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Ictal kissing (IK) is a rare type of automatism observed during epileptic seizures. Despite its uncommon occurrence, understanding the underlying mechanisms, the role of emotions, and the level of consciousness during seizures with IK is essential in providing a comprehensive understanding of epilepsy. We describe five cases (.13%) of IK after performing a retrospective analysis of 3794 long-term, ictal video-EEGs from an epilepsy monitoring unit in Mumbai, India. Our patients with drug-resistant epilepsy showed IK had a wide epileptogenic zone. We discuss the current hypotheses on the mechanisms behind IK, the involvement of temporal lobe structures, and the implications of awareness during seizures. The review concludes by suggesting future directions for research to elucidate the complex phenomenon of IK further., (© 2024 International League Against Epilepsy.)

Oral automatism (OA) and manual automatism (MA) are common signs during initiation of temporal seizures. However, the precise symptomatogenic zones for OA and MA remains largely unclear. In this study, we presented a case of intractable frontal lobe epilepsy (FLE) in which the patient received intracranial EEG monitoring with subdural electrodes. During electrical stimulation of a grid contact located over the right pars opercularis cortex, OA and contralateral MA were observed unexpectedly without afterdischarges (ADs) or with brief ADs detected in the adjacent contacts. This case suggested that the pars opercularis cortex might play an important role in generating OA. In addition, our data implied that the symptomatogenic zone for MA might locate contralaterally to symptomatic hand., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Automatisms are frequently encountered during video-monitoring of patients with focal epilepsy in the EMU and generally thought to have a low lateralizing value in isolation. Rhythmic ictal nonclonic hand (RINCH) motions have been described in small series as a potentially lateralizing semiologic sign. We aimed to expand on prior work and determine the prevalence, characteristics, and lateralizing value of RINCH motions in general epilepsy monitoring unit (EMU) population with focal epilepsy., Methods: All patients with recorded seizures in the EMU were included in our database search. Search was performed to identify seizures with reported RINCH motions. Both electroencephalography (EEG) and video of identified seizures were reviewed., Results: We identified RINCH motions in 131 seizures in 71 patients. Overall seizure localization was temporal in 57 patients, frontotemporal in 3 patients, and extratemporal in 7 patients. We estimated RINCH motions to occur in 8.5% of EMU patients with recorded seizures. The most common RINCH motions in descending order were as follows: hand opening and closing, finger rubbing, milking motions, finger flexion/extension, and pill rolling. The mean RINCH motion latency from seizure onset was 34.48 s in temporal lobe epilepsy and 10.31 s in frontal lobe epilepsy. The RINCH motions were contralateral to seizure onset in 61 of 65 (93.8%) with lateralized seizure onset. Dystonic posturing was present in 43% of seizures with RINCH motions., Conclusion: The RINCH motions are a common sign in focal seizures and should be distinguished from other types of manual automatism as they carry a strong lateralizing value., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose. The authors confirm that they have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Phenotypical study was carried out in rats with pendulum movements. The animals exhibited a high level of abortive seizures in response to audiogenic stimuli and longer postictal catalepsy in comparison with those in Wistar population. Seizure severity positively correlated with the duration of poststimulus catalepsy (r=0.90). High aggressiveness towards humans, the absence of BP elevation in stress, lower body weights, and lower weights of the kidneys and spleen in PM rats are considered concomitant traits. Correlations were detected between startle-1 and BP in rats with pendulum movements (r=0.70) and between startle-10 and BP in narcotized Wistar rats (r=-0.0.71). The newly described signs in rats with pendulum movements did not contradict the signs of the focal seizure model with typical automatisms in humans.

Lower limb automatism has not been known well in temporal lobe epilepsy (TLE) patients. This study investigated the distribution of risk factors, EEG features, and pathology types in surgically treated TLE patients. We also made a comparison of this group to surgically treated TLE patients with isolated hand automatism. Twenty TLE patients with lower limb automatism (Group 1) and 20 TLE patients with isolated hand automatisms (Group 2) of similar age/sex distribution were enrolled in our study. Male/female ratio was 14/6 in both groups. Demographical characteristics, risk factors, pathology types and EEG features were compared between two groups. 15 and 8 patients out of Group 1 (75%) and Group 2 (40%) respectively, were undergone right-sided surgery. Ipsilateral lower limb automatism was seen in 80% of patients. The age of epilepsy onset was earlier in patients with lower limb automatism (p = 0.02). There was no significant difference between the groups in terms of the risk factors and other demographical characteristics. Although, EEG features were not different, onset of ictal EEG changes in the first 10 seconds were seen less frequently in Group 1(6 vs 9 patients) (p = 0.31). Hippocampal sclerosis as a pathology type was detected in 11 patients (55%) of Group 1, whereas in 16 patients (80%) of Group 2. TLE patients with lower limb automatism have an earlier age of epilepsy onset and the onset of ictal EEG changed in the first 10 seconds of clinical seizure and pure HS pathology was rarer than in TLE patients with hand automatisms. Further studies are needed to shed more light on the pathophysiology of lower extremity automatisms in TLE patients., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

