise OR: Tonic-clonic relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.5pairwise OR: F to BTC relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.1pairwise OR: Laughter relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.9pairwise OR: Laughter relative to Tonic-clonicOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.9pairwise OR: Laughter relative to F to BTCOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 7 findings · 6 reported values

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdf; chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

focal atonic seizure; gelastic seizure; ictal poutingFocal atonic seizures may indicate involvement of negative motor areas or the supplementary motor area; gelastic seizures and ictal pouting may occur in mesiofrontal and anterior cingulate frontal seizures and are discussed as separate semiologies.PDF p.4, Other frontal regions; PDF p.3, Figure 1
gelastic seizure; hypothalamic hamartomaIn the cited case series from the authors’ centre, one third of gelastic seizure cases had hypothalamic hamartomas.PDF p.9, Gelastic seizures
gelastic seizure; temporal lobe sourceIn the same cited gelastic-seizure case series, one third of seizures were temporal.PDF p.9, Gelastic seizures
gelastic seizure; frontal sourceIn the same cited gelastic-seizure case series, one third of seizures were frontal.PDF p.9, Gelastic seizures
gelastic seizureGelastic seizures from hypothalamic hamartomas are described as usually beginning in early childhood, brief, stereotyped, and very frequent, with usually mirthless laughter without impaired consciousness, commonly accompanied by facial flushing or pupillary dilation and sometimes a dacrystic component; gelastic seizures from other brain structures usually present in adulthood, while temporal cases commonly include automotor features and loss of consciousness.PDF p.9, Gelastic seizures; PDF p.3, Figure 1
gelastic seizuresGelastic seizures typically arise from hypothalamic hamartomas, but the review states that a cited case series found one third of cases with hypothalamic hamartomas, one third temporal, and one third frontal; hypothalamic-hamartoma seizures usually begin in early childhood, are brief, stereotyped, and very frequent with mirthless laughter and common autonomic signs, whereas non-hypothalamic and especially temporal gelastic seizures usually present in adulthood as more complex automotor seizures with loss of consciousness.PDF p.9, Gelastic seizures
gelastic seizure with hypothalamic hamartomaIn video case 5, an 18-year-old right-handed man had gelastic seizures beginning at age 2, imaging-confirmed hypothalamic hamartoma, typical gelastic seizures without mirth, and loss of awareness in some seizures.PDF p.9, Video case 5 and Figure 6

Reported values

hypothalamic hamartoma in one third of casesgelastic seizure; hypothalamic hamartomaProportion · gelastic seizure case series from the authors’ centre · ictalPDF p.9, Gelastic seizures
temporal source in one third of seizuresgelastic seizure; temporal lobe sourceProportion · gelastic seizure case series from the authors’ centre · ictalPDF p.9, Gelastic seizures
frontal source in one third of seizuresgelastic seizure; frontal sourceProportion · gelastic seizure case series from the authors’ centre · ictalPDF p.9, Gelastic seizures
one thirdgelastic seizuresOther reported value · Cases in the cited gelastic-seizure series; exact denominator Not reported · hypothalamic hamartoma · Ictal onset and evolutionPDF p.9, Gelastic seizures
one thirdgelastic seizuresOther reported value · Cases in the cited gelastic-seizure series; exact denominator Not reported · temporal · Ictal onset and evolutionPDF p.9, Gelastic seizures
one thirdgelastic seizuresOther reported value · Cases in the cited gelastic-seizure series; exact denominator Not reported · frontal · Ictal onset and evolutionPDF p.9, Gelastic seizures

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdfNarrative, educational, or cited context · 2 findings · 1 reported value

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

ictal laughter; gelastic automatismsThe source states that ictal laughter was relatively common in the reviewed cases but had limited localizing value.PDF p.4, Complex motor phenomena—automatisms
laughter and crying; mimic automatismsOne restricted-OFC case with mimic automatisms displayed a combination of laughter and crying.PDF p.2, Semiology patterns of seizures with EZN restricted to the OFC

Reported values

1 patientlaughter and crying; mimic automatismsCount · OFC-restricted EZN group · OFC-restricted EZN group · ictalPDF p.2, Semiology patterns of seizures with EZN restricted to the OFC

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 1 finding

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

gelastic seizuresBrief laughter or grimacing with or without subjective mirth strongly suggests a hypothalamic hamartoma, although intracranial EEG and electrical-stimulation studies have identified the symptomatogenic zone in anteromesial frontal and basal temporal regions in isolated cases.PDF p.4, section 3.3 Complex motor seizures; PDF p.2, Table 1

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdfSystematic review or meta-analysis · 7 findings · 5 reported values

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

elementary motor symptoms; speech dysfunction; complex motor behavior; respiratory symptoms; salivation; laughter; preserved consciousnessThe source's abstract identifies elementary motor symptoms, speech dysfunction, complex motor behavior, respiratory symptoms, salivation, and laughter as ictal signs with preserved consciousness in fronto-opercular epilepsy.PDF p.1, Abstract; PDF p.2, Key points
laughter; mirthless laughterThe discussion states that two patients in the review were described as presenting with laughter or a sudden outburst of mirthless laughter.PDF p.9, Discussion
laughter; Table 2 versus discussion countThe source contains a direct internal discrepancy for laughter: the Table 2 result is 3/21 (14%), whereas the discussion states that two patients presented with laughter or mirthless laughter.PDF p.7, Table 2; PDF p.9, Discussion
Laughter (mirthless)Table 2 reports 3/21 (14%) for Laughter (mirthless); timing is onset or propagation, and the source's overall agreement that the sign is suggestive of fronto-opercular epilepsy is graded Low.PDF p.7, Table 2
Laughter (mirthless)Table 2 reports 2/12 patients with Laughter (mirthless) in the prefrontal operculum group.PDF p.7, Table 2
Laughter (mirthless)Table 2 reports 1/9 patients with Laughter (mirthless) in the precentral Rolandic operculum group.PDF p.7, Table 2
Laughter (mirthless)Fisher's exact comparison of Laughter (mirthless) between the prefrontal and precentral Rolandic operculum groups has p=1.PDF p.7, Table 2

Reported values

two patientslaughter; mirthless laughterCount · Included fronto-opercular epilepsy patients described in the discussion · Included fronto-opercular epilepsy patients described in the discussion · ictalPDF p.9, Discussion
3/21 (14%)Laughter (mirthless)Percentage · n/N 3/21 · 21 included fronto-opercular epilepsy patients · BothPDF p.7, Table 2
2/12 patientsLaughter (mirthless)Proportion · n/N 2/12 · 12 patients with EZ in the prefrontal operculum · 12 patients with EZ in the prefrontal operculum · BothPDF p.7, Table 2
1/9 patientsLaughter (mirthless)Proportion · n/N 1/9 · 9 patients with EZ in the precentral Rolandic operculum · 9 patients with EZ in the precentral Rolandic operculum · BothPDF p.7, Table 2
p=1Laughter (mirthless)P value · 12 prefrontal-operculum and 9 precentral Rolandic-operculum patients · BothPDF p.7, Table 2

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 1 finding

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Gelastic seizureTable 2 associates gelastic semiology with hypothalamus, anteromesial frontal region, and basal temporal area and describes it as non-lateralising.PDF p.3, Table 2

luders-semiological-seizure-classification-1998.pdfNarrative, educational, or cited context · 2 findings

luders-semiological-seizure-classification-1998.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

gelastic seizureGelastic seizure is reserved for seizures in which laughing is the main ictal motor manifestation; the source classifies it separately because it is common in patients with hypothalamic hamartoma.PDF p.5, Complex motor seizures
Gelastic seizureGelastic seizures are seizures whose main motor manifestation is laughing; they may be preceded or followed by other seizure types and are classified separately because the source states that they are common in patients with hypothalamic hamartoma.PDF p.5, Complex motor seizures, Gelastic seizures; PDF p.2, Table 1

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdfCase report or observation · 2 findings · 2 reported values

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Case 1 gelastic, singing, whistling, and verbal-automatism semiologyCase 1 was a 27-year-old right-handed woman whose seizures began at age 9 with uncontrollable laughter without associated emotion, sometimes singing or whistling, and sometimes repeated vocalizations such as “it doesn’t matter” or “no, no”; she could have a nonspecific “lucidity” warning, was usually aware with possible cognitive slowing, had nocturnal predominance without postictal deficit, and had 10–25-second seizures occurring 1–4 times per day.PDF p.8, Case 1; PDF p.8, Video-EEG data
gelastic seizureFor gelastic seizures without a hypothalamic hamartoma, the chapter reports seizure-onset zones in medial, inferior, or posterior temporal regions, superior or median frontal gyrus, anterior cingulate, orbitofrontal cortex, frontal operculum extending to anterior insula, and parietal lobe; temporo-basal onset is associated with subjective mirth, whereas frontal-lobe gelastic seizures lack that finding.PDF p.8, What localizations are suggested by the seizure semiology?

Reported values

Seizure duration 10–25 secondsCase 1 gelastic, singing, whistling, and verbal-automatism semiologyRange · Individual Case 1; 27-year-old right-handed woman, seizure onset age 9 · Ictal; aura/warning and postictal observationPDF p.8, Case 1; PDF p.8, Video-EEG data
Seizure frequency 1–4 per dayCase 1 gelastic, singing, whistling, and verbal-automatism semiologyRange · Individual Case 1; 27-year-old right-handed woman, seizure onset age 9 · Ictal; aura/warning and postictal observationPDF p.8, Case 1; PDF p.8, Video-EEG data

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdfIndependent primary study · 1 finding

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdf

Independent primary study · Class II · Evidence weight 2.70 · 2 × 1.35 × 1

Findings

ictal laughterIctal laughter was reported among other non-visual symptoms in the cohort.PDF p.6, Results, Non-visual manifestations

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

gelastic seizuresThe review states that approximately 50% of cases with gelastic seizures have a hypothalamic hamartoma detectable by MRI, while extra-hypothalamic epilepsies have also been described in the anterior cingulate region and frontal, parietal, and temporal lobes.PDF p.5, Gelastic seizures

Reported values

Approximately 50% with MRI-detected hypothalamic hamartomagelastic seizuresPercentage · Patients with gelastic seizures; percentage denominator not reported · IctalPDF p.5, Gelastic seizures

15 contributing manuscripts; source-reported values remain separate and are not pooled.

Ictal cry / tonic vocalization (non-linguistic)Source terms: Ictal nonlinguistic vocalization; Ictal cry / tonic vocalizationReported: Dominant hemisphereAlso reported: Left hemisphereAlso reported: Non-dominant hemisphereAlso reported: Right hemisphereNo single reliable side17 manuscripts · 45 findings · 41 reported values

Weighted evidence supportevidence weight 27.07 across 17 manuscripts · 4 manuscript weight pending · 3 independent primary study · 3 systematic review or meta-analysis · 4 structured design not resolved · 7 narrative, educational, or cited context

Non-speech vocalization occurred equally in RTL and LTL seizures, 31% versus 31%, and did not significantly lateralize temporal-lobe onset. No sign-specific lateralizing direction is reported. No lateralizing information is present. Ictal whistling is restated as non-lateralizing. The handbook lists ictal vocalization as a dominant-hemisphere sign, with a source reliability warning on one rendering. The cited review associates temporal verbal automatisms with the non-dominant language hemisphere and describes speech arrest/vocalization in cortical language areas. Cited-study restatement combines right-frontal/mesial-temporal ictal singing with nondominant-temporal ictal whistling. Comprehensible stereotyped ictal speech is described as suggesting a nondominant focus, while dominant-hemisphere lateralization of vocalizations remains controversial. The review states that pure ictal vocalizations may lateralize frontal lobe epilepsy to the left hemisphere. The cited Janszky series is restated as 9/11 pure ictal vocalizations in left frontal lobe epilepsy. No source-supported hemispheric or body-side lateralization is reported. No cerebral hemisphere or body-side direction is reported. The category definition contains no lateralizing evidence. No lateralizing direction is reported. No hemisphere or body-side direction is reported. The review reports no cerebral hemisphere or body-side direction for humming. No lateralizing direction is reported for ictal humming. No lateralizing direction is reported for humming in temporal-lobe seizures. No dominant/nondominant or sign-side lateralizing breakdown is reported for this subset. No lateralizing direction is reported for late vocalization. No lateralizing direction is reported for early automatisms or early vocalization.

Source-defined result groups 16

Localization: FrontalObserved proportion 9.5%All reported · prefrontal operculum versus precentral Rolandic operculum · all included patients1 manuscript · 1 reported value · not pooled

Localization: FrontalObserved proportion 0.0%9 patients with EZ in the precentral Rolandic operculum · prefrontal operculum group (N=12) · patients in the precentral Rolandic operculum group1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Right hemisphereObserved proportion 29.6%RTL · RTL versus LTL · seizure1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTL · T+ 26.1% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 12.5%M · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: FrontalSource-defined values retained separatelyfrontal localization relative to all other semiologies · localizing data point1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelylateral temporal localization relative to all other semiologies · localizing data point1 manuscript · 1 reported value · not pooled

Localization: FrontalSource-defined values retained separatelyfrontal localization given vocalization · localizing data point1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyT+ · TL 16.9% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 38.9%ML · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 7.7%L · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Right hemisphereObserved proportion 23.3%LTL · RTL versus LTL · seizure1 manuscript · 1 reported value · not pooled

Localization: cingulateSource-defined values retained separatelycingulate localization · localizing data point1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelytemporal localization given vocalization · localizing data point1 manuscript · 1 reported value · not pooled

Localization: fronto-opercular epilepsy cohortSource-defined values retained separatelyIncluded fronto-opercular epilepsy patients with propagation data · patients with propagation data1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 17

Alphabetical by manuscript.

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdfSystematic review or meta-analysis · 14 findings · 8 reported values

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

vocalization—unintelligible noisesTable 1 defines or exemplifies the the source's own semiology category “vocalization—unintelligible noises” as Grunting, mumbling, or humming, distinguished from ictal speech and dysphasia.PDF p.7, Table 1 Semiology descriptions and frequencies
vocalization—unintelligible noisesUnintelligible vocalization comprised 5.5% of non-topological data.PDF p.7, Table 1 Semiology descriptions and frequencies
unintelligible vocalization; frontal lobeNon-sensical ictal vocalization was frontal in origin in 44%.PDF p.8, Seizure semiology localizing values
unintelligible vocalization; frontal lobeThe 95% CI for unintelligible vocalization; frontal lobe was 35%–53%.PDF p.8, Seizure semiology localizing values
unintelligible vocalization; temporal lobeNon-sensical ictal vocalization was temporal in origin in 36%.PDF p.8, Seizure semiology localizing values
unintelligible vocalization; temporal lobeThe 95% CI for unintelligible vocalization; temporal lobe was 28%–45%.PDF p.8, Seizure semiology localizing values
unintelligible vocalization; cingulateunintelligible vocalization semiology was cingulate in 9%.PDF p.8, Seizure semiology localizing values
unintelligible vocalization; cingulateThe 95% CI for unintelligible vocalization; cingulate was 6%–13%.PDF p.8, Seizure semiology localizing values
unintelligible vocalization; frontal lobeUnintelligible vocalizations had an intrinsic localizing OR of 1.5 for the frontal lobe.PDF p.8, Relative localizing values of semiologies
unintelligible vocalization; frontal lobeThe 95% CI for unintelligible vocalization; frontal lobe was 1.2–2.0.PDF p.8, Relative localizing values of semiologies
unintelligible vocalization; lateral temporalUnintelligible vocalizations had an intrinsic localizing OR of 2.8 for lateral temporal subregions.PDF p.8, Relative localizing values of semiologies
unintelligible vocalization; lateral temporalThe 95% CI for unintelligible vocalization; lateral temporal was 1.8–4.5.PDF p.8, Relative localizing values of semiologies
ictal vocalization with automatismsA cited study of 102 patients reported 91% sensitivity for detecting temporal-lobe seizures when ictal vocalizations co-occurred with automatisms.PDF p.12, Localizing probabilities
ictal vocalization with automatismsThe same cited study reported 70% specificity for detecting temporal-lobe seizures when ictal vocalizations co-occurred with automatisms.PDF p.12, Localizing probabilities

Reported values

vocalization—unintelligible noises 5.5%vocalization—unintelligible noisesPercentage · non-topological Semio2Brain dataPDF p.7, Table 1 Semiology descriptions and frequencies
unintelligible vocalization; frontal lobe 44%unintelligible vocalization; frontal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
unintelligible vocalization; temporal lobe 36%unintelligible vocalization; temporal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
unintelligible vocalization; cingulate 9%unintelligible vocalization; cingulatePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
OR 1.5unintelligible vocalization; frontal lobeOdds ratio · non-topological Semio2Brain data unless otherwise statedPDF p.8, Relative localizing values of semiologies
OR 2.8unintelligible vocalization; lateral temporalOdds ratio · non-topological Semio2Brain data unless otherwise statedPDF p.8, Relative localizing values of semiologies
sensitivity 91%ictal vocalization with automatismsSensitivity · 102 patients with ictal vocalizationPDF p.12, Localizing probabilities
specificity 70%ictal vocalization with automatismsSpecificity · 102 patients with ictal vocalizationPDF p.12, Localizing probabilities

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfStructured design not resolved · 3 findings · 3 reported values

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.5

Findings

typical anterior early loud vocalizationEarly loud vocalization was seen in four of six typical anterior patients.PDF p.5, Clinical Presentation
atypical anterior early loud vocalizationEarly loud vocalization was seen in two of four atypical anterior patients.PDF p.5, Clinical Presentation
anterior cingulate early loud vocalization aggregateEarly loud vocalization was seen in six of 10 anterior cingulate cases.PDF p.6, Discussion

Reported values

4/6 (67%) early loud vocalizationtypical anterior early loud vocalizationPercentage · n/N 4/6 · 6 typical anterior cingulate cases · ictal semiologyPDF p.5, Clinical Presentation
2/4 (50%) early loud vocalizationatypical anterior early loud vocalizationPercentage · n/N 2/4 · 4 atypical anterior cingulate cases · ictal semiologyPDF p.5, Clinical Presentation
6/10 early loud vocalizationanterior cingulate early loud vocalization aggregateProportion · n/N 6/10 · 10 anterior cingulate cases · ictal semiologyPDF p.6, Discussion

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 1 finding · 3 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

moaningMoaning did not differ significantly between TL and T+ groups.PDF p.6, Table 2

Reported values

TL 16.9%moaningPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictalPDF p.6, Table 2
T+ 26.1%moaningPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictalPDF p.6, Table 2
P=0.35moaningP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictalPDF p.6, Table 2

blair-temporal-lobe-epilepsy-semiology-2012.pdfNarrative, educational, or cited context · 1 finding

blair-temporal-lobe-epilepsy-semiology-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Ictal whistlingIctal whistling is described as a rare automatism during temporal-lobe seizures that localizes to temporal-lobe origin but is not lateralizing.PDF p.3, section 2.5 Automatisms; PDF p.4, Table 2; PDF p.5, autonomic-phenomena paragraph

chauvel-mcgonigal-emergence-semiology-epileptic-seizures-2014.pdfNarrative, educational, or cited context · 2 findings

chauvel-mcgonigal-emergence-semiology-epileptic-seizures-2014.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

ictal speech arrest, vocalization, and verbal automatismsThe review states that most seizures involving cortical language areas reduce to speech arrest or vocalization depending on the involved area and its distance from ventral central regions; verbal automatisms occur in temporal seizures and are associated with the non-dominant language hemisphere, while aphasia-like abnormal production is less frequent.PDF p.7, section 8
ictal hummingA low, steady, continuous tone with closed lips may occur in temporal seizures and is generally delayed after onset; cited SEEG processing associated humming with increased coherence among superior temporal gyrus, planum temporale, and inferior frontal gyrus areas 44/45, while another cited series found simultaneous ictal SPECT hyperperfusion in the same three areas.PDF p.6, section 7

epilepsy-fellowship-handbook-semiologyreferences.pdfNarrative, educational, or cited context · 1 finding

epilepsy-fellowship-handbook-semiologyreferences.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Ictal vocalization (p.2 rendered "ictal vocalization*"; p.3 rendered "Ictal vocalization")Both tables list Ictal vocalization as Dominant hemisphere; p.2 marks the term with an asterisk and p.3 does not.PDF p.2, Lateralizing signs/Localization table entry "ictal vocalization*" (printed p.7); PDF p.3, Lateralizing signs/Localization table row "Ictal vocalization" (printed p.5)

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdfStructured design not resolved · 1 finding · 2 reported values

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.932

Findings

Vocalization other than speechVocalization other than speech did not differ significantly between RTL and LTL seizures.PDF p.4, Table 5; PDF p.2, feature definitions

Reported values

RTL 16 (31%)Vocalization other than speechPercentage · n/N 16/54 · RTL seizure group, n=54, versus LTL seizure group, n=73 · RTL · IctalPDF p.4, Table 5; PDF p.2, feature definitions
LTL 17 (31%)Vocalization other than speechPercentage · n/N 17/73 · RTL seizure group, n=54, versus LTL seizure group, n=73 · LTL · IctalPDF p.4, Table 5; PDF p.2, feature definitions

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdfNarrative, educational, or cited context · 1 finding

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

ictal speech, verbal automatisms, and ictal vocalizationsIctal vocalizations and ictal speech are reported in TLE but are not exclusive to it; comprehensible stereotyped speech, including rare second-language automatisms, suggests a nondominant-hemisphere focus, whereas the lateralizing value of vocalizations toward the dominant hemisphere remains controversial.PDF p.8, Focal impaired awareness seizures

gabr-speech-manifestations-lateralization-temporal-lobe-seizures-1989.pdfStructured design not resolved · 1 finding · 4 reported values

gabr-speech-manifestations-lateralization-temporal-lobe-seizures-1989.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.778

Findings

vocalization in secondarily generalized seizuresFifteen of 36 vocalization seizures (40%) were secondarily generalized and vocalization was the only speech manifestation in all 15; among all 20 secondarily generalized seizures, 15 (75%) had vocalization as the only speech manifestation, while the remaining 5 had either ictal identifiable speech (2) or no speech manifestations (3).PDF p.3, Results

Reported values

15/20 secondarily generalized seizures (75%) had vocalization onlyvocalization in secondarily generalized seizuresPercentage · n/N 15/20 · 36 vocalization seizures and 20 secondarily generalized seizures within the 100-seizure cohort · secondarily generalized seizures · ictal vocalization and ictal identifiable speech; no phase-specific speech manifestation was reported for the three no-speech seizuresPDF p.3, Results
15/36 vocalization seizures (40%) were secondarily generalizedvocalization in secondarily generalized seizuresPercentage · n/N 15/36 · 36 vocalization seizures and 20 secondarily generalized seizures within the 100-seizure cohort · vocalization seizures · ictal vocalization and ictal identifiable speech; no phase-specific speech manifestation was reported for the three no-speech seizuresPDF p.3, Results
2 secondarily generalized seizures had ictal identifiable speechvocalization in secondarily generalized seizuresCount · 36 vocalization seizures and 20 secondarily generalized seizures within the 100-seizure cohort · ictal identifiable speech · ictal vocalization and ictal identifiable speech; no phase-specific speech manifestation was reported for the three no-speech seizuresPDF p.3, Results
3 secondarily generalized seizures had no speech manifestationsvocalization in secondarily generalized seizuresCount · 36 vocalization seizures and 20 secondarily generalized seizures within the 100-seizure cohort · no speech manifestations · ictal vocalization and ictal identifiable speech; no phase-specific speech manifestation was reported for the three no-speech seizuresPDF p.3, Results

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdfSystematic review or meta-analysis · 6 findings · 4 reported values

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

vocalization (grunts) during seizure propagationDuring seizure propagation, vocalization in the form of grunts was observed in two patients.PDF p.6, Anatomical and clinical correlations
vocalization (grunts) during seizure propagationDuring seizure propagation, the source reports vocalization (grunts) in 12% of patients.PDF p.6, Anatomical and clinical correlations
Vocalization (grunts)Table 2 reports 2/21 (10%) for Vocalization (grunts); timing is late, and the source's overall agreement that the sign is suggestive of fronto-opercular epilepsy is graded Low.PDF p.7, Table 2
Vocalization (grunts)Table 2 reports 2/12 patients with Vocalization (grunts) in the prefrontal operculum group.PDF p.7, Table 2
Vocalization (grunts)Table 2 reports 0/9 patients with Vocalization (grunts) in the precentral Rolandic operculum group.PDF p.7, Table 2
Vocalization (grunts)Fisher's exact comparison of Vocalization (grunts) between the prefrontal and precentral Rolandic operculum groups has p=0.486.PDF p.7, Table 2

Reported values

2 patients (12%)vocalization (grunts) during seizure propagationPercentage · Included fronto-opercular epilepsy patients with propagation data · Included fronto-opercular epilepsy patients with propagation data · ictal propagationPDF p.6, Anatomical and clinical correlations
2/21 (10%)Vocalization (grunts)Percentage · n/N 2/21 · 21 included fronto-opercular epilepsy patients · LatePDF p.7, Table 2
2/12 patientsVocalization (grunts)Proportion · n/N 2/12 · 12 patients with EZ in the prefrontal operculum · 12 patients with EZ in the prefrontal operculum · LatePDF p.7, Table 2
0/9 patientsVocalization (grunts)Proportion · n/N 0/9 · 9 patients with EZ in the precentral Rolandic operculum · 9 patients with EZ in the precentral Rolandic operculum · LatePDF p.7, Table 2

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdfNarrative, educational, or cited context · 2 findings · 2 reported values

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

pure ictal vocalizationsPure ictal vocalizations may lateralize frontal lobe epilepsy to the left hemisphere.PDF p.9, section 4.3; PDF p.10, section 4.3 continuation
pure ictal vocalizationsJanszky et al. found left frontal lobe epilepsy in 9 of 11 patients with pure ictal vocalizations.PDF p.9, section 4.3; PDF p.10, section 4.3 continuation

Reported values

9/11 had left frontal-lobe epilepsypure ictal vocalizationsPercentage · n/N 9/11 · 27 frontal lobe epilepsy patients seizure free after surgery · frontal-lobe epilepsy cohort · ictalPDF p.9, section 4.3; PDF p.10, section 4.3 continuation
11/27 had pure ictal vocalizationspure ictal vocalizationsPercentage · n/N 11/27 · 27 frontal lobe epilepsy patients seizure free after surgery · frontal-lobe epilepsy cohort · ictalPDF p.9, section 4.3; PDF p.10, section 4.3 continuation

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdfIndependent primary study · 3 findings · 6 reported values

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdf

Independent primary study · Class II · Evidence weight 5.07 · 2 × 1.5 × 1.69

Findings

early vocalizationsEarly vocalizations, defined here as groaning, howling, moaning, or humming during the first half of the seizure, were more frequent in ML than M or L patients.PDF p.6, Table 4; PDF p.6, Early features; PDF p.8, Vocal verbal and nonverbal automatisms
late vocalizationLate vocalization showed no statistically significant difference across M, ML, and L groups.PDF p.7, Table 5; PDF p.7, Later features
ictal humming and limbic-neocortical involvementThe discussion restates that a prior study of ictal humming found these automatisms when the ictal discharge involved both limbic and neocortical superior and middle temporal gyri.PDF p.8, Vocal verbal and nonverbal automatisms

Reported values

M 3/24 (12.5%)early vocalizationsPercentage · n/N 3/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · early ictal, first half of seizurePDF p.6, Table 4; PDF p.6, Early features; PDF p.8, Vocal verbal and nonverbal automatisms
L 1/13 (7.7%)early vocalizationsPercentage · n/N 1/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · early ictal, first half of seizurePDF p.6, Table 4; PDF p.6, Early features; PDF p.8, Vocal verbal and nonverbal automatisms
ML 7/18 (38.9%)early vocalizationsPercentage · n/N 7/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · early ictal, first half of seizurePDF p.6, Table 4; PDF p.6, Early features; PDF p.8, Vocal verbal and nonverbal automatisms
2/13 (15.4%)late vocalizationPercentage · n/N 2/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · late ictal, second half of seizurePDF p.7, Table 5; PDF p.7, Later features
5/24 (20.8%)late vocalizationPercentage · n/N 5/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · late ictal, second half of seizurePDF p.7, Table 5; PDF p.7, Later features
0/18 (0%)late vocalizationPercentage · n/N 0/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · late ictal, second half of seizurePDF p.7, Table 5; PDF p.7, Later features

mcgonigal-on-seizure-semiology-2021-5ba29d.pdfNarrative, educational, or cited context · 2 findings · 5 reported values

mcgonigal-on-seizure-semiology-2021-5ba29d.pdf; mcgonigal-on-seizure-semiology-2021-9127f2.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

hummingThe review reports that Bartolomei et al. (2002) studied humming in temporal-lobe seizures and found rhythmic discharge over the superior temporal gyrus at 6 or 15 Hz with increased coherence between the superior temporal gyrus and prefrontal cortex.PDF p.4, Table 1, Humming row
hummingIn the summarized Bartolomei et al. study, humming in temporal-lobe seizures was associated during semiologic expression with rhythmic 6-Hz or 15-Hz discharge over the superior temporal gyrus and increased coherence between the superior temporal gyrus and prefrontal cortex.PDF p.4, Table 1, Bartolomei et al. 2002 row; PDF p.11, mechanism 1

Reported values

rhythmic discharge at 6 or 15 HzhummingCount · 3 subjects with temporal-lobe epilepsy · Period of semiologic expressionPDF p.4, Table 1, Humming row
n=3 subjectshummingCount · 3 subjects with temporal-lobe epilepsy · Period of semiologic expressionPDF p.4, Table 1, Humming row
Auditory steady-state stimulation 6 HzhummingFrequency · 3 subjects with temporal-lobe epilepsy; number of seizures Not reported · 6-Hz condition · ictal, during semiologic expressionPDF p.4, Table 1, Bartolomei et al. 2002 row; PDF p.11, mechanism 1
Auditory steady-state stimulation 15 HzhummingFrequency · 3 subjects with temporal-lobe epilepsy; number of seizures Not reported · 15-Hz condition · ictal, during semiologic expressionPDF p.4, Table 1, Bartolomei et al. 2002 row; PDF p.11, mechanism 1
Subjects with humming paradigm n=3hummingCount · 3 subjects with temporal-lobe epilepsy; number of seizures Not reported · ictal, during semiologic expressionPDF p.4, Table 1, Bartolomei et al. 2002 row; PDF p.11, mechanism 1

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdfNarrative, educational, or cited context · 1 finding

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

ictal singing and ictal whistlingThe chapter reports ictal singing from the right frontal lobe, particularly prefrontal cortex and mesial temporal regions, and describes ictal whistling as a nonverbal vocalization often reported in nondominant temporal lobe epilepsy.PDF p.8, What localizations are suggested by the seizure semiology?

