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Taxotomy

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Clinical features

Focal seizures arising from the temporal lobe may cause a variety of sensations including: deja vu, jamais vu, oral and manual automatisms, spitting, vomiting and an unpleasant gastric rising sensation, fear, olfactory hallucinations (normally unpleasant) and may involve dystonic posturing.

Dystonic posturing of a limb is strongly predictive of seizure onset in the contralateral mesial temporal lobe. Manual automatisms may occur in ipsilateral to the onset lobe. Following the seizure nose-wiping, blinking and unilateral piloerrection all may be observed ipsilaterally.

Loss of awareness is associated with dominant temporal lobe seizures. The preservation of awareness in non-dominant temporal lobe seizures frequently leads to diagnostic delay. Ictal spitting, vomiting and urinary urge are associated with non-dominant temporal lobe seizures.

Seizures typically last for around a minute to a minute and a half and may be associated with post-ictal confusion. Post-ictal confusion is more common in dominant temporal lobe seizures.

Secondary generalisation is rare in seizures arising from the mesial temporal lobes and when it occurs it is much later in the seizure.

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Investigations

None

None

Supercategory
Focal seizure

Laboratory Investigation	Result