When performing pre-surgical evaluation of patients with refractory epilepsy, the analysis of seizure semiology is one of the key elements used to generate a hypothesis about the location of the epileptogenic zone. Ictal kissing is a very rarely observed ictal automatism described in patients with temporal lobe epilepsy. We present a 62-year-old man who was referred to our epilepsy centre for comprehensive evaluation. During prolonged video-EEG monitoring, six focal-onset hyperkinetic seizures were registered. In five seizures, the patient repeatedly produced sonorous kisses "into the air". Initial ictal EEG pattern consisted of rhythmic theta or alpha activity at the right fronto-polar and fronto-medial electrodes. MRI depicted focal cortical dysplasia located in the right prefrontal medial cortex. This case suggests that ictal kissing can also occur in the setting of right frontal lobe epilepsy; we therefore believe that this observation expands the anatomo-clinical correlation for this rare ictal automatism. [Published with video sequences].

Objectives : To evaluate clinical, electrophysiological, and neuroradiological factors which correlate with the prognosis in patients with mesial temporal lobe epilepsy (MTLE). Methods : This was a single-center prospective outcome study in patients with MTLE. The patients' family history, clinical characteristics, neurophysiological data (electroencephalography - EEG), neuroimaging, antiepileptic therapy, and outcome were collected and analyzed. The population was divided into four groups depending on the frequency of the seizures when they attended their last follow up. All variables and outcome measures were compared between the four groups. Results : In total 83 consecutive patients were included within the four groups. Group 1 (seizure-free) consisted of 7 patients, (9%), Group 2 (rare seizures) consisted of 15 patients (18%), Group 3 (often seizures) consisted of 30 patients (36%), and Group 4 (very often seizures) consisted of 31 patients (37%). The groups did not differ significantly in demographic characteristics. There was a strong positive correlation between resistance to therapy and sleep activation on EEG (p = 0.005), occurrence of focal to bilateral seizures (p = 0.007), automatisms (p = 0.004), and the number of previously used antiepileptic drugs (AEDs) (p = 0.002). There was no association between febrile convulsions (FC), hippocampal sclerosis (HS), and the outcome that was found. Conclusion : MTLE is a heterogeneous syndrome. Establishing the factors responsible for, and associated with, drug resistance is important for optimal management and treatment, as early identification of drug resistance should then ensure a timely referral for surgical treatment is made. This prospective study shows that sleep activation on EEG, ictal automatisms, occurrence of focal to bilateral tonic-clonic seizures, and increased number of tried AEDs are negative prognostic factors.