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdfSystematic review or meta-analysis · 4 findings · 3 reported values

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

early automatisms; early vocalization; rapid medial/lateral involvementThe source reports that early automatisms and vocalization may be more frequent when medial and lateral temporal regions are involved rapidly.PDF p.5, Discussion
early vocalizationTable 6 reports early vocalization in 14% of the medio-lateral synthesis (evidence grade Moderate).PDF p.6, Table 6
early vocalizationTable 6 reports a 0–38% range for early vocalization across the medio-lateral reports (evidence grade Moderate).PDF p.6, Table 6
early vocalization; Maillard cohortThe review states that early vocalization occurred in 28% of Maillard's patients.PDF p.7, Discussion

Reported values

14%early vocalizationPercentage · Medio-lateral temporal seizure semiology synthesis represented in Table 6 · at onsetPDF p.6, Table 6
range 0–38%early vocalizationPercentage Range · Medio-lateral temporal seizure semiology synthesis represented in Table 6 · at onsetPDF p.6, Table 6
28%early vocalization; Maillard cohortPercentage · Maillard cohort as restated in the review · early ictal phasePDF p.7, Discussion

wang-hypermotor-seizures-temporal-pole-lesions-2008.pdfStructured design not resolved · 1 finding · 1 reported value

wang-hypermotor-seizures-temporal-pole-lesions-2008.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1

Findings

quick-onset vocal soundsAmong the four hypermotor patients, the source reports 2 patients with quick onset and moaning, barking, or squealing vocal sound.PDF p.4, Seizure semiology on video-EEG recording

Reported values

2/4 quick-onset vocal soundsquick-onset vocal soundsProportion · n/N 2/4 · 4 patients with hypermotor seizure semiology · ictal semiologyPDF p.4, Seizure semiology on video-EEG recording

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdfIndependent primary study · 1 finding

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

vocalizationTable 2 records vocalization in a seizure sequence with asymmetric tonic posturing and eye blinking.PDF p.6, Table 2 Case 2

17 contributing manuscripts; source-reported values remain separate and are not pooled.

Unilateral manual automatisms (ipsilateral fumbling, picking, patting)Source terms: Unilateral manual automatismsReported: BilateralAlso reported: ContralateralAlso reported: IpsilateralAlso reported: Right hemisphereNo single reliable side14 manuscripts · 57 findings · 40 reported values

Weighted evidence supportevidence weight 26.69 across 14 manuscripts · 1 manuscript weight pending · 2 independent primary study · 5 narrative, educational, or cited context · 3 systematic review or meta-analysis · 3 case report or observation · 1 structured design not resolved

This phenotype includes contralateral upper-limb tonic or asymmetric posturing after eye and oral/hand manifestations. In Case 5, right-hand automatisms were ipsilateral to the right occipital onset. A cited report states that early unilateral motor automatisms without dystonia may point contralateral to neocortical temporal onset. The review associates unilateral limb or upper-limb automatisms with an ipsilateral focus or onset, while retaining cited reports that isolated upper-limb automatisms have no lateralizing value. The handbook labels ictal unilateral automatisms as ipsilateral, with a reliability caveat in one table. Limb automatisms showed no significant lateralizing difference: bilateral and ipsilateral forms were more common than contralateral forms at onset, and after excluding automatisms constrained by contralateral posturing, ipsilateral and contralateral onset frequencies were approximately equal. The cited review describes unilateral limb automatisms as lateralizing only in relation to the opposite limb's tonic or dystonic posturing. The cited Dupont series is restated as predominantly ipsilateral automatisms in mesial TLE, exclusively contralateral automatisms in neocortical TLE, and contralateral dystonia plus ipsilateral automatisms only in mesial TLE. Case 5 had source-described right occipital onset and later bilateral hand automatisms. This record provides no seizure lateralization. No lateralizing direction is reported for the visual-aura-to-automatism phenotype. Left hand is a the source's own symptomatic body-side modifier; no cerebral hemisphere relation is supplied. Right upper limb is a the source's own symptomatic body-side modifier; no cerebral hemisphere relation is supplied. No hemisphere direction is asserted. No hemisphere or body-side direction is reported. No source-supported hemispheric lateralization is reported. No hemisphere or body-side result is reported. The semiology category definition contains no lateralization evidence. The row reports an all-data panel sample size, not lateralization evidence. The row reports a non-topological panel sample size, not lateralization evidence. No lateralizing direction is reported. No lateralization axis information is reported for oral and manual automatisms in the cingulate context. Left-hand automatisms and right version are the source's own sequence directions; no cerebral hemisphere relation is supplied. No source lateralization is reported. No cerebral side or body-side result is reported. Extremity automatisms did not differ significantly between right and left TLE (RTL 37 [71%] versus LTL 47 [85%], NS). The case reports bilateral hand fumbling/picking without cerebral-side information.

Source-defined result groups 31

Localization: TemporalSource-defined values retained separately4 diagnostic-accuracy studies comparing lateral and mesial TLE for Manual automatisms · lateral TLE versus mesial TLE · random-effects diagnostic-accuracy estimate1 manuscript · 1 reported value · not pooled

Localization: lateral temporal onset (L) / medial temporal onset (M) / medial-lateral temporal onset (ML)Observed proportion 38.9%ML; Table 4 · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyLTL; bilateral · RTL versus LTL and within-group laterality patterns · seizure with extremity automatism1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 38.9%ML · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyLTL; contralateral · RTL versus LTL and within-group laterality patterns · seizure with extremity automatism1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyLTL; ipsilateral · RTL versus LTL and within-group laterality patterns · seizure with extremity automatism1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyRTL; contralateral · RTL versus LTL and within-group laterality patterns · seizure with extremity automatism1 manuscript · 1 reported value · not pooled

Localization: lateral temporal onset (L) / medial temporal onset (M) / medial-lateral temporal onset (ML)Observed proportion 7.7%L · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Does not lateralize / Right hemisphereObserved proportion 68.5%RTL · RTL versus LTL · seizure1 manuscript · 1 reported value · not pooled

Localization: lateral temporal onset (L) / medial temporal onset (M) / medial-lateral temporal onset (ML)Observed proportion 33.3%M · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyMesial TLE patients assessed for Manual automatisms · lateral TLE percentage shown separately · reported mesial-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 66.7%M · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyAll reported · reported sign prevalence across included studies1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 15.4%L · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyLateral TLE patients assessed for Manual automatisms · mesial TLE percentage shown separately · reported lateral-TLE sign prevalence1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyRTL; bilateral · RTL versus LTL and within-group laterality patterns · seizure with extremity automatism1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralSource-defined values retained separatelyRTL; ipsilateral · RTL versus LTL and within-group laterality patterns · seizure with extremity automatism1 manuscript · 1 reported value · not pooled

Localization: lateral temporal onset (L) / medial temporal onset (M) / medial-lateral temporal onset (ML)Observed proportion 38.9%ML; prose · M versus ML versus L · patients1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 23.1%L · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 55.6%ML · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Does not lateralize / Right hemisphereObserved proportion 64.4%LTL · RTL versus LTL · seizure1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 58.3%M · Other onset subtypes · patient1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 14

Alphabetical by manuscript.

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdfSystematic review or meta-analysis · 12 findings · 5 reported values

alim-marvasti-probabilistic-landscape-seizure-semiology-localizing-values-2022.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

oral and manual automatismsTable 1 defines or exemplifies the the source's own semiology category “oral and manual automatisms” as Upper-limb automatisms, automotor stereotyped distal limb movements, fiddling, pedal automatisms, lip smacking, chewing, oro-alimentary/orofacial automatisms, ictal drinking, or ictal swallowing.PDF p.7, Table 1 Semiology descriptions and frequencies
oral and manual automatismsOral and manual automatisms comprised 9.7% of non-topological data.PDF p.7, Table 1 Semiology descriptions and frequencies
oral and manual automatisms; Figure 3 all-data subsetFigure 3 reports N = 2298 for the all-data oral and manual automatisms panel.PDF p.9, Figure 3 and caption
oral and manual automatisms; Figure 3 non-topological subsetFigure 3 reports N = 342 for the non-topological oral and manual automatisms panel.PDF p.9, Figure 3 and caption
oral and manual automatisms; temporal lobeOral and manual automatisms were temporal in origin in 47%.PDF p.8, Seizure semiology localizing values
oral and manual automatisms; temporal lobeThe 95% CI for oral and manual automatisms; temporal lobe was 40%–53%.PDF p.8, Seizure semiology localizing values
oral and manual automatisms; frontal lobeOral and manual automatisms were frontal in origin in 31%.PDF p.8, Seizure semiology localizing values
oral and manual automatisms; frontal lobeThe 95% CI for oral and manual automatisms; frontal lobe was 25%–36%.PDF p.8, Seizure semiology localizing values
oral and manual automatisms; cingulateoral and manual automatisms semiology was cingulate in 10%.PDF p.8, Seizure semiology localizing values
oral and manual automatisms; cingulateThe 95% CI for oral and manual automatisms; cingulate was 7%–13%.PDF p.8, Seizure semiology localizing values
oral and manual automatisms; anterior temporalOral and manual automatisms had an intrinsic OR of 2.4 for the anterior temporal subregion.PDF p.8, Relative localizing values of semiologies
oral and manual automatisms; anterior temporalThe 95% CI for oral and manual automatisms; anterior temporal was 1.7–3.3.PDF p.8, Relative localizing values of semiologies

Reported values

oral and manual automatisms 9.7%oral and manual automatismsPercentage · non-topological Semio2Brain dataPDF p.7, Table 1 Semiology descriptions and frequencies
oral and manual automatisms; temporal lobe 47%oral and manual automatisms; temporal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
oral and manual automatisms; frontal lobe 31%oral and manual automatisms; frontal lobePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
oral and manual automatisms; cingulate 10%oral and manual automatisms; cingulatePercentage · non-topological localizing data points unless otherwise statedPDF p.8, Seizure semiology localizing values
OR 2.4oral and manual automatisms; anterior temporalOdds ratio · non-topological Semio2Brain data unless otherwise statedPDF p.8, Relative localizing values of semiologies

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfCase report or observation · 1 finding

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

patient 10 left-hand automatismsLeft-hand automatisms followed by right version were listed for patient 10.PDF p.4, Figure 3

blair-temporal-lobe-epilepsy-semiology-2012.pdfNarrative, educational, or cited context · 3 findings

blair-temporal-lobe-epilepsy-semiology-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Early unilateral motor automatisms without dystonic posturing in neocortical TLESome authors reported that early-onset unilateral motor automatisms without dystonic posturing can localize seizure origin to the contralateral temporal-lobe neocortex.PDF p.3, neocortical TLE paragraph; PDF p.4, section 4 Lateralizing Features in Temporal Lobe Epilepsy
Unilateral upper-limb automatismThe review table and narrative associate unilateral limb or upper-limb automatisms with an ipsilateral seizure focus or onset, but also report that some authors found no lateralizing value for upper-limb automatisms in isolation.PDF p.4, Table 2; PDF p.4, section 4 Lateralizing Features in Temporal Lobe Epilepsy
Hand and mouth automatisms in mesial temporal onsetAutomatisms occur in almost two thirds of CPSs of mesial temporal lobe onset and often involve the hands, including fumbling, picking, or fidgeting, or the mouth, including chewing, lip smacking, or swallowing.PDF p.3, section 2.5 Automatisms

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 1 finding · 1 reported value

chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

behavioural arrest; manual and oral automatismsTemporal lobe seizures are described as typically comprising behavioural arrest and manual and oral automatisms in two thirds of cases, with variable loss of awareness and postictal confusion.PDF p.4, Temporal lobe seizures

Reported values

behavioural arrest and manual/oral automatisms in two thirdsbehavioural arrest; manual and oral automatismsProportion · temporal lobe seizure literature · ictal and postictalPDF p.4, Temporal lobe seizures

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdfSystematic review or meta-analysis · 20 findings · 7 reported values

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

oral automatisms; manual automatisms; behavioral arrestThe source identifies oral automatisms, manual automatisms, and behavioral arrests as the most common semiologies in lateral temporal epilepsy, while noting that they likely emerge during propagation rather than at seizure onset.PDF p.1, Abstract; PDF p.4, Anatomo-clinical correlations; PDF p.8, Discussion
Manual automatismTable 3 reports 5 studies assessing Manual automatism.PDF p.6, Table 3
Manual automatismTable 3 reports 86 patients assessed for Manual automatism.PDF p.6, Table 3
Manual automatismTable 3 reports 15.4–80% as the percentage range or value for Manual automatism; the overall association grade is Low.PDF p.6, Table 3
Manual automatismTable 3 reports 1 study with onset timing for Manual automatism.PDF p.6, Table 3
Manual automatismTable 3 reports an onset latency of 14 s for Manual automatism.PDF p.6, Table 3
odds of occurrence; Manual automatismsTable 4 reports overall odds of 0.97 for occurrence of Manual automatisms in lateral TLE.PDF p.7, Table 4; PDF p.8, Figure 2
odds confidence interval; Manual automatismsTable 4 reports a 95% confidence interval of 0.42–2.26 for the overall odds of Manual automatisms.PDF p.7, Table 4; PDF p.8, Figure 2
heterogeneity test; Manual automatismsThe heterogeneity test for the Table 4 odds estimate for Manual automatisms has p=0.0142.PDF p.7, Table 4
Manual automatisms; lateral versus mesial comparisonTable 5 reports 4 studies comparing Manual automatisms in lateral and mesial TLE.PDF p.9, Table 5
Manual automatisms; lateral TLE patient denominatorTable 5 reports 64 lateral-TLE patients assessed for Manual automatisms.PDF p.9, Table 5
Manual automatisms; mesial TLE patient denominatorTable 5 reports 112 mesial-TLE patients assessed for Manual automatisms.PDF p.9, Table 5
Manual automatisms; lateral TLE prevalenceTable 5 reports a lateral-TLE percentage of 15.4–80% for Manual automatisms.PDF p.9, Table 5
Manual automatisms; mesial TLE prevalenceTable 5 reports a mesial-TLE percentage of 25–83.9% for Manual automatisms.PDF p.9, Table 5
Manual automatisms; diagnostic sensitivityTable 6 reports overall sensitivity 0.45 for Manual automatisms in 4 studies comparing lateral with mesial TLE.PDF p.9, Table 6
Manual automatisms; diagnostic sensitivity confidence intervalTable 6 reports a 95% confidence interval of 0.22–0.70 for sensitivity of Manual automatisms.PDF p.9, Table 6
Manual automatisms; sensitivity heterogeneityThe heterogeneity test for sensitivity of Manual automatisms has p=0.0154.PDF p.9, Table 6
Manual automatisms; diagnostic specificityTable 6 reports overall specificity 0.35 for Manual automatisms in 4 studies comparing lateral with mesial TLE.PDF p.9, Table 6
Manual automatisms; diagnostic specificity confidence intervalTable 6 reports a 95% confidence interval of 0.17–0.60 for specificity of Manual automatisms.PDF p.9, Table 6
Manual automatisms; specificity heterogeneityThe heterogeneity test for specificity of Manual automatisms has p=0.0022.PDF p.9, Table 6

Reported values

15.4–80%Manual automatismPercentage Range · Lateral temporal epilepsy patients assessed for Manual automatism · ictalPDF p.6, Table 3
median onset latency 14 sManual automatismMedian · Lateral temporal epilepsy study reporting onset timing for Manual automatism · ictal onsetPDF p.6, Table 3
odds 0.97odds of occurrence; Manual automatismsOdds · Lateral temporal epilepsy patients assessed for Manual automatisms · ictalPDF p.7, Table 4; PDF p.8, Figure 2
15.4–80%Manual automatisms; lateral TLE prevalencePercentage Range · Lateral TLE patients assessed for Manual automatisms · Lateral TLE patients assessed for Manual automatisms · ictalPDF p.9, Table 5
25–83.9%Manual automatisms; mesial TLE prevalencePercentage Range · Mesial TLE patients assessed for Manual automatisms · Mesial TLE patients assessed for Manual automatisms · ictalPDF p.9, Table 5
sensitivity 0.45Manual automatisms; diagnostic sensitivitySensitivity · 4 diagnostic-accuracy studies comparing lateral and mesial TLE for Manual automatisms · 4 diagnostic-accuracy studies comparing lateral and mesial TLE for Manual automatisms · ictal sign presencePDF p.9, Table 6
specificity 0.35Manual automatisms; diagnostic specificitySpecificity · 4 diagnostic-accuracy studies comparing lateral and mesial TLE for Manual automatisms · 4 diagnostic-accuracy studies comparing lateral and mesial TLE for Manual automatisms · ictal sign presencePDF p.9, Table 6

epilepsy-fellowship-handbook-semiologyreferences.pdfNarrative, educational, or cited context · 1 finding

epilepsy-fellowship-handbook-semiologyreferences.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Ictal unilateral automatismsBoth tables list Ictal unilateral automatisms as Ipsilateral; p.2 marks the term with an asterisk and p.3 does not.PDF p.2, Lateralizing signs/Localization table row "Ictal unilateral automatisms*" (printed p.7); PDF p.3, Lateralizing signs/Localization table row "Ictal unilateral automatisms" (printed p.5)

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdfStructured design not resolved · 3 findings · 14 reported values

fakhoury-right-left-temporal-lobe-clinical-features-1994.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.932

Findings

Limb automatisms: onset and late lateralityNo significant differences in lateralization of limb automatisms at onset or late in the seizure were identified; at onset, limb automatisms were more common bilaterally and ipsilaterally than contralaterally in both groups, and after excluding ipsilateral automatisms associated with contralateral posturing, contralateral and ipsilateral automatisms were approximately equal at onset.PDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion
Unilateral limb automatisms in cited studiesThe current paper reports that Wada (1982) considered unilateral automatisms to have lateralizing value, whereas Kotagal et al. (1989) considered them valuable only when accompanied by tonic or dystonic posturing in the opposite limb.PDF p.5, Discussion, limb-automatisms paragraph; PDF p.6, Discussion
Extremity automatismsExtremity automatisms did not differ significantly between RTL and LTL seizures.PDF p.4, numbered clinical-feature results; PDF p.4, Table 5

Reported values

LTL bilateral onset 20 (43%)Limb automatisms: onset and late lateralityPercentage · RTL seizure group, n=54, versus LTL seizure group, n=73; limb-automatisms subset · LTL; bilateral · Ictal onset and late ictal phasePDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion
RTL ipsilateral late 11 (30%)Limb automatisms: onset and late lateralityPercentage · RTL seizure group, n=54, versus LTL seizure group, n=73; limb-automatisms subset · RTL; ipsilateral · Ictal onset and late ictal phasePDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion
LTL ipsilateral late 18 (38%)Limb automatisms: onset and late lateralityPercentage · RTL seizure group, n=54, versus LTL seizure group, n=73; limb-automatisms subset · LTL; ipsilateral · Ictal onset and late ictal phasePDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion
LTL bilateral late 22 (47%)Limb automatisms: onset and late lateralityPercentage · RTL seizure group, n=54, versus LTL seizure group, n=73; limb-automatisms subset · LTL; bilateral · Ictal onset and late ictal phasePDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion
RTL ipsilateral onset 13 (35%)Limb automatisms: onset and late lateralityPercentage · RTL seizure group, n=54, versus LTL seizure group, n=73; limb-automatisms subset · RTL; ipsilateral · Ictal onset and late ictal phasePDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion
RTL contralateral onset 7 (19%)Limb automatisms: onset and late lateralityPercentage · RTL seizure group, n=54, versus LTL seizure group, n=73; limb-automatisms subset · RTL; contralateral · Ictal onset and late ictal phasePDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion
LTL ipsilateral onset 19 (40%)Limb automatisms: onset and late lateralityPercentage · RTL seizure group, n=54, versus LTL seizure group, n=73; limb-automatisms subset · LTL; ipsilateral · Ictal onset and late ictal phasePDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion
LTL contralateral late 7 (15%)Limb automatisms: onset and late lateralityPercentage · RTL seizure group, n=54, versus LTL seizure group, n=73; limb-automatisms subset · LTL; contralateral · Ictal onset and late ictal phasePDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion
LTL contralateral onset 8 (17%)Limb automatisms: onset and late lateralityPercentage · RTL seizure group, n=54, versus LTL seizure group, n=73; limb-automatisms subset · LTL; contralateral · Ictal onset and late ictal phasePDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion
RTL contralateral late 12 (32%)Limb automatisms: onset and late lateralityPercentage · RTL seizure group, n=54, versus LTL seizure group, n=73; limb-automatisms subset · RTL; contralateral · Ictal onset and late ictal phasePDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion
RTL bilateral late 14 (58%)Limb automatisms: onset and late lateralityPercentage · RTL seizure group, n=54, versus LTL seizure group, n=73; limb-automatisms subset · RTL; bilateral · Ictal onset and late ictal phasePDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion
RTL bilateral onset 17 (46%)Limb automatisms: onset and late lateralityPercentage · RTL seizure group, n=54, versus LTL seizure group, n=73; limb-automatisms subset · RTL; bilateral · Ictal onset and late ictal phasePDF p.4, numbered clinical-feature results; PDF p.4, Table 5; PDF p.6, Discussion
RTL 37 (71%)Extremity automatismsPercentage · n/N 37/54 · RTL seizure group, n=54, versus LTL seizure group, n=73 · RTL · IctalPDF p.4, numbered clinical-feature results; PDF p.4, Table 5
LTL 47 (85%)Extremity automatismsPercentage · n/N 47/73 · RTL seizure group, n=54, versus LTL seizure group, n=73 · LTL · IctalPDF p.4, numbered clinical-feature results; PDF p.4, Table 5

jobst-insula-and-its-epilepsies-2019.pdfNarrative, educational, or cited context · 2 findings

jobst-insula-and-its-epilepsies-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

manual automatismsTemporal-like insular seizures may include manual automatisms.PDF p.2, Clinical Features
hand movement to throatHand movement to the throat is among the observed signs that suggest an insular focus.PDF p.3, Video EEG

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

unilateral motor automatisms with dystonic posturingDupont et al. reported predominantly ipsilateral automatisms in mesial TLE, exclusively contralateral automatisms in neocortical TLE, and the combination of contralateral dystonia with ipsilateral automatisms only in mesial TLE.PDF p.6, section 3.9

Reported values

26/60 had unilateral motor automatismsunilateral motor automatisms with dystonic posturingCount · n/N 26/60 · 60 patients with temporal lobe epilepsy, including 26 with unilateral motor automatisms · ictalPDF p.6, section 3.9

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdfIndependent primary study · 3 findings · 11 reported values

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdf

Independent primary study · Class II · Evidence weight 5.07 · 2 × 1.5 × 1.69

Findings

upper-limb elementary automatismsUpper-limb elementary automatisms over the whole seizure course were more frequent in M and ML than L patients.PDF p.6, Table 3; PDF p.6, General ictal characteristics
early upper-limb elementary automatismsEarly upper-limb elementary automatisms were reported in M and ML more often than L numerically, but the comparison was not statistically significant; the ML percentage differs between the table and prose.PDF p.6, Table 4; PDF p.6, Early features
late upper-limb elementary automatismsLate upper-limb elementary automatisms were more frequent in M than ML or L patients.PDF p.7, Table 5; PDF p.7, Later features; PDF p.8, Upper-limb automatisms

Reported values

L 3/13 (23.1%)upper-limb elementary automatismsPercentage · n/N 3/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · ictal course, early or late combinedPDF p.6, Table 3; PDF p.6, General ictal characteristics
ML 10/18 (55.6%)upper-limb elementary automatismsPercentage · n/N 10/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · ictal course, early or late combinedPDF p.6, Table 3; PDF p.6, General ictal characteristics
M 16/24 (66.7%)upper-limb elementary automatismsPercentage · n/N 16/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · ictal course, early or late combinedPDF p.6, Table 3; PDF p.6, General ictal characteristics
prose ML=36.9%early upper-limb elementary automatismsPercentage · n/N 7/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML; prose · early ictal, first half of seizurePDF p.6, Table 4; PDF p.6, Early features
p=0.13early upper-limb elementary automatismsP value · 55 patients with unilateral TLE; M=24, ML=18, L=13 · early ictal, first half of seizurePDF p.6, Table 4; PDF p.6, Early features
Table 4 ML=7/18 (38.9%)early upper-limb elementary automatismsPercentage · n/N 7/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML; Table 4 · early ictal, first half of seizurePDF p.6, Table 4; PDF p.6, Early features
M=8/24 (33.3%)early upper-limb elementary automatismsPercentage · n/N 8/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · early ictal, first half of seizurePDF p.6, Table 4; PDF p.6, Early features
L=1/13 (7.7%)early upper-limb elementary automatismsPercentage · n/N 1/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · early ictal, first half of seizurePDF p.6, Table 4; PDF p.6, Early features
L 2/13 (15.4%)late upper-limb elementary automatismsPercentage · n/N 2/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · late ictal, second half of seizurePDF p.7, Table 5; PDF p.7, Later features; PDF p.8, Upper-limb automatisms
M 14/24 (58.3%)late upper-limb elementary automatismsPercentage · n/N 14/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · late ictal, second half of seizurePDF p.7, Table 5; PDF p.7, Later features; PDF p.8, Upper-limb automatisms
ML 7/18 (38.9%)late upper-limb elementary automatismsPercentage · n/N 7/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · late ictal, second half of seizurePDF p.7, Table 5; PDF p.7, Later features; PDF p.8, Upper-limb automatisms

moser-chapeau-de-gendarme-sign-focal-epilepsy-systematic-review-2025.pdfCase report or observation · 1 finding

moser-chapeau-de-gendarme-sign-focal-epilepsy-systematic-review-2025.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

hand-to-eye movementA hand-to-eye movement followed the non-painful eye sensation in the Figure 2 case.PDF p.7, Figure 2

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdfCase report or observation · 1 finding

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

fumbling and picking at bed clothes in Fig. 2The Figure 2 tracing labels fumbling and picking at bed clothes with both hands during seizure evolution.PDF p.14, Fig. 2

wang-hypermotor-seizures-temporal-pole-lesions-2008.pdfNarrative, educational, or cited context · 1 finding

wang-hypermotor-seizures-temporal-pole-lesions-2008.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

psychomotor semiology: limb automatismsTypical temporal psychomotor semiology included limb automatisms.PDF p.4, Seizure semiology on video-EEG recording

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdfIndependent primary study · 7 findings · 1 reported value

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdf

Independent primary study · Class II · Evidence weight 4.92 · 2 × 1.5 × 1.639

Findings

oculomotor-onset evolving motor phenotypePhenotype IV begins with eye blinking or eye pursuit without a clear visual aura, followed by oral/hand automatisms and contralateral upper-limb tonic or asymmetric posturing, sometimes progressing to GTCS.PDF p.9, Phenotype IV
right-hand automatismsTable 2 records right-hand automatisms in Case 5 after tachycardia and behavioral pause.PDF p.6, Table 2 Case 5
bilateral hand automatismsTable 2 records progression to bilateral hand automatisms in Case 5.PDF p.6, Table 2 Case 5
orolingual and hand automatismsOrolingual/hand automatisms occurred in 10 of 19 patients (52.6%).PDF p.5, Ictal Semiology and Seizure Capture During SEEG Monitoring; PDF p.9, Figure 1
visual aura to automatism phenotypePhenotype II is characterized primarily by oropharyngeal, limb, or verbal automatisms, with or without a preceding visual aura.PDF p.9, Phenotype II
left-hand automatismsTable 2 records left-hand automatisms after the Case 6 Sz1 visual aura and rightward pursuit.PDF p.6, Table 2 Case 6 Sz1
right-upper-limb automatismsTable 2 records right-upper-limb automatisms in Case 11 after chewing/swallowing automatisms.PDF p.7, Table 2 Case 11

Reported values

10/19 (52.6%) orolingual/hand automatismsorolingual and hand automatismsPercentage · n/N 10/19 · 19 patients monitored with SEEG · ictal automatismsPDF p.5, Ictal Semiology and Seizure Capture During SEEG Monitoring; PDF p.9, Figure 1

14 contributing manuscripts; source-reported values remain separate and are not pooled.

Bilateral asymmetric tonic posturing (fencing posture / BATS)Source terms: Bilateral asymmetric tonic posturingReported: BilateralAlso reported: ContralateralAlso reported: IpsilateralAlso reported: Left hemisphereAlso reported: Right hemisphereNo single reliable side16 manuscripts · 55 findings · 75 reported values

Weighted evidence supportevidence weight 25.91 across 16 manuscripts · 2 manuscript weight pending · 2 independent primary study · 3 systematic review or meta-analysis · 2 structured design not resolved · 8 narrative, educational, or cited context · 1 case report or observation

Source reports contralateral limb posturing in a sequential occipital-onset phenotype. This phenotype includes contralateral upper-limb tonic or asymmetric posturing after eye and oral/hand manifestations. Phenotype III occipital seizures included progression to contralateral limb tonic posturing or asymmetric tonic posturing. Bilateral asymmetric tonic posture occurred in 5/21 (24%) of the included fronto-opercular epilepsy patients. Bilateral asymmetric tonic posture occurred in 2/12 patients in the prefrontal operculum group; the source reports p=0.611 for the subgroup comparison. Bilateral asymmetric tonic posture occurred in 3/9 patients in the precentral Rolandic operculum group. Two of seven PCE patients had bilateral asymmetric tonic seizures. The review describes the common SMA seizure pattern as tonic asymmetric posturing with variable head deviation and arm flexion generally contralateral to ictal discharge. The review describes unilateral/bilateral asymmetric tonic posturing as a possible early localizing sign in SMA epilepsy because it is mostly reported at seizure onset. The review restates contralateral frontal-eye-field involvement for versive seizures and possible SMA involvement for asymmetric tonic posturing. The cited table associates asymmetric tonic limb posturing during secondary generalized tonic-clonic seizures with contralateral direction. The extended elbow was contralateral to the source-reported ictal-onset side in 35 of 39 patients with ATLP. In Group I, the extended arm was contralateral to the seizure focus in 10/12 TLE patients and 7/8 XTLE patients with ATLP. ATLP was contralateral to the source-reported side of ictal EEG onset in 17/18 Group II patients (94.4%). Group I ATLP ratings had overall kappa 0.71, TLE kappa 0.68, and XTLE kappa 0.71, with overall p<0.01 for agreement. Group II ATLP had overall kappa 0.711 with p<0.001 for interobserver agreement. ATLP was usually on the same side as version, with one complex two-direction version exception; the head was midline or returning to midline when ATLP appeared. The lower extremity was generally extended ipsilateral to the extended upper limb, except in two seizures from two patients. In two Group II patients, initial ATLP was contralateral to ictal onset, followed by bilateral upper-limb extension/clonic movements; later apparent ATLP side could change during evolution. The case depicts right occipital onset, left head-eye version and left arm extension, right-arm flexion, and later bilateral extension and clonic jerking. The single case combines a nonlateralized visual aura with right-arm extension/right head deviation, left-arm flexion, and a left occipital focal pattern during the aura. ATLP was contralateral to ictal onset in both the patient's left- and right-temporal seizure types. The cited one-arm-flexed/one-arm-extended phenomenon was reported in 9% of metrazol-induced seizures and was considered non-lateralizing. SMA seizures are restated with bilateral tonic posturing, contralateral extension/head-eye deviation, and ipsilateral flexion. The review defines the initial figure-of-4 posture as extension of the limb contralateral to the epileptogenic hemisphere with flexion of the ipsilateral limb and reports 90% correct lateralization. The cited rule lateralizes seizure onset contralateral to the initially extended tonic arm in the figure-of-4 sign. The review describes the extended limb in the figure-of-four posture as contralateral to the seizure focus. The review reports that the extended elbow in asymmetric tonic limb posturing is predominantly contralateral to seizure onset, with ipsilateral and bilateral exceptions. The cited series predominantly associated the extended elbow component with the hemisphere contralateral to seizure onset. The cited study reported asymmetric tonic limb posturing as contralateral in 70%, ipsilateral in 17%, and bilateral in 13% of affected patients. The cited study restates asymmetric tonic arm extension with opposite-arm flexion as contralateral to seizure onset in 94% of temporal-lobe-epilepsy patients. The bilateral asymmetric-tonic-posture comparison reports no cerebral-side direction. No cerebral lateralization is reported for bilateral asymmetric tonic posture. The review describes the last clonic jerk at an asymmetric generalized-seizure ending as usually ipsilateral to the seizure-onset hemisphere. No hemisphere or body-side direction is reported. No lateralizing direction is reported for asymmetric tonic posturing. No lateralizing direction is reported for asymmetric tonic posturing heterogeneity. The cited anterior-versus-posterior insular comparison provides no lateralizing information. The ventral-versus-dorsal insular focus record provides no lateralizing information. The review describes brief bilateral asymmetric motor posturing with retained awareness and no postictal confusion; no hemisphere direction is reported. No lateralizing direction is reported for ATLP occurrence. ATLP occurred in 18/26 patients; no hemisphere or body-side direction is reported. ATLP occurred in 22/64 analyzed seizures; no hemisphere or body-side direction is reported. No lateralizing direction is reported for version or ATLP. No source-supported hemispheric or body-side lateralization is reported. No lateralizing direction is reported for ATLP onset time. No lateralizing direction is reported for ATLP duration. ATLP without prior version occurred in 9/23 patients; the card calls it the only observed lateralizing sign but gives no side direction. No seizure lateralization is reported. Patient 7 had right arm and leg extension followed by right arm clonic activity.

Source-defined result groups 18

Localization: TemporalObserved proportion 100.0%Temporal-lobe seizures with secondary generalization · seizure1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 94.4%All reported · ictal EEG onset side · patient1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 83.3%TLE with ATLP · XTLE · patient1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 87.5%XTLE with ATLP · TLE · patient1 manuscript · 1 reported value · not pooled

Lateralization: BilateralObserved proportion 28.6%All reported · hypermotor, dialeptic, and automotor seizures · patients1 manuscript · 1 reported value · not pooled

Lateralization: ATLP interobserver agreementSource-defined values retained separatelyOverall · TLE and XTLE subgroup agreement · observer rating1 manuscript · 1 reported value · not pooled

Lateralization: BilateralObserved proportion 16.7%12 patients with EZ in the prefrontal operculum · precentral Rolandic operculum group (N=9) · patients in the prefrontal operculum group1 manuscript · 1 reported value · not pooled

Lateralization: BilateralObserved proportion 33.3%9 patients with EZ in the precentral Rolandic operculum · prefrontal operculum group (N=12) · patients in the precentral Rolandic operculum group1 manuscript · 1 reported value · not pooled

Lateralization: ATLP interobserver agreementSource-defined values retained separatelyAll reported · observer ratings1 manuscript · 1 reported value · not pooled

Lateralization: ATLP interobserver agreementSource-defined values retained separatelyTLE · TLE and XTLE subgroup agreement · observer rating1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / ContralateralSource-defined values retained separatelyAll reported · Initial ATLP side versus later clonic/postural asymmetry · patient and seizure1 manuscript · 1 reported value · not pooled

Lateralization: ATLP interobserver agreementSource-defined values retained separatelyXTLE · TLE and XTLE subgroup agreement · observer rating1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 89.7%All reported · ictal-onset side · patient1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Contralateral / IpsilateralObserved proportion 89.7%asymmetric tonic limb posturing · non-contralateral · case1 manuscript · 1 reported value · not pooled

Localization: TemporalObserved proportion 0.0%Primary GTC seizures · seizure1 manuscript · 1 reported value · not pooled

Lateralization: BilateralObserved proportion 23.8%All reported · prefrontal operculum versus precentral Rolandic operculum · all included patients1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 16

Alphabetical by manuscript.

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfCase report or observation · 1 finding

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

patient 7 asymmetric right tonicAsymmetric tonic right arm and leg extension followed by right arm clonic activity was listed for patient 7.PDF p.4, Figure 3

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 5 findings · 2 reported values

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

asymmetric tonic posturingThe discussion identifies asymmetric tonic posturing as a possible early localizing sign in SMA epilepsy because it is mostly reported at seizure onset.PDF p.8, Discussion
asymmetric tonic posturingTable 3 lists 17 patients for the the source's own ictal symptom “asymmetric tonic posturing”; its table phase label is onset.PDF p.6, Table 3
asymmetric tonic posturingTable 3 reports a pooled prevalence of 47% for the the source's own ictal symptom “asymmetric tonic posturing”; its table phase label is onset.PDF p.6, Table 3
asymmetric tonic posturing; between-study heterogeneityThe source reports I2 heterogeneity of 33.49% for pooled asymmetric tonic posturing prevalence.PDF p.4, Results
asymmetric tonic posturing; heterogeneity testThe source reports p = 0.07 for the between-study heterogeneity test of pooled asymmetric tonic posturing prevalence.PDF p.4, Results

Reported values

47% pooled prevalenceasymmetric tonic posturingPercentage · Patients with SMA or pre-SMA epilepsy in the selected studies · onsetPDF p.6, Table 3
I2 = 33.49%asymmetric tonic posturing; between-study heterogeneityHeterogeneity I2 · Patients with SMA or pre-SMA epilepsy in the selected studies · ictal symptom prevalence analysisPDF p.4, Results

chauvel-mcgonigal-emergence-semiology-epileptic-seizures-2014.pdfNarrative, educational, or cited context · 1 finding

chauvel-mcgonigal-emergence-semiology-epileptic-seizures-2014.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

supplementary motor area tonic asymmetric posturingThe review describes the common SMA seizure pattern as tonic asymmetric posturing with variable head deviation and arm flexion generally contralateral to ictal discharge; arm-raising and fencing postures are described as rare.PDF p.3, section 4

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 1 finding

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

supplementary motor area seizure; fencing postureSupplementary motor area seizures are characterized by asymmetric bilateral tonic posturing, with or without impaired awareness, sometimes with contralateral upper-limb extension and ipsilateral upper-limb flexion in a fencing posture plus contralateral head and eye deviation; sensory tingling or tightness may precede the motor signs.PDF p.3, Supplementary motor area; PDF p.4, Supplementary motor area

enatsu-posterior-cingulate-epilepsy-clinical-neurophysiological-analysis-2014.pdfStructured design not resolved · 1 finding · 1 reported value

enatsu-posterior-cingulate-epilepsy-clinical-neurophysiological-analysis-2014.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.423

Findings

bilateral asymmetric tonic seizures in PCETwo of seven PCE patients had bilateral asymmetric tonic seizures.PDF p.1, Abstract; PDF p.5, Ictal semiology and SEEG findings

Reported values

2/7 bilateral asymmetric tonic seizuresbilateral asymmetric tonic seizures in PCEProportion · n/N 2/7 · 7 PCE patients · ictal semiologyPDF p.1, Abstract; PDF p.5, Ictal semiology and SEEG findings

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

asymmetric tonic limb posturing or figure-4 signAsymmetric tonic limb posturing is a figure-4 posture in which the elbow contralateral to the epileptogenic hemisphere is extended and the ipsilateral limb flexes over the chest during the tonic phase of an SGTCS. The sign provides correct lateralization in 90% of cases, is most common in temporal-lobe seizures, and can change sides, so only its initial appearance should be used for lateralization.PDF p.6, section 7 Lateralizing signs of secondarily generalized tonic–clonic seizures; PDF p.5, Table 2

Reported values

Correct lateralization in 90% of casesasymmetric tonic limb posturing or figure-4 signPercentage · patients with secondarily generalized tonic-clonic seizures · initial tonic phase of SGTCSPDF p.6, section 7 Lateralizing signs of secondarily generalized tonic–clonic seizures; PDF p.5, Table 2

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdfNarrative, educational, or cited context · 1 finding

frazzini-cousyn-navarro-semiology-eeg-neuroimaging-temporal-lobe-epilepsies-2022.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

asymmetric tonic limb posturing (“figure-of-4” sign)During the tonic phase of a focal to bilateral tonic-clonic seizure, asymmetric tonic limb posturing, also called the “figure-of-4” sign, is described as contralateral to the seizure focus.PDF p.9, Focal to bilateral tonic-clonic seizures

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdfSystematic review or meta-analysis · 4 findings · 3 reported values

gokce-samar-ictal-semiology-fronto-opercular-epilepsy-systematic-review-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

Bilateral asymmetric tonic postureTable 2 reports 5/21 (24%) for Bilateral asymmetric tonic posture; timing is onset or propagation, and the source's overall agreement that the sign is suggestive of fronto-opercular epilepsy is graded High.PDF p.7, Table 2
Bilateral asymmetric tonic postureTable 2 reports 2/12 patients with Bilateral asymmetric tonic posture in the prefrontal operculum group.PDF p.7, Table 2
Bilateral asymmetric tonic postureTable 2 reports 3/9 patients with Bilateral asymmetric tonic posture in the precentral Rolandic operculum group.PDF p.7, Table 2
Bilateral asymmetric tonic postureFisher's exact comparison of Bilateral asymmetric tonic posture between the prefrontal and precentral Rolandic operculum groups has p=0.611.PDF p.7, Table 2

Reported values

5/21 (24%)Bilateral asymmetric tonic posturePercentage · n/N 5/21 · 21 included fronto-opercular epilepsy patients · BothPDF p.7, Table 2
2/12 patientsBilateral asymmetric tonic postureProportion · n/N 2/12 · 12 patients with EZ in the prefrontal operculum · 12 patients with EZ in the prefrontal operculum · BothPDF p.7, Table 2
3/9 patientsBilateral asymmetric tonic postureProportion · n/N 3/9 · 9 patients with EZ in the precentral Rolandic operculum · 9 patients with EZ in the precentral Rolandic operculum · BothPDF p.7, Table 2

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 3 findings

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Versive seizures and asymmetric tonic posturingThe review states that electrical stimulation of M1 and SMA produces myoclonic, tonic, clonic, tonic-clonic, or version responses; versive seizures indicate contralateral frontal eye field involvement, and asymmetric tonic posturing can indicate SMA involvement.PDF p.4, section 1.6
Asymmetric tonic limb posturingTable 3 associates asymmetric tonic limb posturing during secondary generalized tonic-clonic seizures with SSMA and precentral area and lists contralateral lateralisation.PDF p.4, Table 3
Brief bilateral asymmetric motor posturing with retained awarenessThe review states that seizures with brief bilateral asymmetric motor posturing, retained awareness, and no postictal confusion may indicate SMA semiology and may lack clear surface EEG manifestations.PDF p.7, section 1.18

kotagal-asymmetric-tonic-limb-posturing-secondarily-generalized.pdfStructured design not resolved · 25 findings · 49 reported values

kotagal-asymmetric-tonic-limb-posturing-secondarily-generalized.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.903

Findings

asymmetric tonic limb posturing (ATLP) / “Figure 4 Sign”The article summary reports that the extended elbow was contralateral to the side of ictal onset in 35 of 39 patients who had ATLP during their seizures.PDF p.1, Summary—Results
extended arm in ATLPIn Group I, the extended arm was contralateral to the seizure focus in 10 of 12 TLE patients (83.3%) and 7 of 8 XTLE patients (87.5%) with ATLP.PDF p.3, Table 1—Patients with ATLP contralateral to focus; PDF p.3, Results—Group I; PDF p.6, Conclusion
ATLPIn Group II, ATLP was contralateral to the side of ictal EEG onset in 17 of 18 patients (94.4%) with ATLP.PDF p.3, Table 1—Patients with ATLP contralateral to focus; PDF p.3, Results—Group II; PDF p.6, Conclusion
ATLP interobserver agreementGroup I ATLP ratings had an overall kappa of 0.71, with kappa 0.68 in TLE and 0.71 in XTLE; the overall result was reported as p<0.01.PDF p.3, Table 1—Kappa index for ATLP; PDF p.3, Results—Group I
ATLP interobserver agreementGroup II ATLP had a kappa score of 0.711 overall, reported as p<0.001.PDF p.3, Table 1—Kappa index for ATLP; PDF p.3, Results—Group II
ATLP following head and eye versionAt the time of ATLP, the head was midline or returning to midline from version in all instances, and ATLP was on the same side as version in all but one Group II patient; the exception had left version followed by right version, right ATLP, and generalized clonic movements, with EEG higher over the left hemisphere.PDF p.3, Other characteristics of ATLP—item 2
ATLP limb configurationThe extended arm was usually in front of the trunk and occasionally raised; the flexed arm could be in front of or behind it; the lower extremity on the same side as the extended arm was also extended except in two seizures from two patients.PDF p.3, Other characteristics of ATLP—item 3; PDF p.4, Other characteristics of ATLP—item 4
ATLP changing sides during seizure evolutionIn two Group II patients, initial ATLP was contralateral to ictal onset, followed by bilateral upper-limb extension and clonic movements more prominent on the initial-ATLP side; the source states that initial ATLP was contralateral and that each patient showed the same ATLP side in all seizures with the phenomenon.PDF p.4, Other characteristics of ATLP—item 6; PDF p.5, Fig. 3 caption and images
ATLP in Figure 1Figure 1 depicts a secondarily generalized GTC seizure beginning in the right occipital region; after head/eye version to the left and return to midline, the left arm was tonically extended and the right arm flexed, followed by bilateral extension and clonic jerking.PDF p.2, Fig. 1 image and caption
ATLP in Figure 2Figure 2 depicts right-arm tonic extension with left-arm flexion in a patient whose seizures had a nonlateralized visual aura followed by right head deviation and secondary generalization; a focal seizure pattern was seen in the left occipital region during the aura.PDF p.2, Fig. 2 image and caption
ATLP with independent temporal onsetsIn an anecdotal patient with independent seizure onsets from the left and right temporal lobes, ATLP was contralateral to the side of ictal onset in both seizure types.PDF p.4, Anecdotal information
“asymmetrical generalized seizure” / asymmetric arm posturingThe article reports that Ajmone-Marsan and Ralston described one arm flexed and the other extended at the elbow in metrazol-induced seizures; it was seen in 9% and was thought not to have lateralizing significance.PDF p.5, Discussion
ATLPIn Group I seizures progressing to secondary generalization, ATLP occurred in 12 of 16 TLE patients (75%) and 8 of 15 XTLE patients (53.3%).PDF p.2, Results—Group I; PDF p.3, Table 1—Number of patients with ATLP in GTC seizures
ATLPIn Group I, ATLP appeared in 19 of 27 analyzed GTC seizures from TLE patients (70.3%) and 10 of 32 from XTLE patients (31.2%).PDF p.3, Table 1—Number of seizures showing ATLP
ATLPIn Group II, ATLP occurred in 18 of 26 patients (69.2%).PDF p.3, Results—Group II; PDF p.5, Discussion
ATLPIn Group II, 22 of 64 analyzed GTC or generalized clonic seizures showed ATLP (34.3%).PDF p.3, Table 1—Number of seizures showing ATLP
ATLP and versionTable 1 reports patient-level joint version/ATLP categories as TLE: version+ATLP 8/16, version without ATLP 1/16, ATLP without version 4/16, neither 3/16; XTLE: 4/15, 4/15, 4/15, 3/15; Group II: 10/26, 12/26, 9/26, 0, respectively.PDF p.3, Table 1—Version and ATLP
ATLP in every GTC seizureTable 1 reports ATLP in every GTC seizure for 10/12 TLE patients (83.3%), 6/8 XTLE patients (75%), and 2/26 Group II patients (7.6%).PDF p.3, Table 1—Patients who had ATLP in every GTC seizure
ATLP onset timeATLP appeared at a median of 23.5 seconds from clinical onset (range 4-108); onset was 28.5 seconds in TLE (range 11-108) versus 22.5 seconds in XTLE (range 4-52), without a statistically significant difference.PDF p.3, Results—ATLP timing
ATLP durationMedian ATLP duration was 10 seconds in XTLE patients (range 2-20) versus 4.5 seconds in temporal patients (range 2-20), without a statistically significant difference.PDF p.3, Results—ATLP duration; PDF p.6, Discussion
ATLP without prior versionIn Group II patients with partial-onset seizures evolving to GTC seizures, ATLP occurred without prior version in 9 of 23 patients (39.1%) and was the only observed lateralizing sign in those cases.PDF p.4, Other characteristics of ATLP—item 5; PDF p.5, Discussion; PDF p.1, Summary—Conclusions
ATLP in temporal epilepsy versus primary GTC in JMEIn an anecdotal patient with both JME and temporal lobe epilepsy, ATLP occurred in four temporal-lobe complex-partial seizures with secondary generalization but not in two primary GTC seizures.PDF p.4, Anecdotal information; PDF p.5, Discussion
ATLP in prior partial-onset seizure studyThe authors state that a previous study had noticed ATLP during partial-onset seizures progressing to secondary generalized tonic-clonic seizures.PDF p.1, Introduction
asymmetric tonic limb posturing and supplementary motor area seizuresThe article states that asymmetric tonic posturing of the limbs is typically observed in supplementary motor area seizures.PDF p.6, Discussion
asymmetric tonic posturing and SMA stimulationThe article states that asymmetric tonic posturing of the limbs can be reproduced with electrical stimulation of the supplementary motor area.PDF p.6, Discussion

Reported values

35 of 39 patientsasymmetric tonic limb posturing (ATLP) / “Figure 4 Sign”Count · n/N 35/39 · Patients with ATLP across the two analyzed groups; aggregate construction Not reported · Tonic phase of a secondarily generalized GTC seizurePDF p.1, Summary—Results
10/12 (83.3%)extended arm in ATLPPercentage · n/N 10/12 · Group I patients with ATLP; TLE and XTLE subgroups · TLE with ATLP · Tonic phase of secondarily generalized GTC seizuresPDF p.3, Table 1—Patients with ATLP contralateral to focus; PDF p.3, Results—Group I; PDF p.6, Conclusion
7/8 (87.5%)extended arm in ATLPPercentage · n/N 7/8 · Group I patients with ATLP; TLE and XTLE subgroups · XTLE with ATLP · Tonic phase of secondarily generalized GTC seizuresPDF p.3, Table 1—Patients with ATLP contralateral to focus; PDF p.3, Results—Group I; PDF p.6, Conclusion
17/18 patients (94.4%)ATLPPercentage · n/N 17/18 · Group II patients with ATLP · Tonic phase of GTC seizuresPDF p.3, Table 1—Patients with ATLP contralateral to focus; PDF p.3, Results—Group II; PDF p.6, Conclusion
TLE ATLP kappa 0.68ATLP interobserver agreementKappa · Group I observer ratings of ATLP presence/absence and side; TLE and XTLE subgroups · TLEPDF p.3, Table 1—Kappa index for ATLP; PDF p.3, Results—Group I
XTLE ATLP kappa 0.71ATLP interobserver agreementKappa · Group I observer ratings of ATLP presence/absence and side; TLE and XTLE subgroups · XTLEPDF p.3, Table 1—Kappa index for ATLP; PDF p.3, Results—Group I
Overall ATLP kappa 0.71ATLP interobserver agreementKappa · Group I observer ratings of ATLP presence/absence and side; TLE and XTLE subgroups · OverallPDF p.3, Table 1—Kappa index for ATLP; PDF p.3, Results—Group I
p<0.001ATLP interobserver agreementP value · Group II observer ratings of ATLP presence/absence and sidePDF p.3, Table 1—Kappa index for ATLP; PDF p.3, Results—Group II
kappa 0.711ATLP interobserver agreementKappa · Group II observer ratings of ATLP presence/absence and sidePDF p.3, Table 1—Kappa index for ATLP; PDF p.3, Results—Group II
Head midline or returning to midline at ATLP in all instancesATLP following head and eye versionPercentage · Group II patients with ATLP and version; one symptomatic generalized epilepsy exception is described · ATLP after version and before generalized clonic movementsPDF p.3, Other characteristics of ATLP—item 2
ATLP on same side as version in all but one Group II patientATLP following head and eye versionPercentage · Group II patients with ATLP and version; one symptomatic generalized epilepsy exception is described · Group II with ATLP and version · ATLP after version and before generalized clonic movementsPDF p.3, Other characteristics of ATLP—item 2
two seizuresATLP limb configurationCount · ATLP observations; exact subgroup Not reported · exceptions to same-side lower-extremity extension · Tonic phase of ATLPPDF p.3, Other characteristics of ATLP—item 3; PDF p.4, Other characteristics of ATLP—item 4
two patientsATLP limb configurationCount · ATLP observations; exact subgroup Not reported · patients contributing lower-extremity exceptions · Tonic phase of ATLPPDF p.3, Other characteristics of ATLP—item 3; PDF p.4, Other characteristics of ATLP—item 4
2 patientsATLP changing sides during seizure evolutionCount · Two Group II patients with ATLP that changed side during seizure evolution · Initial ATLP followed by bilateral tonic extension and clonic phasePDF p.4, Other characteristics of ATLP—item 6; PDF p.5, Fig. 3 caption and images
within-patient side consistency stated qualitativelyATLP changing sides during seizure evolutionCount · Two Group II patients with ATLP that changed side during seizure evolution · Initial ATLP followed by bilateral tonic extension and clonic phasePDF p.4, Other characteristics of ATLP—item 6; PDF p.5, Fig. 3 caption and images
9% of metrazol-induced seizures“asymmetrical generalized seizure” / asymmetric arm posturingPercentage · Metrazol-induced seizures in the cited reportPDF p.5, Discussion
XTLE patients with ATLP 8/15 (53.3%)ATLPPercentage · n/N 8/15 · Group I surgical patients with seizures progressing to secondary generalization; TLE and XTLE subgroups · XTLE · Tonic phase of secondarily generalized GTC seizuresPDF p.2, Results—Group I; PDF p.3, Table 1—Number of patients with ATLP in GTC seizures
TLE patients with ATLP 12/16 (75%)ATLPPercentage · n/N 12/16 · Group I surgical patients with seizures progressing to secondary generalization; TLE and XTLE subgroups · TLE · Tonic phase of secondarily generalized GTC seizuresPDF p.2, Results—Group I; PDF p.3, Table 1—Number of patients with ATLP in GTC seizures
19/27 (70.3%)ATLPPercentage · n/N 19/27 · Group I analyzed secondarily generalized GTC seizures; TLE and XTLE subgroups · TLE · Tonic phase of secondarily generalized GTC seizuresPDF p.3, Table 1—Number of seizures showing ATLP
10/32 (31.2%)ATLPPercentage · n/N 10/32 · Group I analyzed secondarily generalized GTC seizures; TLE and XTLE subgroups · XTLE · Tonic phase of secondarily generalized GTC seizuresPDF p.3, Table 1—Number of seizures showing ATLP
18/26 patients (69.2%)ATLPPercentage · n/N 18/26 · Group II prospectively collected patients with GTC or generalized clonic seizures · Tonic phase of GTC seizuresPDF p.3, Results—Group II; PDF p.5, Discussion
22/64 seizures (34.3%)ATLPPercentage · n/N 22/64 · Group II analyzed seizures · Tonic phase of GTC or generalized clonic seizuresPDF p.3, Table 1—Number of seizures showing ATLP
XTLE Version + ATLP 4/15ATLP and versionPercentage · n/N 4/15 · Group I TLE, Group I XTLE, and Group II patients represented in Table 1 · XTLE; Version + ATLPPDF p.3, Table 1—Version and ATLP
Group II Version + ATLP 10/26ATLP and versionPercentage · n/N 10/26 · Group I TLE, Group I XTLE, and Group II patients represented in Table 1 · Group II; Version + ATLPPDF p.3, Table 1—Version and ATLP
XTLE ATLP without version 4/15ATLP and versionPercentage · n/N 4/15 · Group I TLE, Group I XTLE, and Group II patients represented in Table 1 · XTLE; ATLP without versionPDF p.3, Table 1—Version and ATLP
TLE ATLP without version 4/16ATLP and versionPercentage · n/N 4/16 · Group I TLE, Group I XTLE, and Group II patients represented in Table 1 · TLE; ATLP without versionPDF p.3, Table 1—Version and ATLP
XTLE Neither 3/15ATLP and versionPercentage · n/N 3/15 · Group I TLE, Group I XTLE, and Group II patients represented in Table 1 · XTLE; NeitherPDF p.3, Table 1—Version and ATLP
TLE Neither 3/16ATLP and versionPercentage · n/N 3/16 · Group I TLE, Group I XTLE, and Group II patients represented in Table 1 · TLE; NeitherPDF p.3, Table 1—Version and ATLP
TLE Version + ATLP 8/16ATLP and versionPercentage · n/N 8/16 · Group I TLE, Group I XTLE, and Group II patients represented in Table 1 · TLE; Version + ATLPPDF p.3, Table 1—Version and ATLP
Group II Version without ATLP 12/26ATLP and versionPercentage · n/N 12/26 · Group I TLE, Group I XTLE, and Group II patients represented in Table 1 · Group II; Version without ATLPPDF p.3, Table 1—Version and ATLP
TLE Version without ATLP 1/16ATLP and versionPercentage · n/N 1/16 · Group I TLE, Group I XTLE, and Group II patients represented in Table 1 · TLE; Version without ATLPPDF p.3, Table 1—Version and ATLP
Group II Neither 0/26ATLP and versionPercentage · n/N 0/26 · Group I TLE, Group I XTLE, and Group II patients represented in Table 1 · Group II; NeitherPDF p.3, Table 1—Version and ATLP
XTLE Version without ATLP 4/15ATLP and versionPercentage · n/N 4/15 · Group I TLE, Group I XTLE, and Group II patients represented in Table 1 · XTLE; Version without ATLPPDF p.3, Table 1—Version and ATLP
Group II ATLP without version 9/26ATLP and versionPercentage · n/N 9/26 · Group I TLE, Group I XTLE, and Group II patients represented in Table 1 · Group II; ATLP without versionPDF p.3, Table 1—Version and ATLP
2/26 (7.6%)ATLP in every GTC seizurePercentage · n/N 2/26 · Patients with Group I TLE, Group I XTLE, or Group II GTC seizures as represented in Table 1 · Group II · Tonic phase of GTC seizuresPDF p.3, Table 1—Patients who had ATLP in every GTC seizure
6/8 (75%)ATLP in every GTC seizurePercentage · n/N 6/8 · Patients with Group I TLE, Group I XTLE, or Group II GTC seizures as represented in Table 1 · Group I XTLE · Tonic phase of GTC seizuresPDF p.3, Table 1—Patients who had ATLP in every GTC seizure
10/12 (83.3%)ATLP in every GTC seizurePercentage · n/N 10/12 · Patients with Group I TLE, Group I XTLE, or Group II GTC seizures as represented in Table 1 · Group I TLE · Tonic phase of GTC seizuresPDF p.3, Table 1—Patients who had ATLP in every GTC seizure
XTLE range 4–52 sATLP onset timeRange · Patients/seizures with ATLP; TLE and XTLE comparison · XTLE · Onset of ATLP during a secondarily generalized GTC seizurePDF p.3, Results—ATLP timing
TLE median 28.5 sATLP onset timeMedian · Patients/seizures with ATLP; TLE and XTLE comparison · TLE · Onset of ATLP during a secondarily generalized GTC seizurePDF p.3, Results—ATLP timing
TLE range 11–108 sATLP onset timeRange · Patients/seizures with ATLP; TLE and XTLE comparison · TLE · Onset of ATLP during a secondarily generalized GTC seizurePDF p.3, Results—ATLP timing
Wilcoxon rank-sum p=0.46ATLP onset timeP value · Patients/seizures with ATLP; TLE and XTLE comparison · Onset of ATLP during a secondarily generalized GTC seizurePDF p.3, Results—ATLP timing
XTLE median 22.5 sATLP onset timeMedian · Patients/seizures with ATLP; TLE and XTLE comparison · XTLE · Onset of ATLP during a secondarily generalized GTC seizurePDF p.3, Results—ATLP timing
overall median 23.5 sATLP onset timeMedian · Patients/seizures with ATLP; TLE and XTLE comparison · overall · Onset of ATLP during a secondarily generalized GTC seizurePDF p.3, Results—ATLP timing
overall range 4–108 sATLP onset timeRange · Patients/seizures with ATLP; TLE and XTLE comparison · overall · Onset of ATLP during a secondarily generalized GTC seizurePDF p.3, Results—ATLP timing
XTLE median ATLP duration 10 seconds (range 2–20)ATLP durationMedian · Patients/seizures with ATLP; XTLE and temporal comparison · XTLE · ATLP during secondarily generalized GTC seizurePDF p.3, Results—ATLP duration; PDF p.6, Discussion
TLE median ATLP duration 4.5 seconds (range 2–20)ATLP durationMedian · Patients/seizures with ATLP; XTLE and temporal comparison · TLE · ATLP during secondarily generalized GTC seizurePDF p.3, Results—ATLP duration; PDF p.6, Discussion
9/23 patients (39.1%)ATLP without prior versionPercentage · n/N 9/23 · Group II patients with partial-onset seizures evolving to GTC seizures · ATLP during evolution to secondary generalizationPDF p.4, Other characteristics of ATLP—item 5; PDF p.5, Discussion; PDF p.1, Summary—Conclusions
ATLP in temporal-lobe seizures with secondary generalization 4/4ATLP in temporal epilepsy versus primary GTC in JMEPercentage · n/N 4/4 · One anecdotal patient with JME and temporal lobe epilepsy, excluded from Groups I and II · Temporal-lobe seizures with secondary generalization · Secondary generalization versus primary GTC seizurePDF p.4, Anecdotal information; PDF p.5, Discussion
ATLP in primary GTC seizures 0/2ATLP in temporal epilepsy versus primary GTC in JMEPercentage · n/N 0/2 · One anecdotal patient with JME and temporal lobe epilepsy, excluded from Groups I and II · Primary GTC seizures · Secondary generalization versus primary GTC seizurePDF p.4, Anecdotal information; PDF p.5, Discussion