During seizures, a myriad of clinical manifestations may occur. The analysis of these signs, known as seizure semiology, gives clues to the underlying cerebral networks involved. When patients with drug-resistant epilepsy are monitored to assess their suitability for epilepsy surgery, semiology is a vital component to the presurgical evaluation. Specific patterns of facial movements, head motions, limb posturing and articulations, and hand and finger automatisms may be useful in distinguishing between mesial temporal lobe epilepsy (MTLE) and extratemporal lobe epilepsy (ETLE). However, this analysis is time-consuming and dependent on clinical experience and training. Given this limitation, an automated analysis of semiological patterns, i.e., detection, quantification, and recognition of body movement patterns, has the potential to help increase the diagnostic precision of localization. While a few single modal quantitative approaches are available to assess seizure semiology, the automated quantification of patients' behavior across multiple modalities has seen limited advances in the literature. This is largely due to multiple complicated variables commonly encountered in the clinical setting, such as analyzing subtle physical movements when the patient is covered or room lighting is inadequate. Semiology encompasses the stepwise/temporal progression of signs that is reflective of the integration of connected neuronal networks. Thus, single signs in isolation are far less informative. Taking this into account, here, we describe a novel modular, hierarchical, multimodal system that aims to detect and quantify semiologic signs recorded in 2D monitoring videos. Our approach can jointly learn semiologic features from facial, body, and hand motions based on computer vision and deep learning architectures. A dataset collected from an Australian quaternary referral epilepsy unit analyzing 161 seizures arising from the temporal (n = 90) and extratemporal (n = 71) brain regions has been used in our system to quantitatively classify these types of epilepsy according to the semiology detected. A leave-one-subject-out (LOSO) cross-validation of semiological patterns from the face, body, and hands reached classification accuracies ranging between 12% and 83.4%, 41.2% and 80.1%, and 32.8% and 69.3%, respectively. The proposed hierarchical multimodal system is a potential stepping-stone towards developing a fully automated semiology analysis system to support the assessment of epilepsy., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Epilepsy with myoclonic absences is a rare generalized epilepsy syndrome with distinctive seizures. Two unrelated children had mild developmental impairment and onset of myoclonic-absences at 3 and 8 years. Seizures were characterized by bilateral 3 Hz myoclonic jerks superimposed on tonic abduction of the upper limbs. Events lasted 10-60 s, and complex gestural automatisms were often observed; in one case, a boy undid his seatbelt and attempted to exit a moving vehicle. Post-ictally, both children immediately regained awareness without recollection of their actions. Ictal EEGs showed 3 Hz generalized spike-wave. Complex automatisms have not been described in myoclonic absence seizures. This generalized seizure type can be confused with focal seizures when these ictal behaviours occur., (Copyright © 2017 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.)

Objectives: Genital automatisms (GAs) are uncommon clinical phenomena of focal seizures. They are defined as repeated fondling, grabbing, or scratching of the genitals. The aim of this study was to determine the lateralizing and localizing value and associated clinical characteristics of GAs., Methods: Three hundred thirteen consecutive patients with drug-resistant seizures who were referred to our tertiary center for presurgical evaluation between 2009 and 2016 were investigated. The incidence of specific kinds of behavior, clinical semiology, associated symptoms/signs with corresponding ictal electroencephalography (EEG) findings, and their potential role in seizure localization and lateralization were evaluated., Results: Fifteen (4.8%) of 313 patients had GAs. Genital automatisms were identified in 19 (16.4%) of a total 116 seizures. Genital automatisms were observed to occur more often in men than in women (M/F: 10/5). Nine of fifteen patients (60%) had temporal lobe epilepsy (right/left: 4/5) and three (20%) had frontal lobe epilepsy (right/left: 1/2), whereas the remaining two patients could not be classified. One patient was diagnosed as having Rasmussen encephalitis. Genital automatisms were ipsilateral to epileptic focus in 12 patients and contralateral in only one patient according to ictal-interictal EEG and neuroimaging findings. Epileptic focus could not be lateralized in the last 2 patients. Genital automatisms were associated with unilateral hand automatisms such as postictal nose wiping or manual automatisms in 13 (86.7%) of 15 and contralateral dystonia was seen in 6 patients. All patients had amnesia of the performance of GAs., Conclusion: Genital automatisms are more frequent in seizures originating from the temporal lobe, and they can also be seen in frontal lobe seizures. Genital automatisms seem to have a high lateralizing value to the ipsilateral hemisphere and are mostly concordant with other unilateral hand automatisms. Men exhibit GAs more often than women., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: It is well known that sleep-related motor seizures can originate from the temporal lobe. However, little is known about the clinical features of minor motor manifestations during sleep in patients with temporal lobe epilepsy. The main objective of our study was to verify the existence of minor motor events during sleep in patients with mesial temporal lobe epilepsy (MTLE) and to define their clinical features and electroencephalography (EEG) correlations., Methods: We enrolled in the study patients with diagnosis of symptomatic MTLE and a group of healthy controls. All patients and controls underwent long-term video -EEG monitoring, including at least one night of nocturnal sleep. We analyzed all the movements recorded during nocturnal sleep of patients and controls and their electroencephalographic correlations., Results: We analyzed the nocturnal sleep of 15 patients with symptomatic MTLE (8 males and 7 females; mean age ± standard deviation [SD]31.8 ± 14.9 years) and of 15 healthy controls (6 males and 9 females; mean age ± SD 32.8 ± 11.2 years). The analysis of movements during sleep revealed significant differences between groups, with the patients presenting significantly more movements in sleep than healthy controls (56.7 ± 39.2 vs. 15 ± 6.1; p < 0.001) with significant differences regarding oroalimentary automatisms, limb dystonia, straightening movements and gestural automatisms. EEG analysis showed that the proportion of movements preceded by EEG abnormalities was significantly higher in patients than in controls (57.8 ± 35.9 movements vs. 16.6 ± 13.4 movements; p < 0.001)., Significance: The results of our study demonstrated the presence of minor motor events during sleep in patients with MTLE, suggesting an epileptic origin of these episodes. The study of nocturnal sleep in MTLE patients is useful in helping the clinicians in the diagnostic and therapeutic workup of these patients., (Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.)