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdfNarrative, educational, or cited context · 5 findings · 15 reported values

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Asymmetric tonic limb posturing (figure-of-4 sign)The review describes asymmetric tonic limb posturing before bilateral tonic arm posturing as a lateralizing sign in which the extended elbow is usually contralateral to seizure onset; Table 1 summarizes 17.7% in temporal and 15% in extratemporal lobe epilepsy and 89% contralateral.PDF p.5, section 3.6 Asymmetric tonic limb posturing; PDF p.5, section 3.6.1 Mechanism; PDF p.12, Table 1
Asymmetric tonic limb posturing (figure-of-4 sign)Kotagal et al. retrospectively reviewed 59 secondary generalized tonic-clonic seizures in 31 patients seizure free after surgery and prospectively analyzed 64 seizures in 26 patients; the extended elbow was contralateral to seizure onset in 35 of 39 cases.PDF p.5, section 3.6 Asymmetric tonic limb posturing
Asymmetric tonic limb posturingTrinka et al. noted asymmetric tonic limb posturing in 23 of 57 retrospectively and prospectively reviewed patients; it was contralateral in 70%, ipsilateral in 17%, and bilateral in 13%, with P < 0.001.PDF p.5, section 3.6 Asymmetric tonic limb posturing
Asymmetric tonic arm extension with opposite arm flexionJobst et al. described asymmetric tonic arm extension with opposite arm flexion and found it contralateral in 94% of patients with temporal lobe epilepsy and documented seizure freedom 12 months after surgery.PDF p.5, section 3.6 Asymmetric tonic limb posturing
Last clonic jerk and asymmetric endingThe review describes asymmetric ending of a generalized tonic-clonic seizure, particularly a last clonic jerk ipsilateral to the hemisphere of seizure onset, as a lateralizing sign with high reported observer agreement in the cited series.PDF p.5, section 3.4 Significance of last clonic jerk

Reported values

15%Asymmetric tonic limb posturing (figure-of-4 sign)Percentage · Patients with secondary generalized tonic-clonic seizures and temporal or extratemporal lobe epilepsy · extratemporal lobe epilepsy · Early tonic phase of secondary generalized tonic-clonic seizurePDF p.12, Table 1
17.7%Asymmetric tonic limb posturing (figure-of-4 sign)Percentage · Patients with secondary generalized tonic-clonic seizures and temporal or extratemporal lobe epilepsy · temporal lobe epilepsy · Early tonic phase of secondary generalized tonic-clonic seizurePDF p.12, Table 1
35 of 39 (89%)Asymmetric tonic limb posturing (figure-of-4 sign)Percentage · n/N 35/39 · Patients with secondary generalized tonic-clonic seizures and temporal or extratemporal lobe epilepsy · asymmetric tonic limb posturing · Early tonic phase of secondary generalized tonic-clonic seizurePDF p.5, section 3.6 Asymmetric tonic limb posturing; PDF p.5, section 3.6.1 Mechanism; PDF p.12, Table 1
26 prospective patientsAsymmetric tonic limb posturing (figure-of-4 sign)Count · 31 patients seizure free after epilepsy surgery and 26 prospectively analyzed patients; 59 retrospective and 64 prospective secondary generalized tonic-clonic seizures · prospective series · Early tonic phase of secondary generalized tonic-clonic seizurePDF p.5, section 3.6 Asymmetric tonic limb posturing
64 prospective seizuresAsymmetric tonic limb posturing (figure-of-4 sign)Count · 31 patients seizure free after epilepsy surgery and 26 prospectively analyzed patients; 59 retrospective and 64 prospective secondary generalized tonic-clonic seizures · prospective series · Early tonic phase of secondary generalized tonic-clonic seizurePDF p.5, section 3.6 Asymmetric tonic limb posturing
extended elbow contralateral in 35/39 casesAsymmetric tonic limb posturing (figure-of-4 sign)Percentage · n/N 35/39 · 31 patients seizure free after epilepsy surgery and 26 prospectively analyzed patients; 59 retrospective and 64 prospective secondary generalized tonic-clonic seizures · Early tonic phase of secondary generalized tonic-clonic seizurePDF p.5, section 3.6 Asymmetric tonic limb posturing
59 retrospective seizuresAsymmetric tonic limb posturing (figure-of-4 sign)Count · 31 patients seizure free after epilepsy surgery and 26 prospectively analyzed patients; 59 retrospective and 64 prospective secondary generalized tonic-clonic seizures · retrospective series · Early tonic phase of secondary generalized tonic-clonic seizurePDF p.5, section 3.6 Asymmetric tonic limb posturing
31 retrospective patientsAsymmetric tonic limb posturing (figure-of-4 sign)Count · 31 patients seizure free after epilepsy surgery and 26 prospectively analyzed patients; 59 retrospective and 64 prospective secondary generalized tonic-clonic seizures · retrospective series · Early tonic phase of secondary generalized tonic-clonic seizurePDF p.5, section 3.6 Asymmetric tonic limb posturing
ATLP bilateral 13% of affected patientsAsymmetric tonic limb posturingPercentage · 57 patients with temporal lobe epilepsy · Bilateral · Early tonic phase of generalized tonic-clonic seizurePDF p.5, section 3.6 Asymmetric tonic limb posturing
ATLP ipsilateral 17% of affected patientsAsymmetric tonic limb posturingPercentage · 57 patients with temporal lobe epilepsy · Ipsilateral · Early tonic phase of generalized tonic-clonic seizurePDF p.5, section 3.6 Asymmetric tonic limb posturing
ATLP contralateral 70% of affected patientsAsymmetric tonic limb posturingPercentage · 57 patients with temporal lobe epilepsy · Contralateral · Early tonic phase of generalized tonic-clonic seizurePDF p.5, section 3.6 Asymmetric tonic limb posturing
Patients with ATLP 23/57Asymmetric tonic limb posturingPercentage · n/N 23/57 · 57 patients with temporal lobe epilepsy · Early tonic phase of generalized tonic-clonic seizurePDF p.5, section 3.6 Asymmetric tonic limb posturing
94% contralateralAsymmetric tonic arm extension with opposite arm flexionPercentage · Patients with temporal lobe epilepsy and documented seizure freedom 12 months after surgery · Early tonic phase of secondary generalized seizurePDF p.5, section 3.6 Asymmetric tonic limb posturing
Table 1 does not list this signLast clonic jerk and asymmetric endingCount · n/N 25/30 · Patients with mesial or temporal lobe epilepsy and generalized tonic-clonic seizures · End of generalized tonic-clonic seizurePDF p.5, section 3.4 Significance of last clonic jerk
specific series are reported in F012 and F013Last clonic jerk and asymmetric endingCount · n/N 25/30 · Patients with mesial or temporal lobe epilepsy and generalized tonic-clonic seizures · End of generalized tonic-clonic seizurePDF p.5, section 3.4 Significance of last clonic jerk

marashly-ictal-motor-sequences-lateralization-localization-values-2016.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

marashly-ictal-motor-sequences-lateralization-localization-values-2016.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

figure of 4 sign; asymmetric tonic limb posturingThe current paper reports that figure of 4 has been described as having approximately 90% contralateral lateralizing value and attributes to the original Kotagal report the rule that the initial tonic arm extension is the component to use because a later figure of 4 may appear on the opposite side.PDF p.7, figure of 4 definition and cited value; PDF p.8, cited initial-component rule; PDF p.12, discussion of the source definition

Reported values

Approximately 90% contralateral lateralizing valuefigure of 4 sign; asymmetric tonic limb posturingPercentage · Cited source population as summarized in the current paper; Not reported · Beginning of the tonic phase of a secondary generalized tonic-clonic seizurePDF p.7, figure of 4 definition and cited value; PDF p.8, cited initial-component rule; PDF p.12, discussion of the source definition

mcgonigal-on-seizure-semiology-2021-5ba29d.pdfNarrative, educational, or cited context · 1 finding · 2 reported values

mcgonigal-on-seizure-semiology-2021-9127f2.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

hyperkinetic signs; speech modifications; viscerosensory symptoms; pain; asymmetric tonic; focal clonic; tonic symptomsIn the summarized Peltola et al. study of pure insular epilepsies, hyperkinetic signs, speech modifications, and viscerosensory symptoms were related to an anterior insular seizure-onset zone, whereas pain, asymmetric tonic, focal clonic, and tonic symptoms were more frequent in patients with a posterior insular seizure onset.PDF p.7, Table 2 (continued), Peltola et al. 2020 row

Reported values

79 seizureshyperkinetic signs; speech modifications; viscerosensory symptoms; pain; asymmetric tonic; focal clonic; tonic symptomsCount · 11 subjects with pure insular epilepsy; 79 seizures · Peltola et al. study · ictal onset and semiologic expressionPDF p.7, Table 2 (continued), Peltola et al. 2020 row
11 subjectshyperkinetic signs; speech modifications; viscerosensory symptoms; pain; asymmetric tonic; focal clonic; tonic symptomsCount · 11 subjects with pure insular epilepsy; 79 seizures · Peltola et al. pure insular epilepsy study · ictal onset and semiologic expressionPDF p.7, Table 2 (continued), Peltola et al. 2020 row

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdfNarrative, educational, or cited context · 1 finding

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

focal nonmotor unaware seizures; hyperkinetic features; asymmetric tonic posturing; elementary facial contractionsThe source relates more ventrally located insular foci to focal nonmotor unaware seizures and more dorsally located foci to motor manifestations caused by propagation toward frontal areas, including often sleep-related hyperkinetic features, asymmetric tonic posturing, or elementary facial contractions; patients are frequently unaware of these manifestations.PDF p.5, Ictal Semiology; PDF p.16, Summary

wang-electroclinical-insulo-opercular-epilepsy-seeg-pet-2019.pdfIndependent primary study · 1 finding · 1 reported value

wang-electroclinical-insulo-opercular-epilepsy-seeg-pet-2019.pdf

Independent primary study · Class II · Evidence weight 5.01 · 2 × 1.5 × 1.671

Findings

bilateral asymmetric tonic postureBilateral asymmetric tonic posture occurred in two patients.PDF p.4, Results—Seizure semiology; PDF p.10, Discussion

Reported values

2/22 (9%)bilateral asymmetric tonic posturePercentage · n/N 2/22 · 22 patients with insulo-opercular epilepsy · ictal complex motor behaviorPDF p.4, Results—Seizure semiology; PDF p.10, Discussion

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdfIndependent primary study · 3 findings

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

visual aura to oculomotor to evolving motor phenotypePhenotype III progresses from visual aura to head-eye deviation or eye pursuit, then to contralateral limb tonic or asymmetric tonic posturing, with some seizures evolving to GTCS.PDF p.9, Phenotype III
oculomotor-onset evolving motor phenotypePhenotype IV begins with eye blinking or eye pursuit without a clear visual aura, followed by oral/hand automatisms and contralateral upper-limb tonic or asymmetric posturing, sometimes progressing to GTCS.PDF p.9, Phenotype IV
asymmetric tonic posturingPhenotype III includes progression to asymmetric tonic posturing.PDF p.9, Phenotype III

16 contributing manuscripts; source-reported values remain separate and are not pooled.

Motionless stare / ictal behavioral arrest (hypomotor onset)Source terms: Motionless stare / behavioral arrest; Motionless stare / ictal behavioral arrestReported: Dominant hemisphereAlso reported: Right hemisphere14 manuscripts · 26 findings · 19 reported values

Weighted evidence supportevidence weight 25.55 across 14 manuscripts · 1 manuscript weight pending · 2 independent primary study · 7 narrative, educational, or cited context · 3 systematic review or meta-analysis · 1 structured design not resolved · 1 case report or observation

A right middle frontal gyrus lesion case had left-face/left-arm clonic spread and fencing posture, with semiology and ictal EEG interpreted as right frontocentral onset. The supplied evidence identifies the subsequent contraversion as directed contralateral to the hemisphere of seizure onset. No lateralization is reported for the behavioral-arrest phenotype. The study-specific ≥3-second definition reports no hemisphere or body-side direction. This finding provides no lateralization information. The TL-versus-T+ comparison provides no lateralization information. No hemisphere direction is asserted. This finding provides no hemispheric lateralization information. No source-supported hemispheric or body-side lateralization is reported. The educational duration description provides no lateralizing direction. The co-occurrence analysis provides no lateralization information. No lateralizing direction is reported for motionless staring. No cerebral hemisphere or body-side direction is reported. The PNES differential-diagnosis statement supplies no lateralizing direction. No lateralizing direction is reported. No lateralizing direction is reported for the staring observation.

Source-defined result groups 5

Localization: TemporalSource-defined values retained separatelyT+ · TL 32.2% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyQuiet staring; extratemporal origin · Temporal origin · seizure1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyQuiet staring; temporal origin · Extratemporal origin · seizure1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyTL · T+ 43.5% · seizures (one analyzed seizure per patient)1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 14

Alphabetical by manuscript.

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfNarrative, educational, or cited context · 1 finding

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

posterior cingulate staring and automatisms cited caseThe discussion cites a lesional posterior cingulate case with seizures characterized by staring and automatisms.PDF p.7, Discussion

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 1 finding · 3 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 5.65 · 2 × 1.5 × 1.882

Findings

staringStaring did not differ significantly between TL and T+ groups.PDF p.6, Table 2

Reported values

T+ 43.5%staringPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ · ictalPDF p.6, Table 2
P=0.34staringP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictalPDF p.6, Table 2
TL 32.2%staringPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL · ictalPDF p.6, Table 2

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfSystematic review or meta-analysis · 7 findings · 6 reported values

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

staring or behavioral arrestStaring or behavioral arrest was reported in 42% of reviewed cases.PDF p.4, Semiology and clinical features; PDF p.6, Table 3
Staring/Behavioral Arrest (Table 3)Table 3 reports staring or behavioral arrest in 35 cases (42%), more during propagation.PDF p.6, Table 3
Staring/Behavioral Arrest (Table 4)In the 60 high/very-high-confidence cases, Table 4 reports staring or behavioral arrest in 17 cases (28%).PDF p.7, Table 4
staring/behavioral arrest plus pleasant sensationThe co-occurrence analysis identified staring/behavioral arrest with pleasant sensation in 22% of the 18-patient detailed-data set.PDF p.7, Figure 2 discussion
motionless staring in HS (Mirandola study)Motionless staring occurred in 20 HS patients (81%) in the cited comparison.PDF p.7, cited-study discussion
motionless staring in basal temporal/PIT group (Mirandola study)Motionless staring occurred in 6 PIT patients (43%) in the cited comparison.PDF p.7, cited-study discussion
motionless staring group comparison (Mirandola study)The cited comparison of motionless staring between HS and PIT groups is reported as statistically significant at p<.05.PDF p.7, cited-study discussion

Reported values

42% staring/behavioral arreststaring or behavioral arrestPercentage · reviewed basal temporal seizure cases · ictal propagation in Table 3PDF p.4, Semiology and clinical features; PDF p.6, Table 3
35 cases (42%)Staring/Behavioral Arrest (Table 3)Percentage · Table 3 basal temporal seizure cases · propagationPDF p.6, Table 3
17/60 (28%)Staring/Behavioral Arrest (Table 4)Percentage · n/N 17/60 · 60 basal temporal seizure cases with high or very-high EZ confidence · ictalPDF p.7, Table 4
22% co-occurrencestaring/behavioral arrest plus pleasant sensationPercentage · 18 patients with detailed semiology data · ictal; timing not otherwise reportedPDF p.7, Figure 2 discussion
81% (n = 20)motionless staring in HS (Mirandola study)Percentage · source-reported HS group; the preceding sentence describes 36 HS patients, which is not used as this statistic's denominator · ictalPDF p.7, cited-study discussion
6/14 patients (43%)motionless staring in basal temporal/PIT group (Mirandola study)Percentage · n/N 6/14 · 14 PIT-lesion patients in the cited Mirandola comparison · ictalPDF p.7, cited-study discussion

blair-temporal-lobe-epilepsy-semiology-2012.pdfNarrative, educational, or cited context · 2 findings · 1 reported value

blair-temporal-lobe-epilepsy-semiology-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Initial motionless stareTable 1 reports an initial motionless stare as common in temporal lobe seizures and less common in frontal lobe seizures.PDF p.2, Table 1
Behavioural arrest and staring with altered consciousnessCPSs are described as associated with altered consciousness and amnesia, typically with behavioural arrest and staring lasting 30 seconds to 1–2 minutes.PDF p.2, section 2.3 Altered Consciousness

Reported values

30 seconds to 1–2 minutesBehavioural arrest and staring with altered consciousnessCount · Patients with CPSs as described in the review; no single cohort reported. · IctalPDF p.2, section 2.3 Altered Consciousness

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 2 findings · 1 reported value

chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

aura; behavioural arrest; left-face clonic activity; fencing postureIn an illustrative 50-year-old man with a right middle frontal gyrus cystic lesion, a seizure evolved from an aura to behavioural arrest, left-face clonic movements spreading over the left arm, and left-arm extension in a fencing posture before secondary generalisation; the authors state that the semiology and ictal EEG supported right frontocentral onset.PDF p.3, Video case 1 and Figure 1; PDF p.3, Figure 2 caption
behavioural arrest; manual and oral automatismsTemporal lobe seizures are described as typically comprising behavioural arrest and manual and oral automatisms in two thirds of cases, with variable loss of awareness and postictal confusion.PDF p.4, Temporal lobe seizures

Reported values

behavioural arrest and manual/oral automatisms in two thirdsbehavioural arrest; manual and oral automatismsProportion · temporal lobe seizure literature · ictal and postictalPDF p.4, Temporal lobe seizures

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdfSystematic review or meta-analysis · 1 finding

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

oral automatisms; manual automatisms; behavioral arrestThe source identifies oral automatisms, manual automatisms, and behavioral arrests as the most common semiologies in lateral temporal epilepsy, while noting that they likely emerge during propagation rather than at seizure onset.PDF p.1, Abstract; PDF p.4, Anatomo-clinical correlations; PDF p.8, Discussion

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdfNarrative, educational, or cited context · 1 finding

kinney-structured-testing-ictal-postictal-video-eeg-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Behavioural arrest with preserved posterior dominant alphaThe review states that behavioural arrest with preserved posterior dominant alpha rhythm and no other EEG abnormality is virtually always indicative of PNES, while behavioural arrest spells may otherwise show subtle midline rhythmic EEG slowing.PDF p.7, section 1.18

luders-semiological-seizure-classification-1998.pdfNarrative, educational, or cited context · 1 finding

luders-semiological-seizure-classification-1998.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Hypomotor seizureHypomotor seizures are defined by decreased or absent motor activity without new motor manifestations and are used exclusively when consciousness cannot be tested during or after the seizure, including in newborns, infants, and severely mentally retarded patients; the source states that consciousness is probably altered in many such patients but may be preserved in a few.PDF p.5, Special seizures, Hypomotor seizures; PDF p.2, Table 1

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdfNarrative, educational, or cited context · 1 finding

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

staring or behavioral arrest in neocortical temporal lobe seizuresThe discussion restates that staring or behavioral arrest had been reported as the most common manifestation of neocortical temporal lobe seizures, but not as a discriminating feature between medial and lateral temporal lobe seizures.PDF p.8, Initial loss of contact

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdfCase report or observation · 1 finding

salanova-occipital-lobe-epilepsy-electroclinical-manifestations-42-patients-1992.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

eyes staring in Fig. 2The Figure 2 tracing labels eyes staring during the illustrated depth-recorded seizure.PDF p.14, Fig. 2

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdfNarrative, educational, or cited context · 1 finding

tufenkjian-luders-seizure-semiology-localizing-epileptogenic-zone-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

hypomotor seizuresThe review limits the term hypomotor seizures to patients in whom consciousness cannot be tested during or after the seizure and states that, in focal epilepsy, these seizures occur most frequently in temporal and parietal lobe epilepsy.PDF p.5, Hypomotor seizures

wang-hypermotor-seizures-temporal-pole-lesions-2008.pdfNarrative, educational, or cited context · 1 finding

wang-hypermotor-seizures-temporal-pole-lesions-2008.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

psychomotor semiology: staringTypical temporal psychomotor semiology included staring.PDF p.4, Seizure semiology on video-EEG recording

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdfIndependent primary study · 5 findings · 1 reported value

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

behavioral-arrest onset phenotypePhenotype V begins with behavioral arrest and progresses to oculomotor or motor signs, including limb tonic or hypermotor activity, with a tendency to evolve into GTCS.PDF p.9, Phenotype V
behavioral arrest operational definitionThe source operationalizes behavioral arrest as sustained cessation of ongoing voluntary behavior, including speech and limb movement, with reduced responsiveness lasting at least three seconds on synchronized video-EEG/SEEG review.PDF p.9, Phenotype V
behavioral arrest from posterior midline involvementThe authors associate early PCu/PCC involvement with initial behavioral arrest in Phenotype V.PDF p.14, Phenotype V discussion
motor arrest and staringTable 2 records motor arrest or staring as an early seizure sign in multiple cases.PDF p.6, Table 2 cases 1, 4, and 5
staring with unresponsivenessTable 2 records staring with unresponsiveness after oropharyngeal automatisms and eye blinking.PDF p.6, Table 2 Case 1 Sz2

Reported values

reduced responsiveness lasting ≥3 secondsbehavioral arrest operational definitionThreshold · Phenotype V seizure classification · early ictal semiologyPDF p.9, Phenotype V

wyllie1986.pdfStructured design not resolved · 1 finding · 7 reported values

wyllie1986.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.893

Findings

quiet staring and staring with automatisms before contraversionQuiet staring preceded contraversion for 8 versive seizures for 2-31 seconds (mean 17), while staring with automatisms preceded contraversion for 18 seizures for 4-227 seconds (mean 34); all seizures with automatisms before contraversion originated in temporal lobes, whereas the quiet-staring subgroup arose from temporal (25%) and extratemporal (75%) locations.PDF p.2, Table 2; PDF p.3, paragraphs reporting quiet-staring and automatisms durations and onset regions; PDF p.4, discussion of temporal localization before contraversion

Reported values

Quiet staring before contraversion 8/61 (13%)quiet staring and staring with automatisms before contraversionPercentage · n/N 8/61 · 26 versive seizures with a reported pre-contraversion staring phase · Quiet staring · Ictal period before contraversionPDF p.2, Table 2; PDF p.3, paragraphs reporting quiet-staring and automatisms durations and onset regions; PDF p.4, discussion of temporal localization before contraversion
Staring-with-automatisms duration mean 34 seconds (range 4–227)quiet staring and staring with automatisms before contraversionMean · 26 versive seizures with a reported pre-contraversion staring phase · Staring with automatisms · Ictal period before contraversionPDF p.2, Table 2; PDF p.3, paragraphs reporting quiet-staring and automatisms durations and onset regions; PDF p.4, discussion of temporal localization before contraversion
Quiet-staring subgroup temporal origin 25%quiet staring and staring with automatisms before contraversionPercentage · 26 versive seizures with a reported pre-contraversion staring phase · Quiet staring; temporal origin · Ictal period before contraversionPDF p.2, Table 2; PDF p.3, paragraphs reporting quiet-staring and automatisms durations and onset regions; PDF p.4, discussion of temporal localization before contraversion
Staring-with-automatisms subgroup temporal origin 18/18quiet staring and staring with automatisms before contraversionPercentage · n/N 18/18 · 26 versive seizures with a reported pre-contraversion staring phase · Staring with automatisms · Ictal period before contraversionPDF p.2, Table 2; PDF p.3, paragraphs reporting quiet-staring and automatisms durations and onset regions; PDF p.4, discussion of temporal localization before contraversion
Quiet-staring duration mean 17 seconds (range 2–31)quiet staring and staring with automatisms before contraversionMean · 26 versive seizures with a reported pre-contraversion staring phase · Quiet staring · Ictal period before contraversionPDF p.2, Table 2; PDF p.3, paragraphs reporting quiet-staring and automatisms durations and onset regions; PDF p.4, discussion of temporal localization before contraversion
Quiet-staring subgroup extratemporal origin 75%quiet staring and staring with automatisms before contraversionPercentage · 26 versive seizures with a reported pre-contraversion staring phase · Quiet staring; extratemporal origin · Ictal period before contraversionPDF p.2, Table 2; PDF p.3, paragraphs reporting quiet-staring and automatisms durations and onset regions; PDF p.4, discussion of temporal localization before contraversion
Staring with automatisms before contraversion 18/61 (30%)quiet staring and staring with automatisms before contraversionPercentage · n/N 18/61 · 26 versive seizures with a reported pre-contraversion staring phase · Staring with automatisms · Ictal period before contraversionPDF p.2, Table 2; PDF p.3, paragraphs reporting quiet-staring and automatisms durations and onset regions; PDF p.4, discussion of temporal localization before contraversion

14 contributing manuscripts; source-reported values remain separate and are not pooled.

Sensory auraReported: Contralateral10 manuscripts · 26 findings · 17 reported values

Weighted evidence supportevidence weight 24.06 across 10 manuscripts · 1 manuscript weight pending · 3 narrative, educational, or cited context · 4 systematic review or meta-analysis · 2 independent primary study · 1 structured design not resolved

Seven of 18 patients had sensory auras contralateral to the resected side. The educational statement gives no hemisphere or body-side direction for focal aware or focal sensory auras. No hemisphere or body-side relationship is reported. The study and patient counts report no hemisphere direction. The study or patient count reports no hemisphere direction. The sensory-aura prevalence supplies no hemisphere direction. The lateral-TLE sensory-aura prevalence supplies no hemisphere direction. The mesial-TLE sensory-aura prevalence supplies no hemisphere direction. The basal-temporal sensory-sensation prevalence reports no hemisphere direction. The Table 3 sensory prevalence reports no hemisphere direction. The restricted basal-temporal subset prevalence reports no hemisphere direction. No hemisphere-direction relationship is reported. No body-side, hemisphere, or dominance direction is reported. No hemisphere or body-side relationship is assigned. The heterogeneity-test p value has no lateralization content. The multimodal aura clue reports no hemisphere direction. No seizure lateralization is reported. The review places fear, auditory or gustatory hallucinations, sensory hallucinations, and vertigo between lateral and medial temporal patterns. The term medio-lateral describes temporal network organization, not hemisphere laterality. The term medio-lateral describes a temporal network, not hemisphere laterality.

Source-defined result groups 11

Localization: SMA / pre-SMASource-defined values retained separatelyAll reported · patients with the ictal symptom1 manuscript · 1 reported value · not pooled

Localization: medio-lateral temporal network / temporo-lateral region / temporo-mesial regionSource-defined values retained separatelyAll reported · Table 6 point estimate 33% · Table 6 between-report frequency range1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralObserved proportion 38.9%All reported · ipsilateral resected side · patients1 manuscript · 1 reported value · not pooled

Localization: Frontal / ParietalSource-defined values retained separatelyExtrafrontal SHE · Frontal SHE · patient1 manuscript · 1 reported value · not pooled

Localization: orbitofrontal cortex-restricted EZNObserved proportion 11.5%OFC-restricted EZN cases · patients with sensory phenomena1 manuscript · 1 reported value · not pooled

Localization: ParietalObserved proportion 38.9%All reported · ipsilateral resected side · patients1 manuscript · 1 reported value · not pooled

Localization: Frontal / ParietalSource-defined values retained separatelyExtrafrontal SHE · Operculoinsular SOZ · patient1 manuscript · 1 reported value · not pooled

Localization: Frontal / ParietalSource-defined values retained separatelyFrontal SHE · Extrafrontal SHE · patient1 manuscript · 1 reported value · not pooled

Localization: medio-lateral temporal network / temporo-lateral region / temporo-mesial regionSource-defined values retained separatelyAll reported · other Table 6 medio-lateral sign frequencies · Table 6 sign-frequency estimate1 manuscript · 1 reported value · not pooled

Localization: Frontal / ParietalObserved proportion 75.0%Frontal SHE · frontal versus extrafrontal focal sensory onset · sensory manifestation1 manuscript · 1 reported value · not pooled

Localization: Frontal / ParietalSource-defined values retained separatelyExtrafrontal SHE · Parietal SOZ near postcentral gyrus · patient1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 10

Alphabetical by manuscript.

asadollahi-drug-resistant-parietal-lobe-epilepsy-clinical-manifestations-surgery-outcome-2017.pdfIndependent primary study · 1 finding · 1 reported value

asadollahi-drug-resistant-parietal-lobe-epilepsy-clinical-manifestations-surgery-outcome-2017.pdf

Independent primary study · Class II · Evidence weight 3.91 · 2 × 1.2 × 1.628

Findings

sensory auras contralateral to resected sideSeven patients had sensory auras contralateral to the resected side.PDF p.2, Results

Reported values

7/18 (38.8%) contralateral sensory aurassensory auras contralateral to resected sidePercentage · n/N 7/18 · 18-patient drug-resistant parietal lobe epilepsy cohort · auraPDF p.2, Results

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfSystematic review or meta-analysis · 4 findings · 3 reported values

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

sensory sensationsSensory sensations were reported in 27% of patients.PDF p.4, Semiology and clinical features; PDF p.6, Table 3
Sensory (Table 3)Table 3 reports sensory symptoms in 22 cases (27%), with timing marked onset/propagation uncertain.PDF p.6, Table 3
Sensory (Table 4)In the 60 high/very-high-confidence cases, Table 4 reports sensory symptoms in 15 cases (25%).PDF p.7, Table 4
sensory symptomsThe review characterizes sensory symptoms as rare and visual symptoms as infrequently observed in basal temporal seizures.PDF p.8, Discussion

Reported values

27% sensory sensationssensory sensationsPercentage · reviewed basal temporal seizure patients · ictal onset/propagation uncertain in Table 3PDF p.4, Semiology and clinical features; PDF p.6, Table 3
22 cases (27%)Sensory (Table 3)Percentage · Table 3 basal temporal seizure cases · onset/propagation?PDF p.6, Table 3
15/60 (25%)Sensory (Table 4)Percentage · n/N 15/60 · 60 basal temporal seizure cases with high or very-high EZ confidence · ictalPDF p.7, Table 4

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 5 findings · 2 reported values

buonocore-ictal-semiology-sma-pre-sma-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

sensory phenomena; sensory aura; paresthesiaSensory phenomena associated with SMA epilepsy may be diffuse and poorly localized, including nonspecific cephalic sensations, paresthesia, or a sense of impending movement.PDF p.7, Discussion
sensory phenomenaTable 3 lists 8 patients for the the source's own ictal symptom “sensory phenomena”; its table phase label is onset.PDF p.6, Table 3
sensory phenomenaTable 3 reports a pooled prevalence of 11% for the the source's own ictal symptom “sensory phenomena”; its table phase label is onset.PDF p.6, Table 3
sensory phenomena; between-study heterogeneityThe source reports I2 heterogeneity of 0.00% for pooled sensory phenomena prevalence.PDF p.5, Results
sensory phenomena; heterogeneity testThe source reports p = 0.59 for the between-study heterogeneity test of pooled sensory phenomena prevalence.PDF p.5, Results

Reported values

11% pooled prevalencesensory phenomenaPercentage · Patients with SMA or pre-SMA epilepsy in the selected studies · onsetPDF p.6, Table 3
I2 = 0.00%sensory phenomena; between-study heterogeneityHeterogeneity I2 · Patients with SMA or pre-SMA epilepsy in the selected studies · ictal symptom prevalence analysisPDF p.5, Results

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.54 · 1 × 0.9 × 1.707

Findings

sensory phenomenaSensory phenomena were reported in three of 26 restricted-OFC cases.PDF p.2, Semiology patterns of seizures with EZN restricted to the OFC

Reported values

3/26 (11.6%)sensory phenomenaPercentage · n/N 3/26 · OFC-restricted EZN cases · OFC-restricted EZN cases · ictalPDF p.2, Semiology patterns of seizures with EZN restricted to the OFC

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdfSystematic review or meta-analysis · 8 findings · 3 reported values

doerrfuss-ictal-semiology-lateral-temporal-epilepsy-systematic-review-meta-analysis-2026.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

Sensory auraTable 3 reports 1 studies assessing Sensory aura.PDF p.6, Table 3
Sensory auraTable 3 reports 15 patients assessed for Sensory aura.PDF p.6, Table 3
Sensory auraTable 3 reports 6.7% as the percentage range or value for Sensory aura; the overall association grade is Low.PDF p.6, Table 3
Sensory aura; lateral versus mesial comparisonTable 5 reports 1 studies comparing Sensory aura in lateral and mesial TLE.PDF p.9, Table 5
Sensory aura; lateral TLE patient denominatorTable 5 reports 15 lateral-TLE patients assessed for Sensory aura.PDF p.9, Table 5
Sensory aura; mesial TLE patient denominatorTable 5 reports 31 mesial-TLE patients assessed for Sensory aura.PDF p.9, Table 5
Sensory aura; lateral TLE prevalenceTable 5 reports a lateral-TLE percentage of 6.7% for Sensory aura.PDF p.9, Table 5
Sensory aura; mesial TLE prevalenceTable 5 reports a mesial-TLE percentage of 16.1% for Sensory aura.PDF p.9, Table 5

Reported values

6.7%Sensory auraPercentage · Lateral temporal epilepsy patients assessed for Sensory aura · ictalPDF p.6, Table 3
6.7%Sensory aura; lateral TLE prevalencePercentage · Lateral TLE patients assessed for Sensory aura · Lateral TLE patients assessed for Sensory aura · ictalPDF p.9, Table 5
16.1%Sensory aura; mesial TLE prevalencePercentage · Mesial TLE patients assessed for Sensory aura · Mesial TLE patients assessed for Sensory aura · ictalPDF p.9, Table 5

gibbs-clinical-features-sleep-related-hypermotor-epilepsy-2019.pdfIndependent primary study · 1 finding · 5 reported values

gibbs-clinical-features-sleep-related-hypermotor-epilepsy-2019.pdf

Independent primary study · Class II · Evidence weight 4.62 · 2 × 1.5 × 1.54

Findings

focal sensory onsetFocal sensory onset occurred in 14% of frontal SHE and 39% of extrafrontal SHE. In frontal SHE, 9/12 sensory manifestations were associated with a small lesion in the precentral gyrus or supplementary motor area (SMA). In extrafrontal SHE, sensory onset was associated with a parietal SOZ near the postcentral gyrus (n=5) or an operculoinsular SOZ (n=12).PDF p.5, section 3.3; PDF p.6, section 3.3

Reported values

Frontal focal sensory onset 14%focal sensory onsetPercentage · Frontal and extrafrontal SHE patients in the 115-patient SOZ-defined semiology cohort · Frontal SHE · early nonmotor seizure onsetPDF p.5, section 3.3; PDF p.6, section 3.3
Extrafrontal sensory onset with parietal SOZ near postcentral gyrus n=5focal sensory onsetCount · Frontal and extrafrontal SHE patients in the 115-patient SOZ-defined semiology cohort · Extrafrontal SHE · early nonmotor seizure onsetPDF p.5, section 3.3; PDF p.6, section 3.3
Frontal sensory manifestations associated with precentral gyrus or SMA lesion 9/12focal sensory onsetPercentage · n/N 9/12 · Frontal and extrafrontal SHE patients in the 115-patient SOZ-defined semiology cohort · Frontal SHE · early nonmotor seizure onsetPDF p.5, section 3.3; PDF p.6, section 3.3
Extrafrontal sensory onset with operculoinsular SOZ n=12focal sensory onsetCount · Frontal and extrafrontal SHE patients in the 115-patient SOZ-defined semiology cohort · Extrafrontal SHE · early nonmotor seizure onsetPDF p.5, section 3.3; PDF p.6, section 3.3
Extrafrontal focal sensory onset 39%focal sensory onsetPercentage · Frontal and extrafrontal SHE patients in the 115-patient SOZ-defined semiology cohort · Extrafrontal SHE · early nonmotor seizure onsetPDF p.5, section 3.3; PDF p.6, section 3.3

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdfNarrative, educational, or cited context · 1 finding

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

focal aware and focal sensory auras across regionsThe authors state that auras classified in the latest ILAE seizure classification as focal aware or focal sensory seizures can be seen in seizures arising from both temporal and extratemporal regions.PDF p.5, Discussion

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdfStructured design not resolved · 1 finding

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1

Findings

pure sensory hallucinations and dreamy stateThe authors distinguish pure sensory illusions or hallucinations from complex or mnemonic experiential phenomena, interpreting pure sensory hallucinations as related to a neocortical epileptogenic network and dreamy state as tending to a network including temporolimbic structures.PDF p.9, Trends toward other electroclinical correlations, Dreamy state

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdfNarrative, educational, or cited context · 1 finding

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

co-occurring sensory aurasCo-occurrence of somatosensory, auditory, gustatory, and/or olfactory auras is presented as a clue to ictal insular involvement because the insula is described as an important multimodal integrative sensory area.PDF p.5, Ictal Semiology; PDF p.13, What localizations are suggested by the seizure semiology?

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdfSystematic review or meta-analysis · 3 findings · 2 reported values

schulze-bonhage-semiology-temporo-polar-mediolateral-temporal-origin-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

fear; auditory hallucinations; gustatory hallucinations; sensory hallucinations; vertigoThe source describes fear, auditory or gustatory hallucinations, sensory hallucinations, and vertigo as intermediate features between lateral and medial temporal patterns.PDF p.5, Discussion
sensory hallucinationsTable 6 reports sensory hallucinations in 33% of the medio-lateral synthesis (evidence grade Low).PDF p.6, Table 6
sensory hallucinationsTable 6 reports a 33–33% range for sensory hallucinations across the medio-lateral reports (evidence grade Low).PDF p.6, Table 6

Reported values

33%sensory hallucinationsPercentage · Medio-lateral temporal seizure semiology synthesis represented in Table 6 · earlyPDF p.6, Table 6
range 33–33%sensory hallucinationsPercentage Range · Medio-lateral temporal seizure semiology synthesis represented in Table 6 · earlyPDF p.6, Table 6

10 contributing manuscripts; source-reported values remain separate and are not pooled.

Unilateral tonic posturingReported: ContralateralAlso reported: IpsilateralAlso reported: Right hemisphere10 manuscripts · 14 findings · 57 reported values

Weighted evidence supportevidence weight 22.82 across 10 manuscripts · 3 narrative, educational, or cited context · 3 independent primary study · 3 systematic review or meta-analysis · 1 case report or observation

The cited synthesis reports rare ipsilateral tonic motor signs during frontal-lobe seizures and relates them to frontal stimulation findings. Cerebral lateralization: these signs are contralateral to seizure onset; target lobe is not differentiated by these signs alone. Unilateral tonic posturing is reported as contralateral to the epileptogenic zone, with lobar-subgroup variation. The temporal-plus description preserves contraversive eye/head and ipsilateral tonic-motor relations without assigning a left/right cerebral hemisphere. Patient 8 had sudden stiffening of the left arm with oral automatisms. The review restates contralateral unilateral tonic posturing with different ranges in TLE and EXTLE cohorts. The study reports sign-specific epileptogenic-zone direction, predominantly contralateral, with ipsilateral direction for asymmetric clonic ending. The review restates a generally contralateral but cohort-variable lateralization pattern for unilateral tonic activity. The cited frontal-lobe series is summarized as contralateral unilateral tonic posturing in 89% of cases. No source lateralization is reported. The source reports a unilateral body-side modifier but no body-side distribution and no cerebral hemisphere.

Source-defined result groups 16

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyasymmetric clonic ending · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyEXTLE · TLE · patient1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyfrontal · other lobar subgroups · sign-positive occurrence1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelytemporal · other lobar subgroups · sign-positive occurrence1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyAll reported · case1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyunilateral tonic · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyTLE · EXTLE · patient1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyunilateral clonic · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyoccipital · other lobar subgroups · sign-positive occurrence1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyM2e · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyoverall · incorrect direction · sign-positive occurrence1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyFig of 4 · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: ContralateralSource-defined values retained separatelyparietal · other lobar subgroups · sign-positive occurrence1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelydystonia · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyversion · representative seizure with sign1 manuscript · 1 reported value · not pooled

Lateralization: Contralateral / IpsilateralSource-defined values retained separatelyTodd's paralysis · representative seizure with sign1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 10

Alphabetical by manuscript.

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfCase report or observation · 1 finding

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

patient 8 left-arm stiffening and oral automatismsSudden stiffening of the left arm and oral automatisms were listed for patient 8.PDF p.4, Figure 3

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfNarrative, educational, or cited context · 1 finding

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

ipsilateral tonic motor signThe source states that ipsilateral tonic motor signs have been reported during frontal lobe seizures and that this is consistent with frontal-lobe electrical stimulation results.PDF p.8, Motor signs

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfSystematic review or meta-analysis · 3 findings · 3 reported values

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

unilateral tonic changesUnilateral tonic changes were reported in 25% of reviewed cases.PDF p.4, Semiology and clinical features; PDF p.6, Table 3
Unilateral tonic (Table 3)Table 3 reports unilateral tonic signs in 21 cases (25%), more during propagation.PDF p.6, Table 3
Unilateral tonic (Table 4)In the 60 high/very-high-confidence cases, Table 4 reports unilateral tonic signs in 9 cases (15%).PDF p.7, Table 4

Reported values

25% unilateral tonic changesunilateral tonic changesPercentage · reviewed basal temporal seizure cases · ictal propagation in Table 3PDF p.4, Semiology and clinical features; PDF p.6, Table 3
21 cases (25%)Unilateral tonic (Table 3)Percentage · Table 3 basal temporal seizure cases · propagationPDF p.6, Table 3
9/60 (15%)Unilateral tonic (Table 4)Percentage · n/N 9/60 · 60 basal temporal seizure cases with high or very-high EZ confidence · ictalPDF p.7, Table 4

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 1 finding · 1 reported value

chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

unilateral clonic movement; unilateral tonic/dystonic posturing; early head versionThe review describes unilateral clonic movements, unilateral tonic or dystonic posturing, and early forced head version as robust lateralising motor signs with positive predictive value greater than 80%, and states that these signs are contralateral to the side of seizure onset.PDF p.10, Lateralising signs

Reported values

positive predictive value >80%unilateral clonic movement; unilateral tonic/dystonic posturing; early head versionPositive predictive value · focal seizure literature · ictal onset/early ictalPDF p.10, Lateralising signs

elwan-kotagal-lateralizing-localizing-seizure-semiology-2018.pdfIndependent primary study · 1 finding · 16 reported values

elwan-kotagal-lateralizing-localizing-seizure-semiology-2018.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

Unilateral tonicUnilateral tonic posturing had moderate inter-observer agreement and a 77% contralateral PPV overall, with a lower PPV in frontal than temporal, parietal, or occipital epilepsy.PDF p.3, Table 1; PDF p.3, §5.1

Reported values

3 patientsUnilateral tonicCount · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 11 seizures/8 patients, frontal 6/3, parietal 3/2, and occipital 2/1. · frontal · IctalPDF p.3, Table 1; PDF p.3, §5.1
2 patientsUnilateral tonicCount · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 11 seizures/8 patients, frontal 6/3, parietal 3/2, and occipital 2/1. · parietal · IctalPDF p.3, Table 1; PDF p.3, §5.1
33% PPVUnilateral tonicPositive predictive value · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 11 seizures/8 patients, frontal 6/3, parietal 3/2, and occipital 2/1. · frontal · IctalPDF p.3, Table 1; PDF p.3, §5.1
3 seizuresUnilateral tonicCount · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 11 seizures/8 patients, frontal 6/3, parietal 3/2, and occipital 2/1. · parietal · IctalPDF p.3, Table 1; PDF p.3, §5.1
kappa 0.56Unilateral tonicKappa · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 11 seizures/8 patients, frontal 6/3, parietal 3/2, and occipital 2/1. · overall · IctalPDF p.3, Table 1; PDF p.3, §5.1
100% PPVUnilateral tonicPositive predictive value · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 11 seizures/8 patients, frontal 6/3, parietal 3/2, and occipital 2/1. · parietal · IctalPDF p.3, Table 1; PDF p.3, §5.1
11 seizuresUnilateral tonicCount · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 11 seizures/8 patients, frontal 6/3, parietal 3/2, and occipital 2/1. · temporal · IctalPDF p.3, Table 1; PDF p.3, §5.1
100% PPVUnilateral tonicPositive predictive value · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 11 seizures/8 patients, frontal 6/3, parietal 3/2, and occipital 2/1. · occipital · IctalPDF p.3, Table 1; PDF p.3, §5.1
14 patientsUnilateral tonicCount · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 11 seizures/8 patients, frontal 6/3, parietal 3/2, and occipital 2/1. · overall sign-positive occurrences · IctalPDF p.3, Table 1; PDF p.3, §5.1
6 seizuresUnilateral tonicCount · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 11 seizures/8 patients, frontal 6/3, parietal 3/2, and occipital 2/1. · frontal · IctalPDF p.3, Table 1; PDF p.3, §5.1
77% overall PPVUnilateral tonicPositive predictive value · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 11 seizures/8 patients, frontal 6/3, parietal 3/2, and occipital 2/1. · overall · IctalPDF p.3, Table 1; PDF p.3, §5.1
2 seizuresUnilateral tonicCount · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 11 seizures/8 patients, frontal 6/3, parietal 3/2, and occipital 2/1. · occipital · IctalPDF p.3, Table 1; PDF p.3, §5.1
91% PPVUnilateral tonicPositive predictive value · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 11 seizures/8 patients, frontal 6/3, parietal 3/2, and occipital 2/1. · temporal · IctalPDF p.3, Table 1; PDF p.3, §5.1
1 patientsUnilateral tonicCount · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 11 seizures/8 patients, frontal 6/3, parietal 3/2, and occipital 2/1. · occipital · IctalPDF p.3, Table 1; PDF p.3, §5.1
22 seizuresUnilateral tonicCount · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 11 seizures/8 patients, frontal 6/3, parietal 3/2, and occipital 2/1. · overall sign-positive occurrences · IctalPDF p.3, Table 1; PDF p.3, §5.1
8 patientsUnilateral tonicCount · Sign-positive occurrences included 22 seizures in 14 patients overall; temporal 11 seizures/8 patients, frontal 6/3, parietal 3/2, and occipital 2/1. · temporal · IctalPDF p.3, Table 1; PDF p.3, §5.1

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdfNarrative, educational, or cited context · 1 finding · 4 reported values

foldvary-schaefer-localizing-lateralizing-auras-seizures-2011.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

unilateral tonic posturingUnilateral tonic posturing occurred in 17% of TLE cases and 15% of EXTLE cases; it was contralateral to the epileptogenic zone in 40–86% of TLE patients and 67–89% of EXTLE patients.PDF p.4, section 4 Lateralizing motor signs in complex motor seizures; PDF p.5, Table 2

Reported values

Contralateral to EZ in TLE patients 40%–86%unilateral tonic posturingRange · TLE and EXTLE cases or patients, with the source using both terms · TLE · ictal motorPDF p.4, section 4 Lateralizing motor signs in complex motor seizures; PDF p.5, Table 2
Unilateral tonic posturing in TLE cases 17%unilateral tonic posturingPercentage · TLE and EXTLE cases or patients, with the source using both terms · TLE · ictal motorPDF p.4, section 4 Lateralizing motor signs in complex motor seizures; PDF p.5, Table 2
Contralateral to EZ in EXTLE patients 67%–89%unilateral tonic posturingRange · TLE and EXTLE cases or patients, with the source using both terms · EXTLE · ictal motorPDF p.4, section 4 Lateralizing motor signs in complex motor seizures; PDF p.5, Table 2
Unilateral tonic posturing in EXTLE cases 15%unilateral tonic posturingPercentage · TLE and EXTLE cases or patients, with the source using both terms · EXTLE · ictal motorPDF p.4, section 4 Lateralizing motor signs in complex motor seizures; PDF p.5, Table 2

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdfIndependent primary study · 1 finding · 2 reported values

khoo-semiology-epileptogenic-zone-frontal-surgery-2023.pdf

Independent primary study · Class II · Evidence weight 2.70 · 2 × 1.35 × 1

Findings

Focal motor (unilateral tonic)Focal motor (unilateral tonic) semiology was absent as initial semiology (0/61, 0%) and occurred in 11/61 individuals (18%) in the combined set-of-semiology.PDF p.5, Table 2

Reported values

11/61 (18%) combinedFocal motor (unilateral tonic)Percentage · n/N 11/61 · 61 individuals undergoing frontal lobe epilepsy surgery · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2
0/61 (0%) initialFocal motor (unilateral tonic)Percentage · n/N 0/61 · 61 individuals undergoing frontal lobe epilepsy surgery · Ictal video-EEG; initial manifestation versus all observed ictal manifestationsPDF p.5, Table 2

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdfNarrative, educational, or cited context · 3 findings · 7 reported values

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Unilateral tonic activityThe review describes unilateral tonic activity as potentially lateralizing but not uniformly predictive across studies; its table summarizes 48.1% in frontal lobe epilepsy and 89% contralateral, with the supplementary motor area and other motor structures proposed as symptomatogenic regions.PDF p.5, section 3.5 Unilateral tonic activity; PDF p.5, section 3.5.1 Mechanism; PDF p.12, Table 1
Unilateral tonic posturingIn a series of patients with frontal lobe epilepsy, Janszky et al. found unilateral tonic posturing contralateral to the seizure focus in 89% of cases.PDF p.5, section 3.5 Unilateral tonic activity; PDF p.12, Table 1
Unilateral tonic seizureWerhahn et al. selected 123 patients with 170 tonic seizures from 481 consecutive patients with focal epilepsy; among 24 patients with a known epileptogenic zone and unilateral tonic seizures, a blinded observer always classified the epileptogenic zone correctly.PDF p.5, section 3.5 Unilateral tonic activity

Reported values

Unilateral tonic activity in 48.1% of frontal-lobe epilepsy patientsUnilateral tonic activityPercentage · Patients with focal, temporal, extratemporal, or frontal lobe epilepsy · Frontal lobe epilepsy · Ictal tonic phasePDF p.5, section 3.5 Unilateral tonic activity; PDF p.5, section 3.5.1 Mechanism; PDF p.12, Table 1
89% contralateralUnilateral tonic posturingPercentage · Patients with frontal lobe epilepsy · Ictal tonic phasePDF p.5, section 3.5 Unilateral tonic activity; PDF p.12, Table 1
170 tonic seizuresUnilateral tonic seizureCount · 123 patients with 170 tonic seizures selected from 481 consecutive patients with focal epilepsy; 24 with known zone and unilateral tonic seizures · selected 123 patients · Ictal tonic phasePDF p.5, section 3.5 Unilateral tonic activity
24 patientsUnilateral tonic seizureCount · n/N 24/123 · 123 patients with 170 tonic seizures selected from 481 consecutive patients with focal epilepsy; 24 with known zone and unilateral tonic seizures · known epileptogenic zone and unilateral tonic seizures · Ictal tonic phasePDF p.5, section 3.5 Unilateral tonic activity
always classified correctlyUnilateral tonic seizureOther reported value · 123 patients with 170 tonic seizures selected from 481 consecutive patients with focal epilepsy; 24 with known zone and unilateral tonic seizures · known-zone unilateral-tonic subgroup · Ictal tonic phasePDF p.5, section 3.5 Unilateral tonic activity
123 patientsUnilateral tonic seizureCount · n/N 123/481 · 123 patients with 170 tonic seizures selected from 481 consecutive patients with focal epilepsy; 24 with known zone and unilateral tonic seizures · selected 123 patients · Ictal tonic phasePDF p.5, section 3.5 Unilateral tonic activity
481 consecutive patientsUnilateral tonic seizureCount · 123 patients with 170 tonic seizures selected from 481 consecutive patients with focal epilepsy; 24 with known zone and unilateral tonic seizures · source focal-epilepsy population · Ictal tonic phasePDF p.5, section 3.5 Unilateral tonic activity

marashly-ictal-motor-sequences-lateralization-localization-values-2016.pdfIndependent primary study · 1 finding · 24 reported values

marashly-ictal-motor-sequences-lateralization-localization-values-2016.pdf

Independent primary study · Class II · Evidence weight 4.22 · 2 × 1.15 × 1.836

Findings

version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisIn the 47 representative seizures, Table 1 reports the following prevalence counts, PPVs, and Fleiss Kappa indices: version 36, 97%, 0.6961; unilateral tonic 24, 96%, 0.2594; M2e 21, 100%, 0.7364; unilateral clonic 10, 90%, 0.3643; Fig of 4 23, 74%, 0.4873; dystonia 6, 67%, 0.2620; asymmetric clonic ending 28, 89%, 0.6761; Todd's paralysis 6, 83%, 0.4360.PDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability

Reported values

0.262version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · dystonia · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
28/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 28/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · asymmetric clonic ending · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
89%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · asymmetric clonic ending · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
67%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · dystonia · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
96%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral tonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
10/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 10/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral clonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
23/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 23/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Fig of 4 · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
36/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 36/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · version · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.2594version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral tonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.3643version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral clonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
90%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral clonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
21/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 21/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · M2e · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
83%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Todd's paralysis · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
6/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 6/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Todd's paralysis · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.6961version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · version · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
100%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · M2e · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
97%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · version · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
6/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 6/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · dystonia · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
74%version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPositive predictive value · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Fig of 4 · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.6761version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · asymmetric clonic ending · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.7364version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · M2e · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.4873version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Fig of 4 · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
24/47version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisPercentage · n/N 24/47 · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · unilateral tonic · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability
0.436version; unilateral tonic; M2e; unilateral clonic; Fig of 4; dystonia; asymmetric clonic ending; Todd's paralysisKappa · 47 patients with one representative secondarily generalized motor seizure each; Table 1 labels prevalence n=47 · Todd's paralysis · ictal motor signs before or through secondary generalization; Todd's paralysis is postictalPDF p.18, Table 1; PDF p.9, Results statement on low PPV and exclusion of Fig of 4 and ictal dystonia; PDF p.13, discussion of M2e PPV and inter-rater reliability

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 1 finding

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

temporal plus epilepsy; gustatory; vestibular; auditory; contraversive eyes/head; piloerection; ipsilateral tonic motor; postictal dysphoriaThe source describes temporal-plus semiology as more often including gustatory, vestibular, or auditory symptoms, contraversive eye or head manifestations, piloerection, ipsilateral tonic motor signs, and a more dysphoric postictal phase.PDF p.2, Introduction

10 contributing manuscripts; source-reported values remain separate and are not pooled.