Research reveals improvements in postural control when focus is placed on movement effects rather than movement production, and further improvements during the performance of a concurrent cognitive task. It has yet to be determined if these changes are due to the use of an ankle stiffening strategy or to the use of more automatic postural control processes. The objectives of the present study were to replicate the effect of attentional focus and cognitive tasks on postural control and to test that no change occurs in lower leg muscle activity in these conditions. Twenty five healthy young adults (20.7±2.76years, 10 male) were asked to stand still while performing various tasks: baseline standing, internally focusing on minimizing movement of the ankles, externally focusing on minimizing movement of an apparatus placed on their ankle joint, and two cognitive tasks consisting of counting and simultaneously summing one or two single digits in a series of three-digit numbers. Compared to baseline and internal focus, sway decreased in external focus conditions and decreased further in cognitive task conditions. Furthermore, sway velocity increased in cognitive task conditions and sway frequency increased in the medial-lateral direction in the more difficult cognitive task. Finally, no effect of condition was found on muscle activity around the ankle joint. Collectively, the findings lend support to the hypothesis that changes in postural control were the result of an automatic type of postural control rather than due to stiffening occurring at the ankle joint., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Dancing is a very rare seizure semiology, and has only few case reports so far. Moreover, no case regarded as dancing with both description and video was presented., Case Presentation: A 42-year-old woman with medical intractable epilepsy showed a typical semiology of right temporal lobe epilepsy: right hand automatism and ictal speech. The following semiology, appeared during ictal and post-ictal stage, was complex, rhythmical and sequential movement. It was enough to be called dancing., Conclusions: We hereby report the most plausible dancing in the ictal and post-ictal state, documented by simultaneous video and electroencephalography.

Purpose: The study aimed to describe the electroclinical features of ictal kissing, an unusual behavior that may occur during focal seizures., Method: Twenty-five patients collected from four epilepsy centers and previously published reports were reviewed for their demographic, clinical, and electrophysiological features., Results: Sixteen of 25 patients were female. The mean age was 32.9 years (9.9-51 years) and the average age at seizure onset was 14.5 years. All seizures were localized to the temporal lobe (TL) and lateralized to right side in 17 patients, left side in 2 patients, and unclear in 6 patients. A total of 55 ictal video electroencephalograms (EEGs) were analyzed. There were other symptoms such as speaking, spitting, hugging, and oral and upper-extremity automatisms along with different types of ictal kissing behavior during the seizures. The median duration of all seizures was 106.7±73.73s. Kissing occurred at a median time of 71s (1-95s) after the onset of seizure, and ictal epileptiform discharges usually involved TL during kissing episode., Conclusion: Ictal kissing is mainly associated with right TL and female gender, although association with left TL may also occurs, possibly related to the circuits involving temporo-insular structures., (Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Objective: There is increasing evidence to suggest that developmental dyslexia (DD) and developmental coordination disorder (DCD) actually form part of a broader disorder. Their frequent association could be justified by a deficit of the procedural memory system, that subtends many of the cognitive, motor and linguistic abilities that are impaired in both DD and DCD. However, studies of procedural learning in these two disorders have yielded divergent results, and in any case no studies have so far addressed the issue of automatization (dual-task paradigm)., Methods: We administered a finger tapping task to participants aged 8-12 years (19 DCD, 18 DD, and 22 with both DD and DCD) to explore procedural learning and automatic movements in these three groups of children, comparing motor performances at the prelearning stage, after 2 weeks of training, and in a post-training dual-task condition., Results: First, results indicated that all the children were able to learn a sequence of movements and even automatize their movements. Second, they revealed between-groups differences in procedural/automatization learning abilities, setting the DCD group apart from the other two. Third, contrary to our expectations concerning comorbidity, they suggested that the DD+DCD association does not have an additional impact on behavioral performances., (Copyright © 2015 Elsevier B.V. All rights reserved.)