Speech automatismsReported: BilateralAlso reported: Dominant hemisphereAlso reported: Left hemisphereAlso reported: Non-dominant hemisphereAlso reported: Right hemisphere12 manuscripts · 28 findings · 56 reported values

Weighted evidence supportevidence weight 22.82 across 12 manuscripts · 5 independent primary study · 2 case report or observation · 4 narrative, educational, or cited context · 1 systematic review or meta-analysis

The case observation records right-sided version during habitual partial seizures. Coprolalia and related verbal automatisms have limited lateralizing value toward the nondominant hemisphere and can arise from either hemisphere. The cited Hadidane-series restatement reports verbal automatisms in 54% of right-sided basal temporal seizures versus 11% of left-sided seizures, with p=0.001. Among 100 patients, dysphasia was reported with 30 left-sided versus 4 right-sided resections, speech automatisms with 16 left-sided versus 22 right-sided resections, and no speech disturbance with 14 left-sided versus 19 right-sided resections. Among 23 patients with speech automatisms, 13 were associated with the presumed recessive temporal lobe and 10 with the dominant temporal lobe; selected utterance types showed 11 recessive-side versus 4 dominant-side instances. Among 23 speech-automatism patients, 7 had exclusive-right, 14 bilateral, 1 exclusive-left, and 1 normal interictal EEG; bilateral discharges were right-predominant in 6 and left-predominant in 8. Postoperative speech automatisms persisted in 3/6 patients with continued seizures after dominant temporal-lobe removal and in none of 9 after right-sided resection; the continuing cases had recessive-temporal spike foci. The primary study reports relatively frequent slight left hemicranial diminution in paroxysmal dysphasia and speculates about left posterior temporal speech mechanisms; hemicranial-side context for speech automatisms remained mixed. The cited Bingley restatement reports speech automatism in 6/24 unilateral dominant-focus patients versus 10/17 unilateral recessive-focus patients, with 25% versus 56% when emphasized bilateral foci are included and significance reported at 0.01; 29/74 cases were reported overall. The case had a consistently right sphenoidal EEG focus during recurrent psychomotor seizures; the later left-arm abduction is retained as a separate event feature. The cited Serafetinides and Falconer study restatement reports 7 exclusive-right, 14 bilateral, 1 exclusive-left, and 1 normal EEG among 23 speech-automatism patients. Verbal automatisms were more frequent in the medial-lateral temporal subgroup than in medial or lateral subgroups, with an unquantified nonsignificant trend toward right temporal lateralization. The primary result reports a nonsignificant trend toward right temporal lateralization of verbal automatisms: 31.3% right temporal versus 15.4% left temporal. Speech automatism occurred more often with right- than left-hemisphere EEG-defined foci, 10 cases versus 3, with P<0.05. A cited case restatement describes speech automatism reproduced by right-amygdalar stimulation with right temporal sharp activity. The review preserves conflicting cited left- and right-hemisphere dominance associations while reporting that the current study favored right-hemisphere foci. The review proposes that speech automatism may involve non-temporal or occasionally leftward regions distant from the temporal lobe, without a settled hemispheric direction. No lateralizing direction is reported for the visual-aura-to-automatism phenotype. No hemisphere or body-side direction is reported. The primary TL-versus-T+ verbal-automatism comparison provides no lateralization information. The OFC-restricted EZN review statement reports no hemisphere or lateralization direction. This finding provides no lateralization information. No lateralization axis information is reported for speech automatisms during atypical absence seizures. The review's reactive-automatism classification provides no side or lateralization direction. The primary result distinguishes paroxysmal dysphasia from ictal speech automatism without reporting a hemisphere or lateralization direction. No lateralization axis information is reported for the occipital-plus organization summary. No lateralization axis information is reported for the cited paroxysmal dysphasia and ictal speech-automatism frequency.

Source-defined result groups 12

Localization: TemporalSource-defined values retained separatelyright temporal · right versus left temporal lobe1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Right hemisphereObserved proportion 4.3%exclusive left-sided · Exclusive right-sided versus bilateral versus exclusive left-sided interictal discharges; normal EEG · patient/case as source labels1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Right hemisphereObserved proportion 60.9%bilateral · Exclusive right-sided versus bilateral versus exclusive left-sided interictal discharges; normal EEG · patient/case as source labels1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphere / Non-dominant hemisphere / Right hemisphereObserved proportion 0.0%continued seizures after right-sided resection · dominant temporal-lobe removal · patient1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Right hemisphereSource-defined values retained separatelyleft-predominant bilateral · Exclusive right-sided versus bilateral versus exclusive left-sided interictal discharges; normal EEG · patient/case as source labels1 manuscript · 1 reported value · not pooled

Localization: TemporalSource-defined values retained separatelyleft temporal · right versus left temporal lobe1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Right hemisphereSource-defined values retained separatelyleft temporal · right versus left temporal lobe1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Right hemisphereSource-defined values retained separatelyright-predominant bilateral · Exclusive right-sided versus bilateral versus exclusive left-sided interictal discharges; normal EEG · patient/case as source labels1 manuscript · 1 reported value · not pooled

Lateralization: Dominant hemisphere / Non-dominant hemisphere / Right hemisphereObserved proportion 50.0%continued seizures after dominant temporal-lobe removal · right-sided resection · patient1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphere / Right hemisphereSource-defined values retained separatelyright temporal · right versus left temporal lobe1 manuscript · 1 reported value · not pooled

Lateralization: Bilateral / Right hemisphereObserved proportion 30.4%exclusive right-sided · Exclusive right-sided versus bilateral versus exclusive left-sided interictal discharges; normal EEG · patient/case as source labels1 manuscript · 1 reported value · not pooled

Localization: OFC-involving seizure casesSource-defined values retained separatelyAll reported · patients with coprolalia1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 12

Alphabetical by manuscript.

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 1 finding · 3 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

verbal automatismsVerbal automatisms did not differ significantly between TL and T+ groups.PDF p.6, Table 2

Reported values

TL 20.3%verbal automatismsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictalPDF p.6, Table 2
P=0.4verbal automatismsP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictalPDF p.6, Table 2
T+ 13%verbal automatismsPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictalPDF p.6, Table 2

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfNarrative, educational, or cited context · 1 finding · 2 reported values

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

verbal automatisms (Hadidane study)The review reports verbal automatisms in 54% of right-sided basal temporal seizures in the cited Hadidane series.PDF p.7, cited-study discussion; PDF p.9, Discussion

Reported values

54% right-sided basal temporal seizuresverbal automatisms (Hadidane study)Percentage · right-sided basal temporal seizures in the cited Hadidane series · right-sided seizures · ictalPDF p.7, cited-study discussion; PDF p.9, Discussion
11% left-sided basal temporal seizuresverbal automatisms (Hadidane study)Percentage · left-sided basal temporal seizures in the cited Hadidane series · left-sided seizures · ictalPDF p.7, cited-study discussion; PDF p.9, Discussion

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdfNarrative, educational, or cited context · 2 findings · 1 reported value

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

OFC group (EZN restricted to OFC); hyperkinetic behavior; verbal automatisms; sleep-related seizuresThe source characterizes seizures with an EZN restricted to the OFC as having a relatively sparse semiological profile, mainly hyperkinetic behavior and verbal automatisms, often associated with sleep.PDF p.5, Semiological profiles; PDF p.7, Conclusion
coprolalia; verbal automatismsCoprolalia was documented in one patient in the reviewed OFC-involving literature.PDF p.5, Vocal automatisms

Reported values

1 patientcoprolalia; verbal automatismsCount · OFC-involving seizure cases · ictalPDF p.5, Vocal automatisms

gabr-speech-manifestations-lateralization-temporal-lobe-seizures-1989.pdfNarrative, educational, or cited context · 2 findings · 5 reported values

gabr-speech-manifestations-lateralization-temporal-lobe-seizures-1989.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

speech automatismsThe source reports that Serafetinides and Falconer studied 23 patients with speech automatisms: 7 had exclusively right-sided discharges, 14 bilateral discharges, 1 exclusively left-sided discharge, and 1 a normal EEG.PDF p.5, Discussion
paroxysmal dysphasia and ictal speech automatismsThe source reports that, after excluding speech arrest and vocalization, Serafetinides and Falconer found paroxysmal dysphasia and ictal speech automatisms in 67% of their patients.PDF p.5, Discussion

Reported values

1 exclusively left-sidedspeech automatismsCount · 23 patients with speech automatisms in the cited Serafetinides and Falconer series · exclusively left-sided · ictal/automatisms; exact phase not otherwise reported in this restatementPDF p.5, Discussion
7 exclusively right-sidedspeech automatismsCount · 23 patients with speech automatisms in the cited Serafetinides and Falconer series · exclusively right-sided · ictal/automatisms; exact phase not otherwise reported in this restatementPDF p.5, Discussion
1 normal EEGspeech automatismsCount · 23 patients with speech automatisms in the cited Serafetinides and Falconer series · normal EEG · ictal/automatisms; exact phase not otherwise reported in this restatementPDF p.5, Discussion
14 bilateralspeech automatismsCount · 23 patients with speech automatisms in the cited Serafetinides and Falconer series · bilateral · ictal/automatisms; exact phase not otherwise reported in this restatementPDF p.5, Discussion
67% of patients with paroxysmal dysphasia and/or ictal speech automatismsparoxysmal dysphasia and ictal speech automatismsPercentage · Patients in the cited Serafetinides and Falconer series; exact denominator not reported in this passage · paroxysmal/ictal according to the cited phenomenon namesPDF p.5, Discussion

ictal-speech-disturbance-cerebral-dominance.pdfIndependent primary study · 4 findings · 10 reported values

ictal-speech-disturbance-cerebral-dominance.pdf

Independent primary study · Class II · Evidence weight 1.80 · 2 × 0.9 × 1

Findings

speech automatismSpeech automatism occurred significantly more often with right-hemisphere than left-hemisphere EEG-defined foci in the reported right-handed epileptic cases, 10 cases versus 3, with P<0.05.PDF p.3, Results, Table I; PDF p.5, Discussion and Summary item 2
speech automatismThe current article reports a cited case in which speech automatism was reproduced by electrical stimulation of the right amygdalar area after cortical exposure, with right temporal sharp activity also recognized; the patient had one attack.PDF p.5, Discussion paragraph beginning “Driver and his coworkers”
speech automatism and cerebral dominanceThe authors summarize conflicting prior reports: two cited reports associate speech automatism with left-hemisphere dominance, while two others suggest right-hemisphere dominance is necessary; the present study found significantly more right-hemisphere foci.PDF p.5, Discussion opening paragraph; PDF p.5, Summary item 2
speech automatismThe authors propose that speech automatism may occur when pathological excitation does not spread to speech areas during a confusional state, and that it may arise from regions other than the temporal lobe, including occasionally leftward regions distant from the temporal lobe.PDF p.5, Discussion paragraphs beginning “Speech automatism seem” and “The question of why”

Reported values

P<0.05speech automatismP value · 34 right-handed epileptics in the report; 13 speech-automatism cases in the Table II summation · ictalPDF p.3, Results, Table I; PDF p.5, Discussion and Summary item 2
left 3 casesspeech automatismCount · 34 right-handed epileptics in the report; 13 speech-automatism cases in the Table II summation · left-hemisphere EEG focus · ictalPDF p.3, Results, Table I; PDF p.5, Discussion and Summary item 2
right 10 casesspeech automatismCount · 34 right-handed epileptics in the report; 13 speech-automatism cases in the Table II summation · right-hemisphere EEG focus · ictalPDF p.3, Results, Table I; PDF p.5, Discussion and Summary item 2
one attackspeech automatismCount · One cited patient with temporal-lobe epilepsy · cited patient · ictalPDF p.5, Discussion paragraph beginning “Driver and his coworkers”
one patientspeech automatismCount · One cited patient with temporal-lobe epilepsy · cited temporal-lobe epilepsy case · ictalPDF p.5, Discussion paragraph beginning “Driver and his coworkers”
two cited reports associate speech automatism with left-hemisphere dominancespeech automatism and cerebral dominanceCount · Prior reports plus the current right-handed study population · leftward cited reports · ictalPDF p.5, Discussion opening paragraph; PDF p.5, Summary item 2
two cited reports suggest right-hemisphere dominancespeech automatism and cerebral dominanceCount · Prior reports plus the current right-handed study population · rightward cited reports · ictalPDF p.5, Discussion opening paragraph; PDF p.5, Summary item 2
current study right 10 casesspeech automatism and cerebral dominanceCount · Prior reports plus the current right-handed study population · right-hemisphere focus · ictalPDF p.5, Discussion opening paragraph; PDF p.5, Summary item 2
current study P<0.05speech automatism and cerebral dominanceP value · Prior reports plus the current right-handed study population · ictalPDF p.5, Discussion opening paragraph; PDF p.5, Summary item 2
current study left 3 casesspeech automatism and cerebral dominanceCount · Prior reports plus the current right-handed study population · left-hemisphere focus · ictalPDF p.5, Discussion opening paragraph; PDF p.5, Summary item 2

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdfIndependent primary study · 2 findings · 5 reported values

maillard-semiologic-electrophysiologic-temporal-seizure-subtypes-2004.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

verbal automatismsVerbal automatisms over the whole seizure course were more frequent in ML than M or L patients.PDF p.6, Table 3; PDF p.6, General ictal characteristics; PDF p.8, Vocal verbal and nonverbal automatisms
verbal automatisms and right temporal lateralizationThe authors noted a nonsignificant trend toward right temporal lateralization of verbal automatisms, regardless of delay and seizure subtype.PDF p.6, General ictal characteristics; PDF p.8, Vocal verbal and nonverbal automatisms

Reported values

7/18 (38.9%)verbal automatismsPercentage · n/N 7/18 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · ML · ictal course, early or late combinedPDF p.6, Table 3; PDF p.6, General ictal characteristics; PDF p.8, Vocal verbal and nonverbal automatisms
4/24 (16.7%)verbal automatismsPercentage · n/N 4/24 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · M · ictal course, early or late combinedPDF p.6, Table 3; PDF p.6, General ictal characteristics; PDF p.8, Vocal verbal and nonverbal automatisms
0/13 (0%)verbal automatismsPercentage · n/N 0/13 · 55 patients with unilateral TLE; M=24, ML=18, L=13 · L · ictal course, early or late combinedPDF p.6, Table 3; PDF p.6, General ictal characteristics; PDF p.8, Vocal verbal and nonverbal automatisms
31.3% right temporalverbal automatisms and right temporal lateralizationPercentage · patients with verbal automatisms in the 55-patient cohort; denominators and counts not reported · right temporal · ictal course, timing not restrictedPDF p.6, General ictal characteristics; PDF p.8, Vocal verbal and nonverbal automatisms
15.4% left temporalverbal automatisms and right temporal lateralizationPercentage · patients with verbal automatisms in the 55-patient cohort; denominators and counts not reported · left temporal · ictal course, timing not restrictedPDF p.6, General ictal characteristics; PDF p.8, Vocal verbal and nonverbal automatisms

mcgonigal-on-seizure-semiology-2021-5ba29d.pdfNarrative, educational, or cited context · 1 finding · 2 reported values

mcgonigal-on-seizure-semiology-2021-9127f2.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

occipital epilepsy; occipital-plus epilepsy; altered conscious level; automatic motor behavior; verbal automatismsIn the summarized Marchi et al. study, widespread organization of the epileptogenic zone was typical in occipital or “occipital-plus” epilepsy, with temporal and/or parietal cortex commonly involved; altered conscious level was more common with widespread posterior neocortical onset, while automatic motor behavior and/or verbal automatisms were more often seen with occipitotemporal organization.PDF p.6, Table 2, Marchi et al. 2016 row

Reported values

194 seizuresoccipital epilepsy; occipital-plus epilepsy; altered conscious level; automatic motor behavior; verbal automatismsCount · 29 subjects with occipital-lobe epilepsy; 194 seizures · Marchi et al. study · ictal onset and evolutionPDF p.6, Table 2, Marchi et al. 2016 row
29 subjectsoccipital epilepsy; occipital-plus epilepsy; altered conscious level; automatic motor behavior; verbal automatismsCount · 29 subjects with occipital-lobe epilepsy; 194 seizures · Marchi et al. occipital-lobe epilepsy study · ictal onset and evolutionPDF p.6, Table 2, Marchi et al. 2016 row

montavont-ictal-dysprosody-nondominant-frontal-operculum-2005.pdfCase report or observation · 1 finding

montavont-ictal-dysprosody-nondominant-frontal-operculum-2005.pdf

Case report or observation · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

recurrent ictal speech utterances; oro-alimentary automatisms; right-sided versionIn the patient’s habitual partial seizures, an aura of nausea was followed by staring gaze, partial loss of consciousness, oro-alimentary automatisms, right-sided version, and postictal confusion; family reported recurrent stereotyped French or English sentence repetitions from age 18.PDF p.2, left column, paragraph beginning “Partial seizures began”; PDF p.2, right column, paragraph beginning “Five stereotyped and spontaneous electroclinical seizures”

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdfSystematic review or meta-analysis · 1 finding

oane-ictal-semiology-temporo-frontal-epilepsy-systematic-review-meta-analysis-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

verbal automatisms; coprolaliaThe source states that verbal automatisms, particularly coprolalia, occur in temporal or orbitofrontal epilepsy, have limited lateralizing value toward the non-dominant hemisphere, and can be triggered by seizures from either hemisphere.PDF p.12, Discussion

serafetinides-falconer-speech-disturbances-temporal-lobe-seizures-100-patients-1963.pdfIndependent primary study · 9 findings · 27 reported values

serafetinides-falconer-speech-disturbances-temporal-lobe-seizures-100-patients-1963.pdf

Independent primary study · Class II · Evidence weight 3.22 · 2 × 0.9 × 1.79

Findings

pre-operative speech disturbance; dysphasia; speech automatismsAmong all 100 patients, a pre-operative speech abnormality connected with at least some seizures was recorded in 67 patients; dysphasia was recorded in 34 patients and speech automatisms in 38 patients, while 33 had no recorded speech disturbance.PDF p.4, Table I and immediately adjacent discussion; PDF p.12, Summary
speech automatismsWithin Group A, 23 patients with speech automatisms were associated with epilepsy in the recessive temporal lobe in 13 and the dominant temporal lobe in 10; after excluding warning and perplexity utterances considered probably not truly ictal, the source reports 11 recessive-side versus 4 dominant-side instances for recurrent, irrelevant, and emotional utterances.PDF p.5, Table II; PDF p.7, discussion of speech automatism laterality
speech automatisms; pre-operative interictal spike dischargesAmong 23 Group A patients with speech automatisms, pre-operative interictal EEG showed 7 exclusively right-sided temporal discharges, 14 bilateral discharges, 1 exclusively left-sided discharge, and 1 normal EEG; the bilateral discharges were right-predominant in 6 and left-predominant in 8.PDF p.7, EEG discussion; PDF p.12, Table IV, Group A speech automatism row
post-operative ictal speech automatismOf the 38 patients with pre-operative ictal speech automatisms, all but 3 had lost them post-operatively, including the 15 Group B patients with persisting fits; among 6 Group B patients with continued seizures after dominant temporal-lobe removal, 3 continued to show automatisms, whereas none of 9 patients with right-sided resections did.PDF p.9, discussion point (3); PDF p.11, prognostic discussion
paroxysmal dysphasia; ictal speech automatism; hemicranial diminutionPre-operative radiology showed a relatively high incidence of slight diminution of left hemicranial size among patients with paroxysmal dysphasia compared with the remainder, whereas similar diminution of either hemicranium was uncommon in patients with ictal speech automatisms; the authors speculated that dysphasia might involve wider-ranging discharges reaching vulnerable left posterior temporal speech mechanisms.PDF p.11, discussion of radiological studies
speech automatismThe current article reports that Bingley observed speech automatism in 29/74 temporal-lobe epilepsy cases of non-tumorous origin; it was present in 6/24 patients with a unilateral dominant-lobe EEG focus versus 10/17 with a unilateral recessive-lobe focus, and when emphasized bilateral foci were included it occurred in 25% of dominant-focus patients versus 56% of recessive-focus patients, a difference reported significant at the 0.01 level.PDF p.10, discussion of prior speech-automatism reports
recurrent speech automatism in an acquired languageIn an addendum case, a 38-year-old Polish patient with fluent Russian and English had psychomotor seizures that nearly always began with the recurrent English utterance “I beg your pardon” despite speaking Polish at home; the EEG focus was consistently right sphenoidal, and an induced metrazol seizure produced the utterance eight times at its commencement.PDF p.13, Addendum; PDF p.14, Addendum
paroxysmal dysphasia versus ictal speech automatismThe authors treated paroxysmal dysphasia and ictal speech automatism as different aspects of ictal speech disorder: in the few patients with both phenomena they occurred at separate times and never together in the same seizure.PDF p.9, discussion points (1); PDF p.12, Summary
paroxysmal dysphasia; ictal speech automatism; grand mal attacksThe authors report that more than three-quarters of the 34 patients with paroxysmal dysphasia also had grand mal attacks, whereas slightly less than half of the patients with ictal speech automatism had these major seizures.PDF p.11, discussion of seizure severity

Reported values

no speech disturbance 33/100pre-operative speech disturbance; dysphasia; speech automatismsPercentage · n/N 33/100 · All 100 consecutive temporal lobe epilepsy patients submitted to anterior temporal lobectomy · no recorded speech disturbance · Pre-operative; connected with at least some seizuresPDF p.4, Table I and immediately adjacent discussion; PDF p.12, Summary
any speech abnormality 67/100pre-operative speech disturbance; dysphasia; speech automatismsPercentage · n/N 67/100 · All 100 consecutive temporal lobe epilepsy patients submitted to anterior temporal lobectomy · any speech abnormality · Pre-operative; connected with at least some seizuresPDF p.4, Table I and immediately adjacent discussion; PDF p.12, Summary
speech automatisms 38/100pre-operative speech disturbance; dysphasia; speech automatismsPercentage · n/N 38/100 · All 100 consecutive temporal lobe epilepsy patients submitted to anterior temporal lobectomy · speech automatisms · Pre-operative; connected with at least some seizuresPDF p.4, Table I and immediately adjacent discussion; PDF p.12, Summary
dysphasia 34/100pre-operative speech disturbance; dysphasia; speech automatismsPercentage · n/N 34/100 · All 100 consecutive temporal lobe epilepsy patients submitted to anterior temporal lobectomy · dysphasia · Pre-operative; connected with at least some seizuresPDF p.4, Table I and immediately adjacent discussion; PDF p.12, Summary
4 dominant-side instancesspeech automatismsCount · Group A; 23 patients with pre-operative speech automatisms · dominant temporal lobe · Pre-operative; warning, recurrent, irrelevant, emotional, or perplexity utterances at seizure onset, during seizure, or just afterPDF p.5, Table II; PDF p.7, discussion of speech automatism laterality
13/23 recessive-associatedspeech automatismsPercentage · n/N 13/23 · Group A; 23 patients with pre-operative speech automatisms · recessive temporal lobe · Pre-operative; warning, recurrent, irrelevant, emotional, or perplexity utterances at seizure onset, during seizure, or just afterPDF p.5, Table II; PDF p.7, discussion of speech automatism laterality
10/23 dominant-associatedspeech automatismsPercentage · n/N 10/23 · Group A; 23 patients with pre-operative speech automatisms · dominant temporal lobe · Pre-operative; warning, recurrent, irrelevant, emotional, or perplexity utterances at seizure onset, during seizure, or just afterPDF p.5, Table II; PDF p.7, discussion of speech automatism laterality
11 recessive-side instancesspeech automatismsCount · Group A; 23 patients with pre-operative speech automatisms · recessive temporal lobe · Pre-operative; warning, recurrent, irrelevant, emotional, or perplexity utterances at seizure onset, during seizure, or just afterPDF p.5, Table II; PDF p.7, discussion of speech automatism laterality
normal EEG 1/23speech automatisms; pre-operative interictal spike dischargesCount · n/N 1/23 · Group A; 23 patients with speech automatisms · normal EEG · Pre-operative interictal EEGPDF p.7, EEG discussion; PDF p.12, Table IV, Group A speech automatism row
exclusive right 7/23speech automatisms; pre-operative interictal spike dischargesCount · n/N 7/23 · Group A; 23 patients with speech automatisms · exclusive right-sided · Pre-operative interictal EEGPDF p.7, EEG discussion; PDF p.12, Table IV, Group A speech automatism row
bilateral 14/23speech automatisms; pre-operative interictal spike dischargesCount · n/N 14/23 · Group A; 23 patients with speech automatisms · bilateral · Pre-operative interictal EEGPDF p.7, EEG discussion; PDF p.12, Table IV, Group A speech automatism row
6 right-predominant bilateralspeech automatisms; pre-operative interictal spike dischargesCount · Group A; 23 patients with speech automatisms · right-predominant bilateral · Pre-operative interictal EEGPDF p.7, EEG discussion; PDF p.12, Table IV, Group A speech automatism row
8 left-predominant bilateralspeech automatisms; pre-operative interictal spike dischargesCount · Group A; 23 patients with speech automatisms · left-predominant bilateral · Pre-operative interictal EEGPDF p.7, EEG discussion; PDF p.12, Table IV, Group A speech automatism row
exclusive left 1/23speech automatisms; pre-operative interictal spike dischargesCount · n/N 1/23 · Group A; 23 patients with speech automatisms · exclusive left-sided · Pre-operative interictal EEGPDF p.7, EEG discussion; PDF p.12, Table IV, Group A speech automatism row
3/6post-operative ictal speech automatismPercentage · n/N 3/6 · All 38 speech-automatism patients; Group B subgroup with 15 patients with persisting fits; comparison of 6 dominant-resection and 9 right-resection patients with continued seizures · continued seizures after dominant temporal-lobe removal · Post-operative follow-up during persistent or recurrent seizuresPDF p.9, discussion point (3); PDF p.11, prognostic discussion
3/38post-operative ictal speech automatismPercentage · n/N 3/38 · All 38 speech-automatism patients; Group B subgroup with 15 patients with persisting fits; comparison of 6 dominant-resection and 9 right-resection patients with continued seizures · all pre-operative ictal speech-automatism patients · Post-operative follow-up during persistent or recurrent seizuresPDF p.9, discussion point (3); PDF p.11, prognostic discussion
none of 9post-operative ictal speech automatismPercentage · n/N 0/9 · All 38 speech-automatism patients; Group B subgroup with 15 patients with persisting fits; comparison of 6 dominant-resection and 9 right-resection patients with continued seizures · continued seizures after right-sided resection · Post-operative follow-up during persistent or recurrent seizuresPDF p.9, discussion point (3); PDF p.11, prognostic discussion
15 Group B patients with persisting fitspost-operative ictal speech automatismCount · All 38 speech-automatism patients; Group B subgroup with 15 patients with persisting fits; comparison of 6 dominant-resection and 9 right-resection patients with continued seizures · Group B with persisting fits · Post-operative follow-up during persistent or recurrent seizuresPDF p.9, discussion point (3); PDF p.11, prognostic discussion
35/38post-operative ictal speech automatismPercentage · n/N 35/38 · All 38 speech-automatism patients; Group B subgroup with 15 patients with persisting fits; comparison of 6 dominant-resection and 9 right-resection patients with continued seizures · all pre-operative ictal speech-automatism patients · Post-operative follow-up during persistent or recurrent seizuresPDF p.9, discussion point (3); PDF p.11, prognostic discussion
56% with recessive focus when emphasized bilateral foci includedspeech automatismPercentage · Bingley’s cited 74 patients with non-tumorous temporal-lobe epilepsy; unilateral EEG-focus subgroups and bilateral-focus cases with side emphasis · Recessive focus including emphasized bilateral foci · Speech automatism during seizuresPDF p.10, discussion of prior speech-automatism reports
Speech automatism in 10/17 unilateral recessive-focus patientsspeech automatismCount · n/N 10/17 · Bingley’s cited 74 patients with non-tumorous temporal-lobe epilepsy; unilateral EEG-focus subgroups and bilateral-focus cases with side emphasis · Unilateral recessive-lobe EEG focus · Speech automatism during seizuresPDF p.10, discussion of prior speech-automatism reports
25% with dominant focus when emphasized bilateral foci includedspeech automatismPercentage · Bingley’s cited 74 patients with non-tumorous temporal-lobe epilepsy; unilateral EEG-focus subgroups and bilateral-focus cases with side emphasis · Dominant focus including emphasized bilateral foci · Speech automatism during seizuresPDF p.10, discussion of prior speech-automatism reports
Speech automatism in 6/24 unilateral dominant-focus patientsspeech automatismCount · n/N 6/24 · Bingley’s cited 74 patients with non-tumorous temporal-lobe epilepsy; unilateral EEG-focus subgroups and bilateral-focus cases with side emphasis · Unilateral dominant-lobe EEG focus · Speech automatism during seizuresPDF p.10, discussion of prior speech-automatism reports
Speech automatism in 29/74 cases overallspeech automatismCount · n/N 29/74 · Bingley’s cited 74 patients with non-tumorous temporal-lobe epilepsy; unilateral EEG-focus subgroups and bilateral-focus cases with side emphasis · Non-tumorous temporal-lobe epilepsy · Speech automatism during seizuresPDF p.10, discussion of prior speech-automatism reports
eight repetitions at the commencement of the induced metrazol seizurerecurrent speech automatism in an acquired languageCount · One 38-year-old bilingual patient described in the addendum; Polish home language and acquired English · Addendum case · Seizure onset and early ictal period; induced metrazol seizure commencementPDF p.13, Addendum; PDF p.14, Addendum
slightly less than half of 38 speech-automatism patientsparoxysmal dysphasia; ictal speech automatism; grand mal attacksPercentage · Patients with pre-operative paroxysmal dysphasia and patients with pre-operative ictal speech automatisms · ictal speech automatism · Pre-operative seizure historyPDF p.11, discussion of seizure severity
more than three-quarters of 34 dysphasia patientsparoxysmal dysphasia; ictal speech automatism; grand mal attacksPercentage · Patients with pre-operative paroxysmal dysphasia and patients with pre-operative ictal speech automatisms · paroxysmal dysphasia · Pre-operative seizure historyPDF p.11, discussion of seizure severity

unterberger-epileptic-aphasia-critical-appraisal-2021.pdfCase report or observation · 2 findings · 1 reported value

unterberger-epileptic-aphasia-critical-appraisal-2021.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

speech automatisms during atypical absence seizuresSpeech automatisms during atypical absence seizures are described as phenomenologically overlapping with those in focal seizures of temporal lobe origin and as occurring in 12–39% of patients with temporal lobe epilepsies.PDF p.2, §2 paragraph beginning “Speech automatisms may be divided”
reactive speech automatismsThe review classifies complex automatic speech behavior such as swearing, verbal help seeking, and coprolalia as assumed reactive automatisms and states that they are not indicative of the seizure-onset zone.PDF p.2, §2 paragraph beginning “Complex automatic speech behavior”

Reported values

12–39% of patients with temporal lobe epilepsiesspeech automatisms during atypical absence seizuresPercentage · Patients with temporal lobe epilepsies; atypical absence seizure context · ictalPDF p.2, §2 paragraph beginning “Speech automatisms may be divided”

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdfIndependent primary study · 2 findings

wang-phenotypic-spectrum-occipital-lobe-epilepsy-seeg-network-classification-2026.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

visual aura to automatism phenotypePhenotype II is characterized primarily by oropharyngeal, limb, or verbal automatisms, with or without a preceding visual aura.PDF p.9, Phenotype II
verbal automatismsTable 2 records vocalization/verbal automatisms in Case 11 after orolimentary and right-upper-limb automatisms.PDF p.7, Table 2 Case 11

12 contributing manuscripts; source-reported values remain separate and are not pooled.

Ictal pain (painful somatosensory seizure)Source terms: Ictal painReported: BilateralAlso reported: ContralateralAlso reported: IpsilateralAlso reported: Left hemisphereAlso reported: Non-dominant hemisphereAlso reported: Right hemisphere12 manuscripts · 48 findings · 44 reported values

Weighted evidence supportevidence weight 22.07 across 12 manuscripts · 1 manuscript weight pending · 2 case report or observation · 6 narrative, educational, or cited context · 2 independent primary study · 1 systematic review or meta-analysis · 1 structured design not resolved

In the illustrated case, painful tingling in the left hand was contralateral to right-insular seizure onset. The chapter restates that painful sensation has been described more frequently in the nondominant hemisphere. The case shows pain or pulling in the right face spreading to the right arm and leg. One patient had an aura of a tearing feeling in the left arm. Right facial pain, right-ear ringing, right hemibody and foot manifestations predominated in the early sequence, while left-sided stiffening occurred in half of seizures. Somatosensory auras are described as usually contralateral to the focus; right hemibody pain in the illustrative case suggested a left focus. Unilateral painful aura was usually contralateral to the symptomatogenic zone in perirolandic/parietal epilepsy, with an ipsilateral exception described in temporal lobe epilepsy. The review describes unilateral painful aura as contralateral to the suspected postcentral/parietal symptomatogenic zone. All three presumed perirolandic unilateral painful auras were contralateral, while one of two temporal cases was ipsilateral. Painful somatosensory seizures usually involve a specific body part contralateral to the cortical focus, but can be ipsilateral or bilateral. This finding provides no lateralization information. No lateralization information is reported. The case reports right-sided symptoms but no relation to a seizure-onset hemisphere. No hemisphere or body-side direction is reported. The cited anterior-versus-posterior insular comparison provides no lateralizing information. Ictal pain may present with unilateral truncal or peripheral distribution, but no seizure-relative direction is supplied. The case reports specify chest, genital, facial, pharyngeal, and lingual pain but no lateralizing direction. No hemisphere or body-side relationship is reported. No lateralizing direction is reported for painful somatosensory aura. No lateralizing direction is reported.

Source-defined result groups 13

Localization: Insular / ParietalObserved proportion 100.0%pain at seizure onset · other SOZ · patient1 manuscript · 1 reported value · not pooled

Localization: ParietalObserved proportion 2.5%All reported · other stimulation responses · patients with cortical stimulation1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyAll reported · face versus upper-limb versus lower-limb representation · painful response restricted to one somatotopic body region1 manuscript · 2 reported values · not pooled

Localization: Insular / ParietalObserved proportion 100.0%choking sensation · other SOZ · patient1 manuscript · 1 reported value · not pooled

Localization: InsularObserved proportion 90.0%stimulation-evoked pain · patient-reported painful sensation1 manuscript · 1 reported value · not pooled

Localization: cingulate gyrusObserved proportion 0.0%All reported · painful aura · patients1 manuscript · 1 reported value · not pooled

Localization: FrontalSource-defined values retained separatelyOFC-restricted EZN cases · patients1 manuscript · 1 reported value · not pooled

Lateralization: Left hemisphereObserved proportion 100.0%All reported · right-arm or nonlateralized aura · operative-map case1 manuscript · 1 reported value · not pooled

Localization: InsularSource-defined values retained separatelyAll reported · other evoked-sensation categories and insular locations · painful stimulation response; source also uses patient-level wording for behavioral observation1 manuscript · 1 reported value · not pooled

Localization: InsularObserved proportion 70.0%stimulation-evoked pain · patient-reported painful sensation1 manuscript · 1 reported value · not pooled

Localization: Insular / ParietalObserved proportion 100.0%vertigo or falling sensation · other SOZ · patient1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 12

Alphabetical by manuscript.

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdfStructured design not resolved · 1 finding · 1 reported value

alkawadri-cingulate-epilepsy-three-electroclinical-subtypes-surgical-outcomes-2013.pdf

Structured design not resolved · Class pending · Evidence weight pending · 0 × 0.9 × 1.573

Findings

absence of painful auraNone of the patients in the series reported painful auras despite preservation of awareness.PDF p.7, Discussion

Reported values

0/14 painful aurasabsence of painful auraProportion · n/N 0/14 · 14 lesional cingulate epilepsy cases · auraPDF p.7, Discussion

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 1 finding

chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

pain; warmth auraTable 3 lists pain or warmth aura as localising to secondary somatosensory cortex or insula.PDF p.10, Table 3

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdfNarrative, educational, or cited context · 1 finding · 1 reported value

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 0.90 · 1 × 0.9 × 1

Findings

somatosensory painTwo restricted-OFC cases had somatosensory pain involving the head and full body.PDF p.2, Semiology patterns of seizures with EZN restricted to the OFC

Reported values

2 patientssomatosensory painCount · OFC-restricted EZN cases · OFC-restricted EZN cases · ictalPDF p.2, Semiology patterns of seizures with EZN restricted to the OFC

gibbs-clinical-features-sleep-related-hypermotor-epilepsy-2019.pdfIndependent primary study · 1 finding · 3 reported values

gibbs-clinical-features-sleep-related-hypermotor-epilepsy-2019.pdf

Independent primary study · Class II · Evidence weight 3.90 · 2 × 1.5 × 1.301

Findings

pain, choking sensation, vertigo, and falling sensationAll four patients with pain at seizure onset and all three patients with a choking sensation had an insular SOZ, while all three patients with either vertigo or a falling sensation had a parietal SOZ.PDF p.6, section 3.3

Reported values

all four patientspain, choking sensation, vertigo, and falling sensationPercentage · n/N 4/4 · SHE patients with the specified sensory manifestations; source reports four pain cases, three choking cases, and three vertigo/falling cases · pain at seizure onset · at the beginning of the seizure/early sensory onsetPDF p.6, section 3.3
all three patientspain, choking sensation, vertigo, and falling sensationPercentage · n/N 3/3 · SHE patients with the specified sensory manifestations; source reports four pain cases, three choking cases, and three vertigo/falling cases · vertigo or falling sensation · at the beginning of the seizure/early sensory onsetPDF p.6, section 3.3
all three patientspain, choking sensation, vertigo, and falling sensationPercentage · n/N 3/3 · SHE patients with the specified sensory manifestations; source reports four pain cases, three choking cases, and three vertigo/falling cases · choking sensation · at the beginning of the seizure/early sensory onsetPDF p.6, section 3.3

hwang-painful-seizures-review-ictal-pain-2019.pdfNarrative, educational, or cited context · 12 findings · 9 reported values

hwang-painful-seizures-review-ictal-pain-2019.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

PSS sensory quality and body-side relationshipPSS may feel burning, stabbing, knife-like, prickling, throbbing, or muscle-tearing and can be intense enough to cause grimacing, screaming, or crying; sensations usually involve a specific body part such as a limb or a segmental distribution and usually occur contralateral to the cortical seizure focus, but may be ipsilateral or bilateral.PDF p.2, Table 1; PDF p.4, Somatosensory Pain as a Symptom of Seizures, Description
epileptic ictal painThe review characterizes epileptic ictal pain as a rare phenomenon classically presenting as cephalic, abdominal, or unilateral truncal/peripheral pain and occurring mostly with focal-onset seizures.PDF p.1, Introduction; PDF p.2, Table 1
ictal pain frequencyThe review reports that ictal pain of any type occurs in 0.2% to 2.8% of patients with epilepsy overall, with rates approaching 4.1% in patients with focal epilepsy syndromes.PDF p.1, Introduction
ictal-pain diagnostic cluesThe review identifies brief, abrupt, stereotyped paroxysmal occurrence as a clue to ictal pain, with confusion or loss of awareness, clonic activity, and EEG abnormalities as possible accompanying indicators; empiric anti-epileptic drug response may help but is not specific, and pain may occur alone with little or no electrographic correlate.PDF p.1, Introduction
painful somatosensory seizures (PSS) frequencyThe review estimates PSS occurrence at about 0.2% to 0.6% of patients evaluated in an EMU and 1.5% of epilepsy cases specifically involving somatosensory seizures.PDF p.4, Somatosensory Pain as a Symptom of Seizures, Description
epileptic ictal somatosensory pain in EMUThe review reports that a large retrospective review of 5,133 patients investigated in an EMU found documentation of epileptic ictal somatosensory pain in 10 patients.PDF p.4, Somatosensory Pain as a Symptom of Seizures, Description
peripherally localized ictal painThe review reports that a retrospective review of 4,736 patients with epilepsy identified 4 patients with primarily peripherally localized ictal pain.PDF p.4, Somatosensory Pain as a Symptom of Seizures, Description
unusual PSS topographiesThe review notes EEG-validated PSS cases presenting as ictal chest, genital, facial, pharyngeal, and lingual pain.PDF p.4, Somatosensory Pain as a Symptom of Seizures, Description
PSS accompanying symptoms and tonic-pain distinctionPSS may accompany paraesthesias, thermal sensations, perceptual body distortion, or motor manifestations; pain caused by focal tonic muscle contraction and severe spasm should be distinguished from somatosensory-origin pain.PDF p.4, Somatosensory Pain as a Symptom of Seizures, Description
painful somatosensory aura in focal epilepsyThe review reports that a case review of 604 consecutive focal-epilepsy cases found 6 patients with painful somatosensory auras, considered to arise from parietal or temporal regions by scalp EEG and neuroimaging; the review notes that some may have had operculo-insular onset or spread and that temporal-onset pain was postulated to reflect spread to SII.PDF p.4, Somatosensory Pain as a Symptom of Seizures, Localization; PDF p.5, Localization (continued)
cortical electrical stimulation and pain responsesThe review reports that an extensive study of 4,160 cortical electrical stimulations elicited pain in 60 of 558 triggered responses (11%) when stimulation involved SII and insular areas, with no pain or unpleasant sensations in any other reported regions.PDF p.5, Somatosensory Pain as a Symptom of Seizures, Localization
PSS propagation and symptom-localization interpretationThe review concludes that somatosensory pain perceptions are more likely related to ictal involvement of the insula and SII parietal operculum than to the parietal region alone, but stresses that this does not necessarily indicate seizure origin or a direct lesion there because seizures may spread into the pain network from other locations.PDF p.5, Somatosensory Pain as a Symptom of Seizures, Localization

Reported values

Ictal pain frequency 0.2%–2.8% in epilepsy overallictal pain frequencyRange · Patients with epilepsy overall versus patients with focal epilepsy syndromes · Epilepsy overall · ictalPDF p.1, Introduction
Ictal pain frequency approaching 4.1% in focal epilepsyictal pain frequencyPercentage · Patients with epilepsy overall versus patients with focal epilepsy syndromes · Focal epilepsy syndromes · ictalPDF p.1, Introduction
1.5% of epilepsy cases involving somatosensory seizurespainful somatosensory seizures (PSS) frequencyPercentage · Patients with intractable focal epilepsy evaluated in an EMU versus epilepsy cases involving somatosensory seizures · epilepsy cases involving somatosensory seizures · IctalPDF p.4, Somatosensory Pain as a Symptom of Seizures, Description
about 0.2%–0.6% of EMU-evaluated patientspainful somatosensory seizures (PSS) frequencyRange · Patients with intractable focal epilepsy evaluated in an EMU versus epilepsy cases involving somatosensory seizures · EMU-evaluated patients · IctalPDF p.4, Somatosensory Pain as a Symptom of Seizures, Description
10/5,133 patientsepileptic ictal somatosensory pain in EMUCount · n/N 10/5133 · 5,133 patients investigated in an EMU · IctalPDF p.4, Somatosensory Pain as a Symptom of Seizures, Description
4/4,736 patientsperipherally localized ictal painCount · n/N 4/4736 · 4,736 patients with epilepsy in a retrospective review · IctalPDF p.4, Somatosensory Pain as a Symptom of Seizures, Description
6/604 casespainful somatosensory aura in focal epilepsyCount · n/N 6/604 · 604 consecutive cases of focal epilepsy · Somatosensory aura/ictalPDF p.4, Somatosensory Pain as a Symptom of Seizures, Localization; PDF p.5, Localization (continued)
Pain in 60/558 triggered responses (11%)cortical electrical stimulation and pain responsesPercentage · n/N 60/558 · Cortical electrical stimulation study summarized by the review · Responses elicited by stimulation involving SII and insular areas · Electrical stimulation; not an ictal phasePDF p.5, Somatosensory Pain as a Symptom of Seizures, Localization
4,160 cortical electrical stimulationscortical electrical stimulation and pain responsesCount · Cortical electrical stimulation study summarized by the review · Electrical stimulation; not an ictal phasePDF p.5, Somatosensory Pain as a Symptom of Seizures, Localization

jobst-insula-and-its-epilepsies-2019.pdfCase report or observation · 16 findings · 4 reported values

jobst-insula-and-its-epilepsies-2019.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Figure 3 painful tingling in left handThe patient in Figure 3 described a painful tingling sensation in the left hand after right-insular onset.PDF p.4, Figure 3B
posterior insular stimulation painful sensationsStimulation of the posterior insula typically produces painful sensations.PDF p.1, Abstract; PDF p.5, Somatosensory Sensations
painful sensations as suggestive insular featurePainful sensations are described as highly suggestive of insular or insulo-opercular seizures.PDF p.2, Clinical Features
expression of pain on video EEGExpression of pain is among the observed clinical signs that suggest an insular focus.PDF p.3, Video EEG
posterior-third painful sensationsPainful sensations were elicited mostly from the posterior third of the insula.PDF p.5, Somatosensory Sensations
burning painful sensationBurning was one the source's own description of painful sensations elicited from the posterior insula.PDF p.5, Somatosensory Sensations
electric-shock painful sensationElectric shock was one the source's own description of painful sensations elicited from the posterior insula.PDF p.5, Somatosensory Sensations
painful pins sensationPainful pins was one the source's own description of painful sensations elicited from the posterior insula.PDF p.5, Somatosensory Sensations
cramp painful sensationCramps were one the source's own description of painful sensations elicited from the posterior insula.PDF p.5, Somatosensory Sensations
rare painful responses to stimulationPainful responses were rare, occurring in 60 of more than 4000 stimulations.PDF p.5, Somatosensory Sensations
painful responses from insular and SII stimulationIn the cited stimulation study, painful responses were elicited only by insular and secondary somatosensory cortex stimulation.PDF p.5, Somatosensory Sensations
absence of painful responses from SI stimulationPainful responses were never observed when stimulating primary somatosensory cortex (SI) in the cited study.PDF p.5, Somatosensory Sensations
absence of painful responses from other cortical areasPainful responses were never observed when stimulating cortical areas other than the insula and SII in the cited study.PDF p.5, Somatosensory Sensations
insula or SII involved at onset of painful seizuresIn the cited SEEG study, the insula or SII was systematically involved at seizure onset in all five patients with painful seizures.PDF p.5, Somatosensory Sensations
ictal pain reproduced by insula or SII stimulationIctal pain was reproduced by stimulation of the insula or SII in the cited five-patient study.PDF p.5, Somatosensory Sensations
nociceptive symptoms suggest insular originNociceptive symptoms are described as highly suggestive of an insular-lobe origin.PDF p.5, Other Insular Responses

Reported values

60/>4000 painful responsesrare painful responses to stimulationProportion · cited cortical stimulation series · stimulation-evoked painful symptomPDF p.5, Somatosensory Sensations
no painful responses observed with SI stimulationabsence of painful responses from SI stimulationCount · cited cortical stimulation series · stimulation-evoked painful symptomPDF p.5, Somatosensory Sensations
no painful responses observed in other cortical areasabsence of painful responses from other cortical areasCount · cited cortical stimulation series · stimulation-evoked painful symptomPDF p.5, Somatosensory Sensations
5/5 insula or SII involved at onsetinsula or SII involved at onset of painful seizuresProportion · n/N 5/5 · 5 patients with painful seizures · ictal onsetPDF p.5, Somatosensory Sensations

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdfNarrative, educational, or cited context · 3 findings · 7 reported values

loddenkemper-lateralizing-signs-during-seizures-in-focal-epilepsy-2005.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Painful auraThe review associates unilateral painful auras with a contralateral postcentral or parietal symptomatogenic zone in perirolandic or parietal epilepsy, while noting that temporal lobe epilepsy can produce an ipsilateral representation.PDF p.2, section 2.2 Painful auras; PDF p.2, section 2.2.1 Mechanism
Painful auraYoung and Blume found 24 patients with painful auras among 856 patients with epilepsy, including 10 with unilateral pain; the review reports unilateral pain as 1.2% and describes the suspected symptomatogenic zone as contralateral postcentral gyrus or parietal lobe.PDF p.2, section 2.2 Painful auras
Painful auraNair et al. reviewed 604 consecutive cases and found 25 patients with painful auras, including 5 with unilateral painful auras; the unilateral auras were contralateral in 3 patients with presumed perirolandic epilepsy, while 1 of 2 patients with unilateral pain and temporal lobe epilepsy had ipsilateral representation.PDF p.2, section 2.2 Painful auras

Reported values

10 with unilateral painPainful auraCount · 24 patients with painful auras among 856 patients with epilepsy; 10 had unilateral pain · unilateral pain · Ictal auraPDF p.2, section 2.2 Painful auras
unilateral pain 1.2%Painful auraPercentage · n/N 10/856 · 24 patients with painful auras among 856 patients with epilepsy; 10 had unilateral pain · unilateral pain · Ictal auraPDF p.2, section 2.2 Painful auras
24 patients with painful auras among 856Painful auraPercentage · n/N 24/856 · 24 patients with painful auras among 856 patients with epilepsy; 10 had unilateral pain · painful aura · Ictal auraPDF p.2, section 2.2 Painful auras
Unilateral painful auras 5/25Painful auraPercentage · n/N 5/25 · 604 consecutive cases; 25 patients with painful auras; 5 with unilateral painful auras · Painful-aura patients · Ictal auraPDF p.2, section 2.2 Painful auras
Presumed perirolandic unilateral painful auras contralateral 3/3Painful auraPercentage · n/N 3/3 · 604 consecutive cases; 25 patients with painful auras; 5 with unilateral painful auras · Presumed perirolandic epilepsy · Ictal auraPDF p.2, section 2.2 Painful auras
Temporal-lobe unilateral pain ipsilateral 1/2Painful auraPercentage · n/N 1/2 · 604 consecutive cases; 25 patients with painful auras; 5 with unilateral painful auras · Temporal lobe epilepsy · Ictal auraPDF p.2, section 2.2 Painful auras
Painful auras 25/604Painful auraPercentage · n/N 25/604 · 604 consecutive cases; 25 patients with painful auras; 5 with unilateral painful auras · Ictal auraPDF p.2, section 2.2 Painful auras

mazzola-electrical-stimulation-human-insula-ictal-semiology-2017.pdfNarrative, educational, or cited context · 4 findings · 7 reported values

mazzola-electrical-stimulation-human-insula-ictal-semiology-2017.pdf

Narrative, educational, or cited context · Class III · Evidence weight 3.00 · 1 × 1.5 × 2

Findings

painful sensationsPainful sensations numbered 57 (10.4%) and were evoked in the posterior two thirds of the insula, mostly postero-superiorly where pain-response threshold was lowest; every patient reported by the source as having a painful sensation also showed spontaneous behavioral manifestations of pain.PDF p.3, Results and Table 1; PDF p.4, Somato-sensory Responses and Fig. 3C
painful sensation descriptions and intensityPatients used burning, electric-shock, stinging, painful pins-and-needles, or crushing/cramp descriptions for stimulation-evoked pain, which had a mean visual analog scale score of 6.7/10 with a range of 4-9/10.PDF p.4, Somato-sensory Responses
somatotopic organization of painful responsesWhen pain was restricted to a single somatotopic region, a somatotopic organization was found in the caudal insula; the face representation was rostral to the upper-limb representation, which was above the lower-limb representation.PDF p.4, Somato-sensory Responses
ictal pain and insular/SII seizure-onset involvementRestating a cited SEEG study, the source reports that ictal pain in patients with painful seizures could be reproduced by insular or SII stimulation and that both the insula and SII were systematically involved at seizure onset.PDF p.7, Somato-sensory Responses

Reported values

behavioral pain manifestation reported for all source-described painful-sensation patientspainful sensationsCount · n/N 57/550 · 57 painful responses in the 550-response series; source describes patients reporting pain · stimulation-evoked painful sensationPDF p.3, Results and Table 1; PDF p.4, Somato-sensory Responses and Fig. 3C
57 painful responses (10.4% of 550 clinically eloquent responses)painful sensationsPercentage · 57 painful responses in the 550-response series; source describes patients reporting pain · stimulation-evoked painful sensationPDF p.3, Results and Table 1; PDF p.4, Somato-sensory Responses and Fig. 3C
6.7/10painful sensation descriptions and intensityMean · n/N 7/10 · Source-described patients reporting painful sensations after insular stimulation · stimulation-evoked pain · stimulation-evoked painful sensationPDF p.4, Somato-sensory Responses
4–9/10painful sensation descriptions and intensityRange · n/N 9/10 · Source-described patients reporting painful sensations after insular stimulation · stimulation-evoked pain · stimulation-evoked painful sensationPDF p.4, Somato-sensory Responses
face rostral to upper limbsomatotopic organization of painful responsesCount · Painful responses restricted to a single somatotopic region: face, upper limb, or lower limb · stimulation-evoked painful sensationPDF p.4, Somato-sensory Responses
upper limb above lower limbsomatotopic organization of painful responsesCount · Painful responses restricted to a single somatotopic region: face, upper limb, or lower limb · stimulation-evoked painful sensationPDF p.4, Somato-sensory Responses
single-region painful responses 51% (n=29)somatotopic organization of painful responsesPercentage · Painful responses restricted to a single somatotopic region: face, upper limb, or lower limb · stimulation-evoked painful sensationPDF p.4, Somato-sensory Responses

mcgonigal-on-seizure-semiology-2021-5ba29d.pdfNarrative, educational, or cited context · 1 finding · 2 reported values

mcgonigal-on-seizure-semiology-2021-9127f2.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

hyperkinetic signs; speech modifications; viscerosensory symptoms; pain; asymmetric tonic; focal clonic; tonic symptomsIn the summarized Peltola et al. study of pure insular epilepsies, hyperkinetic signs, speech modifications, and viscerosensory symptoms were related to an anterior insular seizure-onset zone, whereas pain, asymmetric tonic, focal clonic, and tonic symptoms were more frequent in patients with a posterior insular seizure onset.PDF p.7, Table 2 (continued), Peltola et al. 2020 row

Reported values

79 seizureshyperkinetic signs; speech modifications; viscerosensory symptoms; pain; asymmetric tonic; focal clonic; tonic symptomsCount · 11 subjects with pure insular epilepsy; 79 seizures · Peltola et al. study · ictal onset and semiologic expressionPDF p.7, Table 2 (continued), Peltola et al. 2020 row
11 subjectshyperkinetic signs; speech modifications; viscerosensory symptoms; pain; asymmetric tonic; focal clonic; tonic symptomsCount · 11 subjects with pure insular epilepsy; 79 seizures · Peltola et al. pure insular epilepsy study · ictal onset and semiologic expressionPDF p.7, Table 2 (continued), Peltola et al. 2020 row

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdfCase report or observation · 2 findings · 5 reported values

pana-nguyen-operculo-insular-epilepsy-stereo-eeg-2020.pdf

Case report or observation · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Case 2 painful somatosensory, auditory-reflex, hypermotor, and autonomic/speech semiologyCase 2 was a 46-year-old right-handed man whose seizures began with lancinating right facial pain followed within 2 seconds by high-pitched right-ear ringing descending along the right hemibody to the foot, sometimes with right-foot tremor, witnessed erratic right-sided and truncal movements, and left-sided stiffening in half the seizures; he was usually conscious without postictal paresis, had 10–15-second events up to 100 times per day triggered by sounds, and could develop hypersalivation, speech difficulty, later nocturnal hypermotor seizures, and urinary incontinence.PDF p.11, Case 2; PDF p.13, continuation of Case 2
painful somatosensory seizure and contralateral auraIn the Case 2 discussion, the source states that somatosensory auras are usually localized to primary sensory cortex, secondary somatosensory cortex in the parietal operculum, or the posterior third of the insular cortex; painful seizures likely arise in the same regions, although supplementary motor, inferior parietal, and cingulate localizations have been proposed, and somatosensory auras are usually contralateral to the epileptic focus even when the insula is involved.PDF p.13, What localizations are suggested by the seizure semiology?