The growing evidence of Neuroscience leads to a better understanding of cerebral processes in cases of acute or chronic intake of psychotropic substances (ps). Predominantly, structures of the "reward system" contributed to the development of addiction. Chronic consumption of ps provides changing in brain equilibrium and leads to adaptations in the brain architecture. In this article, the complex responses of neurons and neuronal networks are presented in cases of chronic intake of ps. The alterations affect the cognitive, emotional and behavioral processings and influence learning and stress regulation. In summary, all cerebral adaptations are integrated in a complex model of biological, psychological and social factors and therefore, addiction arises as a consequence of combination of individual protecting and risk factors.

Background and Objectives: Cognitive models propose that depression is caused by dysfunctional schemas that endure beyond the depressive episode, representing vulnerability factors for recurrence. However, research testing negative cognitions linked to dysfunctional schemas in formerly depressed individuals is still scarce. Furthermore, negative cognitions are presumed to be linked to biases in recalling negative self-referent information in formerly depressed individuals, but no studies have directly tested this association. In the present study, we evaluated differences between formerly and never-depressed individuals in several experimental indices of negative cognitions and their associations with the recall of emotional self-referent material., Methods: Formerly (n = 30) and never depressed individuals (n = 40) completed measures of explicit (i.e., scrambled sentence test) and automatic (i.e., lexical decision task) processing to evaluate negative cognitions. Furthermore participants completed a self-referent incidental recall task to evaluate memory biases., Results: Formerly compared to never depressed individuals showed greater negative cognitions at both explicit and automatic levels of processing. Results also showed greater recall of negative self-referent information in formerly compared to never-depressed individuals. Finally, individual differences in negative cognitions at both explicit and automatic levels of processing predicted greater recall of negative self-referent material in formerly depressed individuals., Limitations: Analyses of the relationship between explicit and automatic processing indices and memory biases were correlational and the majority of participants in both groups were women., Conclusions: Our findings provide evidence of negative cognitions in formerly depressed individuals at both automatic and explicit levels of processing that may confer a cognitive vulnerability to depression., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

An external focus of attention has been shown to result in superior motor performance compared to an internal focus of attention. This study investigated whether this is due to enhanced levels of movement automatization, as predicted by the constrained action hypothesis (McNevin, Shea, & Wulf, 2003). Thirty healthy participants performed a cyclic one-leg extension-flexion task with both the dominant and non-dominant leg. Focus of attention was manipulated via instructions. The degree of automatization of movement was assessed by measuring dual task costs as well as movement execution parameters (i.e., EMG activity, movement fluency, and movement regularity). Results revealed that an external focus of attention led to significantly better motor performance (i.e., shorter movement duration) than an internal focus. Although dual task costs of the motor task did not differ as a function of attentional focus, cognitive dual task costs were significantly higher when attention was directed internally. An external focus of attention resulted in more fluent and more regular movement execution than an internal focus, whereas no differences were found concerning muscular activity. These results indicate that an external focus of attention results in more automatized movements than an internal focus and, therefore, provide support for the constrained action hypothesis., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Much social-cognitive processing is believed to occur automatically; however, the relative automaticity of the brain systems underlying social cognition remains largely undetermined. We used functional MRI to test for automaticity in the functioning of two brain systems that research has indicated are important for understanding other people's behavior: the mirror neuron system and the mentalizing system. Participants remembered either easy phone numbers (low cognitive load) or difficult phone numbers (high cognitive load) while observing actions after adopting one of four comprehension goals. For all four goals, mirror neuron system activation showed relatively little evidence of modulation by load; in contrast, the association of mentalizing system activation with the goal of inferring the actor's mental state was extinguished by increased cognitive load. These results support a dual-process model of the brain systems underlying action understanding and social cognition; the mirror neuron system supports automatic behavior identification, and the mentalizing system supports controlled social causal attribution.