Reported values

within 2 secondsCase 2 painful somatosensory, auditory-reflex, hypermotor, and autonomic/speech semiologyDuration · Individual Case 2; 46-year-old right-handed man, seizure onset age 16 · early sensory sequence · Ictal; longitudinal diurnal, nocturnal, and postoperative descriptionsPDF p.11, Case 2; PDF p.13, continuation of Case 2
10–15-second eventsCase 2 painful somatosensory, auditory-reflex, hypermotor, and autonomic/speech semiologyRange · Individual Case 2; 46-year-old right-handed man, seizure onset age 16 · habitual events · Ictal; longitudinal diurnal, nocturnal, and postoperative descriptionsPDF p.11, Case 2; PDF p.13, continuation of Case 2
2–3 per monthCase 2 painful somatosensory, auditory-reflex, hypermotor, and autonomic/speech semiologyRange · Individual Case 2; 46-year-old right-handed man, seizure onset age 16 · youth · Ictal; longitudinal diurnal, nocturnal, and postoperative descriptionsPDF p.11, Case 2; PDF p.13, continuation of Case 2
in half the seizuresCase 2 painful somatosensory, auditory-reflex, hypermotor, and autonomic/speech semiologyOther reported value · Individual Case 2; 46-year-old right-handed man, seizure onset age 16 · left-sided stiffening · Ictal; longitudinal diurnal, nocturnal, and postoperative descriptionsPDF p.11, Case 2; PDF p.13, continuation of Case 2
up to 100 times per dayCase 2 painful somatosensory, auditory-reflex, hypermotor, and autonomic/speech semiologyFrequency · Individual Case 2; 46-year-old right-handed man, seizure onset age 16 · later high-frequency period · Ictal; longitudinal diurnal, nocturnal, and postoperative descriptionsPDF p.11, Case 2; PDF p.13, continuation of Case 2

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdfIndependent primary study · 5 findings · 5 reported values

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdf

Independent primary study · Class II · Evidence weight 5.27 · 2 × 1.35 × 1.952

Findings

pain or pulling in right face spreading to right arm and legFigure 3 shows an aura of pain or a sensation of pulling in the right face spreading to the right arm and leg.PDF p.8, Fig. 3
tearing feeling in left armFigure 4 shows an aura of a tearing feeling in the left arm.PDF p.9, Fig. 4
painful somatosensory auraPainful sensations were reported in 13 patients.PDF p.3, Results, Aurae; PDF p.8, Discussion
painful sensation after superior parietal area 5a stimulationTwo patients reported a painful sensation after stimulation of the superior parietal lobe behind the post-central gyrus at source-labeled area 5a.PDF p.5, Electrical cortical stimulation
right-fingertip tingling and pain in Fig. 1Figure 1 shows an aura of tingling and pain in the fingertips of the right hand followed by rightward head deviation and right-arm tonic posturing.PDF p.4, Fig. 1

Reported values

1 casepain or pulling in right face spreading to right arm and legCount · n/N 1/1 · patient 36 (C.J.) · aura sequencePDF p.8, Fig. 3
1 casetearing feeling in left armCount · n/N 1/1 · patient 34 (E.H.) · aura or seizure onsetPDF p.9, Fig. 4
13 patientspainful somatosensory auraCount · 82-patient parietal epilepsy series · aura or seizure onsetPDF p.3, Results, Aurae; PDF p.8, Discussion
2 patientspainful sensation after superior parietal area 5a stimulationCount · n/N 2/80 · 80 stimulated patients · stimulation responsePDF p.5, Electrical cortical stimulation
1 caseright-fingertip tingling and pain in Fig. 1Count · n/N 1/1 · patient 7 (M.B.) · aura and ictal evolutionPDF p.4, Fig. 1

trebuchon-drane-electrical-stimulation-functional-mapping-seeg-2025.pdfNarrative, educational, or cited context · 1 finding

trebuchon-drane-electrical-stimulation-functional-mapping-seeg-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

anesthesia; paresthesia; thermic dispersion; painful sensationThe source reports anesthesia, paresthesia, or thermic dispersion mainly with parietal stimulation, with the main effect in postcentral gyrus but additional involvement of precuneus and posterior cingulum; insular stimulation induced paresthesias and localized warmth, and painful sensations were preferentially associated with the posterior two thirds of the insula and were more frequently described in the nondominant hemisphere.PDF p.14, Somato-sensory sensations and pain

12 contributing manuscripts; source-reported values remain separate and are not pooled.

Goal-directed automatisms (reaching, searching, grabbing - quasi-purposeful)Source terms: Goal-directed automatismsReported: Right hemisphere9 manuscripts · 59 findings · 53 reported values

Weighted evidence supportevidence weight 21.82 across 9 manuscripts · 2 independent primary study · 4 narrative, educational, or cited context · 3 systematic review or meta-analysis

The review lists ictal spitting or drinking as localizing to a right temporal-lobe focus. No lateralizing axis is reported for the 67.5% gestural-automatism summary. The TL-versus-T+ comparison of looking around reports no lateralizing axis. No seizure lateralization is reported. The frontal motor hierarchy provides no lateralizing direction. The EZN-extension association provides no lateralizing information. No lateralizing direction is reported. No lateralization information is reported. No lateralization information is reported for grasping or clutching. The cited frontal rostrocaudal gradient is not lateralizing. No lateralizing direction is reported for the review-table gestural-automatism result. No lateralizing direction is reported for the restricted high/very-high-confidence subset. The rostrocaudal cluster gradient is not lateralizing. This record provides no seizure lateralization. No lateralization axis information is reported for motor gestural/oro-alimentary automatisms. No hemisphere or body-side direction is reported. The row reports an overall association grade, not lateralization evidence. Motor gestural automatisms were reported at 43%; no hemisphere direction is reported. No lateralization axis information is reported for motor gestural/oral automatisms. The source reports OR 0.5 for motor gestural automatisms relative to vocalization/verbalization; no hemisphere direction is reported. No lateralization axis information is reported for the motor-gestural versus affective/autonomic comparison. The source reports OR 0.8 for motor gestural automatisms relative to autonomic signs; no hemisphere direction is reported. The source reports OR 0.9 for motor gestural automatisms relative to facial expression change; no hemisphere direction is reported. No lateralization axis information is reported for affective/autonomic aura versus motor-gestural automatisms. No lateralization evidence is reported. This finding provides no lateralization information.

Source-defined result groups 10

Localization: ACC/cingulate localization / reviewed anterior cingulate cortex seizure casesSource-defined values retained separatelyTonic-clonic · pairwise symptom-occurrence comparison1 manuscript · 1 reported value · not pooled

Localization: ACC/cingulate localization / reviewed anterior cingulate cortex seizure casesSource-defined values retained separatelyF to BTC · pairwise symptom-occurrence comparison1 manuscript · 1 reported value · not pooled

Evidence by contributing manuscript 9

Alphabetical by manuscript.

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdfIndependent primary study · 3 findings · 4 reported values

barba-temporal-plus-epilepsy-clinical-scalp-eeg-2007.pdf

Independent primary study · Class II · Evidence weight 3.00 · 2 × 1.5 × 1

Findings

gestural automatismsComplex behaviours were common and included gestural automatisms, reported in 67.5% of analyzed seizures.PDF p.5, Seizure clinical semiology
looking aroundLooking around did not differ significantly between TL and T+ groups.PDF p.6, Table 2
gestural automatisms and mesio-temporal structuresThe source states that gestural automatisms have been reported more often during mesio-temporal seizures than during neocortical or mesio-lateral temporal seizures and at a particularly high rate in TL seizures with mesio-temporal lesions.PDF p.8, Motor signs

Reported values

gestural automatisms 67.5%gestural automatismsPercentage · 80 analyzed seizures, one typical seizure per patient · ictalPDF p.5, Seizure clinical semiology
TL 32.2%looking aroundPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · TL group · ictalPDF p.6, Table 2
P=0.5looking aroundP value · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · ictalPDF p.6, Table 2
T+ 39.1%looking aroundPercentage · TL group (n=58) versus T+ group (n=22); one analyzed seizure per patient · T+ group · ictalPDF p.6, Table 2

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdfSystematic review or meta-analysis · 3 findings · 3 reported values

bartolomei-clinical-anatomical-characteristics-basal-temporal-seizures-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

gestural automatismsGestural automatisms were reported in 25% of reviewed cases.PDF p.4, Semiology and clinical features; PDF p.6, Table 3
Gestural automatisms (Table 3)Table 3 reports gestural automatisms in 21 cases (25%), more during propagation.PDF p.6, Table 3
Gestural automatisms (Table 4)In the 60 high/very-high-confidence cases, Table 4 reports gestural automatisms in 26 cases (43%).PDF p.7, Table 4

Reported values

25% gestural automatismsgestural automatismsPercentage · reviewed basal temporal seizure cases · ictal propagation in Table 3PDF p.4, Semiology and clinical features; PDF p.6, Table 3
21 cases (25%)Gestural automatisms (Table 3)Percentage · Table 3 basal temporal seizure cases · propagationPDF p.6, Table 3
26/60 (43%)Gestural automatisms (Table 4)Percentage · n/N 26/60 · 60 basal temporal seizure cases with high or very-high EZ confidence · ictalPDF p.7, Table 4

blair-temporal-lobe-epilepsy-semiology-2012.pdfNarrative, educational, or cited context · 1 finding

blair-temporal-lobe-epilepsy-semiology-2012.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Ictal spitting or drinkingIctal spitting or drinking is listed as localizing to a right temporal-lobe focus.PDF p.4, Table 2; PDF p.5, autonomic-phenomena paragraph

bonini-frontal-lobe-seizures-clinical-semiology-localization-2014-46edb4.pdfNarrative, educational, or cited context · 1 finding

bonini-frontal-lobe-seizures-clinical-semiology-localization-2014-46edb4.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

Ictal grasping or clutchingThe Discussion states that grasping or clutching occurs more frequently in seizures arising from frontal than extrafrontal regions, citing Gardella et al., 2006 and Leiguarda et al., 2008.PDF p.10, Electroclinical subgroups; PDF p.11, discussion of Group 3 behavior

chassoux-ictal-semiology-anterior-cingulate-epilepsy-systematic-review-2025.pdfSystematic review or meta-analysis · 34 findings · 31 reported values

chassoux-ictal-semiology-anterior-cingulate-epilepsy-systematic-review-2025.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

motor gestural/oro-alimentary automatismsThe source reports a frequency of 43% for motor gestural/oro-alimentary automatisms.PDF p.13, Table 3
motor gestural/oro-alimentary automatisms; reported frequency rangeThe source reports a frequency range of 0–91% for motor gestural/oro-alimentary automatisms.PDF p.13, Table 3
motor gestural/oro-alimentary automatisms; ACC association gradeTable 3 assigns the source's High overall association grade to motor gestural/oro-alimentary automatisms.PDF p.13, Table 3
motor gestural automatisms; Figure 4 rateFigure 4 displays a 43% rate for motor gestural automatisms.PDF p.10, Figure 4
motor gestural/oral automatismsMotor gestural/oral automatisms were reported in 43% of patients.PDF p.9, Objective symptomatology
motor gestural automatisms typicalityMotor gestural automatisms met the source's typicality criterion of significantly exceeding one-third of patients.PDF p.10, Statistical analysis of ictal semiology; PDF p.11, Figure 5
pairwise OR: Motor (gestural) automatisms relative to Vocalization/verbalizationFigure 6 reports an odds ratio of 0.5 for Motor (gestural) automatisms relative to Vocalization/verbalization.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to Hypermotor-complex motor behaviorFigure 6 reports an odds ratio of 0.5 for Motor (gestural) automatisms relative to Hypermotor-complex motor behavior.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to Affective/autonomic auraFigure 6 reports an odds ratio of 0.6 for Motor (gestural) automatisms relative to Affective/autonomic aura.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to Autonomic signsFigure 6 reports an odds ratio of 0.8 for Motor (gestural) automatisms relative to Autonomic signs.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to Facial expression changeFigure 6 reports an odds ratio of 0.9 for Motor (gestural) automatisms relative to Facial expression change.PDF p.12, Figure 6
pairwise OR: Vocalization/verbalization relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 2.1 for Vocalization/verbalization relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Hypermotor-complex motor behavior relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 2 for Hypermotor-complex motor behavior relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Affective/autonomic aura relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 1.7 for Affective/autonomic aura relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Autonomic signs relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 1.2 for Autonomic signs relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Facial expression change relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 1.1 for Facial expression change relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Loss of consciousness relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 0.7 for Loss of consciousness relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Post-ictal confusion/behavior change disinhibition relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 0.6 for Post-ictal confusion/behavior change disinhibition relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Chapeau de gendarme relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 0.3 for Chapeau de gendarme relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Dystonic posturing relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 0.3 for Dystonic posturing relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Head-eye deviation relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 0.2 for Head-eye deviation relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Laughter relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 0.2 for Laughter relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Oro-alimentary automatisms relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 0.1 for Oro-alimentary automatisms relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Tonic-clonic relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of 0.1 for Tonic-clonic relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: F to BTC relative to Motor (gestural) automatismsFigure 6 reports an odds ratio of <0.1 for F to BTC relative to Motor (gestural) automatisms.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to Loss of consciousnessFigure 6 reports an odds ratio of 1.4 for Motor (gestural) automatisms relative to Loss of consciousness.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to Post-ictal confusion/behavior change disinhibitionFigure 6 reports an odds ratio of 1.7 for Motor (gestural) automatisms relative to Post-ictal confusion/behavior change disinhibition.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to Chapeau de gendarmeFigure 6 reports an odds ratio of 2.9 for Motor (gestural) automatisms relative to Chapeau de gendarme.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to Dystonic posturingFigure 6 reports an odds ratio of 3.1 for Motor (gestural) automatisms relative to Dystonic posturing.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to Head-eye deviationFigure 6 reports an odds ratio of 4.6 for Motor (gestural) automatisms relative to Head-eye deviation.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to LaughterFigure 6 reports an odds ratio of 7 for Motor (gestural) automatisms relative to Laughter.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to Oro-alimentary automatismsFigure 6 reports an odds ratio of 7.9 for Motor (gestural) automatisms relative to Oro-alimentary automatisms.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to Tonic-clonicFigure 6 reports an odds ratio of 13.1 for Motor (gestural) automatisms relative to Tonic-clonic.PDF p.12, Figure 6
pairwise OR: Motor (gestural) automatisms relative to F to BTCFigure 6 reports an odds ratio of 13.1 for Motor (gestural) automatisms relative to F to BTC.PDF p.12, Figure 6

Reported values

43% (frequency range 0–91%)motor gestural/oro-alimentary automatismsPercentage · Reviewed ACC seizure cases with reported semiology · ictal onset and propagationPDF p.13, Table 3
43%motor gestural automatisms; Figure 4 ratePercentage · Reviewed ACC seizure cases with reported semiology · ictal onset and propagationPDF p.10, Figure 4
43%motor gestural/oral automatismsPercentage · Reviewed ACC seizure cases with reported semiology · Reviewed ACC seizure casesPDF p.9, Objective symptomatology
OR 0.5pairwise OR: Motor (gestural) automatisms relative to Vocalization/verbalizationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.5pairwise OR: Motor (gestural) automatisms relative to Hypermotor-complex motor behaviorOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.6pairwise OR: Motor (gestural) automatisms relative to Affective/autonomic auraOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.8pairwise OR: Motor (gestural) automatisms relative to Autonomic signsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.9pairwise OR: Motor (gestural) automatisms relative to Facial expression changeOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 2.1pairwise OR: Vocalization/verbalization relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 2pairwise OR: Hypermotor-complex motor behavior relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.7pairwise OR: Affective/autonomic aura relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.2pairwise OR: Autonomic signs relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.1pairwise OR: Facial expression change relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.7pairwise OR: Loss of consciousness relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.6pairwise OR: Post-ictal confusion/behavior change disinhibition relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.3pairwise OR: Chapeau de gendarme relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.3pairwise OR: Dystonic posturing relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.2pairwise OR: Head-eye deviation relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.1pairwise OR: Laughter relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 0.1pairwise OR: Oro-alimentary automatisms relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR <0.1pairwise OR: Tonic-clonic relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR <0.1pairwise OR: F to BTC relative to Motor (gestural) automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.4pairwise OR: Motor (gestural) automatisms relative to Loss of consciousnessOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 1.7pairwise OR: Motor (gestural) automatisms relative to Post-ictal confusion/behavior change disinhibitionOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 2.9pairwise OR: Motor (gestural) automatisms relative to Chapeau de gendarmeOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 3.1pairwise OR: Motor (gestural) automatisms relative to Dystonic posturingOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 4.6pairwise OR: Motor (gestural) automatisms relative to Head-eye deviationOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 7pairwise OR: Motor (gestural) automatisms relative to LaughterOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 7.9pairwise OR: Motor (gestural) automatisms relative to Oro-alimentary automatismsOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 13.1pairwise OR: Motor (gestural) automatisms relative to Tonic-clonicOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6
OR 13.1pairwise OR: Motor (gestural) automatisms relative to F to BTCOdds ratio · Reviewed ACC seizure cases with reported semiology · ACC symptom-comparison analysisPDF p.12, Figure 6

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdfSystematic review or meta-analysis · 2 findings

chowdhury-localisation-focal-epilepsy-practical-guide-2021.pdf; chowdhury-localisation-in-focal-epilepsy-practical-guide-2021.pdf

Systematic review or meta-analysis · Class I · Evidence weight 3.00 · 3 × 1 × 1

Findings

elementary motor sign; complex motor sign; gestural behaviourIntracranial stereo-EEG literature is summarized as placing elementary clonic, tonic, and versive signs in precentral and premotor regions; less-natural proximal stereotypies such as rocking and turning in premotor/posterior prefrontal regions; and more integrated natural gestural behaviour with distal stereotypies such as manual automatisms in more anterior prefrontal regions including orbitofrontal cortex, frontal pole, and anterior cingulate.PDF p.2, Frontal lobe seizures; PDF p.3, Figure 1
elementary motor signs; complex motor signs; gestural behaviourThe review reports that intracranial stereo-EEG studies associate elementary clonic, tonic, and versive signs with precentral and premotor regions; more complex motor signs with more rostral frontal regions; non-integrated proximal stereotypies such as rocking and turning with premotor and posterior prefrontal regions; and integrated distal stereotypies such as manual automatisms with anterior prefrontal regions including orbitofrontal cortex, frontal pole, and anterior cingulate.PDF p.2, Frontal lobe seizures

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdfNarrative, educational, or cited context · 12 findings · 9 reported values

despins-semiology-seizures-involving-orbitofrontal-cortex-2025.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.54 · 1 × 0.9 × 1.707

Findings

OFC + group (EZN extending beyond OFC); aura; oro-alimentary automatisms; gestural automatismsThe source characterizes EZN extending beyond the OFC as having richer semiological profiles, with temporal extension more often associated with aura, oro-alimentary automatisms, and sleep.PDF p.6, Semiological profile; PDF p.7, Conclusion
frontal and insular EZN extension; hyperkinetic behavior; mimic automatisms; gestural automatismsFrontal and insular extensions are described as more likely to show hyperkinetic behavior, mimic automatisms, and gestural automatisms.PDF p.7, Conclusion
gestural automatismsThe source interprets gestural automatisms as potentially indicating an EZN extending beyond the OFC, particularly into the temporal lobe.PDF p.3, Complex motor phenomena—automatisms
gestural automatismsGestural automatisms were reported in five of 26 restricted-OFC cases.PDF p.2, Semiology patterns of seizures with EZN restricted to the OFC
gestural automatisms; HkB subgroupNo HkB case had gestural automatisms.PDF p.2, Semiology patterns of seizures with EZN restricted to the OFC
gestural automatisms; non-HkB subgroupFive of the non-HkB cases had gestural automatisms.PDF p.2, Semiology patterns of seizures with EZN restricted to the OFC
gestural automatisms; entire groupThe source reports 28% for gestural automatisms in the entire ofc-involving group.PDF p.3, Complex motor phenomena—automatisms
gestural automatisms; OFC-restricted EZNThe source reports 19% for gestural automatisms in the ofc-restricted ezn group.PDF p.3, Complex motor phenomena—automatisms
gestural automatisms; OFC-extended EZNThe source reports 36% for gestural automatisms in the ofc-extended ezn group.PDF p.3, Complex motor phenomena—automatisms
gestural automatisms; temporal subgroupThe source reports 50% for gestural automatisms in the temporal subgroup of ofc-extended ezn.PDF p.3, Complex motor phenomena—automatisms
gestural automatisms; frontal subgroupThe source reports 27% for gestural automatisms in the frontal subgroup of ofc-extended ezn.PDF p.3, Complex motor phenomena—automatisms
gestural automatisms; insular subgroupThe source reports 30% for gestural automatisms in the insular subgroup of ofc-extended ezn.PDF p.3, Complex motor phenomena—automatisms

Reported values

5/26 (19.2%)gestural automatismsPercentage · n/N 5/26 · OFC-restricted EZN group · OFC-restricted EZN group · ictalPDF p.2, Semiology patterns of seizures with EZN restricted to the OFC
0/14 patientsgestural automatisms; HkB subgroupCount · n/N 0/14 · HkB subgroup within OFC-restricted EZN · HkB subgroup within OFC-restricted EZN · ictalPDF p.2, Semiology patterns of seizures with EZN restricted to the OFC
5/12 (41.6%)gestural automatisms; non-HkB subgroupPercentage · n/N 5/12 · Non-HkB subgroup within OFC-restricted EZN · Non-HkB subgroup within OFC-restricted EZN · ictalPDF p.2, Semiology patterns of seizures with EZN restricted to the OFC
28%gestural automatisms; entire groupPercentage · Entire OFC-involving group · Entire OFC-involving group · ictalPDF p.3, Complex motor phenomena—automatisms
19%gestural automatisms; OFC-restricted EZNPercentage · OFC-restricted EZN group · OFC-restricted EZN group · ictalPDF p.3, Complex motor phenomena—automatisms
36%gestural automatisms; OFC-extended EZNPercentage · OFC-extended EZN group · OFC-extended EZN group · ictalPDF p.3, Complex motor phenomena—automatisms
50%gestural automatisms; temporal subgroupPercentage · Temporal subgroup of OFC-extended EZN · Temporal subgroup of OFC-extended EZN · ictalPDF p.3, Complex motor phenomena—automatisms
27%gestural automatisms; frontal subgroupPercentage · Frontal subgroup of OFC-extended EZN · Frontal subgroup of OFC-extended EZN · ictalPDF p.3, Complex motor phenomena—automatisms
30%gestural automatisms; insular subgroupPercentage · Insular subgroup of OFC-extended EZN · Insular subgroup of OFC-extended EZN · ictalPDF p.3, Complex motor phenomena—automatisms

mcgonigal-on-seizure-semiology-2021-5ba29d.pdfNarrative, educational, or cited context · 2 findings · 5 reported values

mcgonigal-on-seizure-semiology-2021-5ba29d.pdf; mcgonigal-on-seizure-semiology-2021-9127f2.pdf

Narrative, educational, or cited context · Class III · Evidence weight 1.00 · 1 × 1 × 1

Findings

elementary motor signs; gestural motor behavior; emotional expressionThe review reports that Bonini, McGonigal et al. (2014) identified four frontal-lobe semiologic groups along a rostro-caudal gradient: Group 1 had elementary motor signs without gestural motor behavior; Group 2 combined elementary and gestural motor signs, often with mainly proximal tonic signs and facial contraction; Group 3 had no elementary motor signs and often distal, integrated gestural behavior; and Group 4 had no elementary motor signs with integrated gestural behavior in an emotional, usually fearful, context.PDF p.6, Table 2, Frontal lobe row
elementary motor signs; gestural motor behavior; emotional expression; frontal lobe seizuresIn the summarized Bonini, McGonigal et al. study, automated clustering of clinical signs and brain areas involved in seizure onset and early propagation found a rostrocaudal frontal gradient with four groups: elementary motor signs without gestural behavior; elementary plus gestural signs with mainly proximal tonic signs and facial contraction; gestural behavior without elementary signs and often distal or integrated; and gestural behavior in an emotional, often fearful, context with an integrated appearance.PDF p.6, Table 2, Bonini, McGonigal et al. 2014 row

Reported values

374 seizureselementary motor signs; gestural motor behavior; emotional expressionCount · 54 subjects with frontal-lobe epilepsy and 374 seizures · Seizure onset and early propagationPDF p.6, Table 2, Frontal lobe row
54 subjectselementary motor signs; gestural motor behavior; emotional expressionCount · 54 subjects with frontal-lobe epilepsy and 374 seizures · Seizure onset and early propagationPDF p.6, Table 2, Frontal lobe row
Semiology clusters n=4elementary motor signs; gestural motor behavior; emotional expression; frontal lobe seizuresCount · 54 subjects with frontal-lobe epilepsy; 374 seizures · seizure onset and early propagation; ictal semiologic expressionPDF p.6, Table 2, Bonini, McGonigal et al. 2014 row
Patients in semiology series n=54elementary motor signs; gestural motor behavior; emotional expression; frontal lobe seizuresCount · 54 subjects with frontal-lobe epilepsy; 374 seizures · seizure onset and early propagation; ictal semiologic expressionPDF p.6, Table 2, Bonini, McGonigal et al. 2014 row
Seizures in semiology series n=374elementary motor signs; gestural motor behavior; emotional expression; frontal lobe seizuresCount · 54 subjects with frontal-lobe epilepsy; 374 seizures · seizure onset and early propagation; ictal semiologic expressionPDF p.6, Table 2, Bonini, McGonigal et al. 2014 row

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdfIndependent primary study · 1 finding · 1 reported value

salanova-parietal-lobe-epilepsy-clinical-manifestations-outcome-1995.pdf

Independent primary study · Class II · Evidence weight 5.28 · 2 × 1.35 × 1.957

Findings

oral and gestural automatismsOral and gestural automatisms occurred in 17% of patients.PDF p.4, Results, Other seizure characteristics; PDF p.5, Table 2

Reported values

17%oral and gestural automatismsPercentage · 82-patient parietal epilepsy series · ictal propagation or later ictal phasePDF p.4, Results, Other seizure characteristics; PDF p.5, Table 2

9 contributing manuscripts; source-reported values remain separate and are not pooled.

Todd postictal paralysis (contralateral hemiparesis/hemiplegia)Source terms: Todd postictal paralysis; Todd paralysisReported: ContralateralAlso reported: Ipsilateral8 manuscripts · 12 findings · 33 reported values

Weighted evidence supportevidence weight 21.4 across 8 manuscripts · 4 narrative, educational, or cited context · 3 independent primary study · 1 systematic review or meta-analysis

The review restates an ipsilateral last clonic jerk and contralateral postictal Todd's paresis as lateralizing signs. The review lists postictal Todd's paresis as contralateral to the seizure focus. Ictal and postictal paresis are difficult to distinguish but are said to convey the same unspecified lateralization. The review restates Todd’s paresis as rare in LTM series and contralateral to the onset hemisphere in 93% of patients who experienced it. The review describes robust motor signs as predominantly contralateral to onset, with the last clonic jerk as an ipsilateral sign. The review states that postictal limb paresis or paralysis occurred in 0.5–13% of focal seizures and was always contralateral to the seizure-origin hemisphere. The current paper restates prior reports of almost 100% or 100% PPV for Todd’s paralysis lateralizing the EZ contralateral to the paralyzed side. The educational review calls Todd's paralysis non-localizing but highly lateralizing and describes preceding ipsilateral motor activity. The cited review describes unilateral ictal or postictal limb immobility as contralateral to the epileptogenic zone in almost all cases. The study reports sign-specific epileptogenic-zone direction, predominantly contralateral, with ipsilateral direction for asymmetric clonic ending. No lateralizing direction is reported for Todd’s paralysis in aggregate. Todd's paralysis occurred in 4/42 patients; no hemisphere or body-side direction is reported.