Recent findings suggest that number processing is intimately linked to space and attention orienting processes. For example, processing numbers induces shifts of spatial attention, with small numbers causing leftward shifts and large numbers causing rightward shifts, suggesting that number magnitude might be represented on a left-to-right mental number line. However, whether inducing spatial attention shifts would in turn influence number production, and whether such influence, if observed, would be restricted to the left-to-right orientation or would extend to an up-to-down orientation in space, remains a matter of debate. The present study assessed whether observing gaze movements, known to moderate spatial attention, was able to influence a random number generation task, and how different directions of the gaze moderated this influence. Participants were asked to randomly produce a number between 1 and 10 after they observed either a horizontal or a vertical eye gaze, or after they observed color changes as a control condition. The results revealed that number production was influenced by the prior presentation of specific gaze changes. Observing leftward or downward gaze led participants to produce more small than large numbers, whereas observing gaze oriented rightward and upward or observing color changes did not influence the magnitude of the numbers produced. These results show that the characteristics of the observed gaze changes primed number magnitude, but that this only held true for some movements, and these were not restricted to the left-to-right axis.

Study Objectives: To describe zolpidem-associated complex behaviors, including both daytime automatisms and sleep-related parasomnias., Methods: A case series of eight clinical patients and six legal defendants is presented. Patients presented to the author after an episode of confusion, amnesia, or somnambulism. Legal defendants were being prosecuted for driving under the influence, and the author reviewed the cases as expert witness for the defense. Potential predisposing factors including comorbidities, social situation, physician instruction, concomitant medications, and patterns of medication management were considered., Results: Patients and defendants exhibited abnormal behavior characterized by poor motor control and confusion. Although remaining apparently interactive with the environment, all reported amnesia for 3 to 5 hours. In some cases, the episodes began during daytime wakefulness because of accidental or purposeful ingestion of the zolpidem and are considered automatisms. Other cases began after ingestion of zolpidem at the time of going to bed and are considered parasomnias. Risk factors for both wake and sleep-related automatic complex behaviors include the concomitant ingestion of other sedating drugs, a higher dose of zolpidem, a history of parasomnia, ingestion at times other than bedtime or when sleep is unlikely, poor management of pill bottles, and living alone. In addition, similar size and shape of two medications contributed to accidental ingestion in at least one case., Conclusions: Sleep driving and other complex behaviors can occur after zolpidem ingestion. Physicians should assess patients for potential risk factors and inquire about parasomnias. Serious legal and medical complications can occur as a result of these forms of automatic complex behaviors.

The human stress hormone cortisol may facilitate effective coping after psychological stress. In apparent agreement, administration of cortisol has been demonstrated to reduce fear in response to stressors. For anxious patients with phobias or posttraumatic stress disorder this has been ascribed to hypothetical inhibition of retrieval of traumatic memories. However, such stress-protective effects may also work via adaptive regulation of early cognitive processing of threatening information from the environment. This paper selectively reviews the available literature on effects of single cortisol administrations on affect and early cognitive processing of affectively significant information. The concluded working hypothesis is that immediate effects of high concentration of cortisol may facilitate stress-coping via inhibition of automatic processing of goal-irrelevant threatening information and through increased automatic approach-avoidance responses in early emotional processing. Limitations in the existing literature and suggestions for future directions are briefly discussed., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Purpose: To evaluate the significance of lateralization of ictal upper limb automatisms in patients with temporal lobe epilepsy (TLE)., Methods: Ictal upper limb automatisms of 28 patients with temporal lobe epilepsy were quantified. Duration of automatisms in relation to total seizure duration, movement speed, extent, length, and predominant frequencies of the movements were analyzed for both upper extremities separately and compared to the lateralization of the epileptogenic temporal lobe., Results: Predominantly ipsilateral upper limb automatisms were more common (n = 19) than predominantly contralateral automatisms (n = 9). The duration of ictal ipsilateral upper limb automatisms was significantly longer than the duration of contralateral automatisms (ipsilateral automatisms: 29 of 86 s total seizure duration; contralateral automatisms: 19 of 110 s total seizure duration; p = 0.048). Patients with ipsilateral upper limb automatisms had more often exclusively unitemporal interictal epileptiform discharges (IEDs) (84.2%) than patients with contralateral automatisms (11.1%; p < 0.001). The positive predictive value (PPV) of the combination of these parameters is 84.2%. Excellent surgical seizure outcome was better in patients with ipsilateral upper limb automatisms (77.8%) compared to those with contralateral automatisms (20%) (p = 0.09). The quantitative analysis of movement extent, average speed, maximum speed, and repetition rate of ipsilateral and contralateral upper limb automatisms did not show any statistically significant difference in this patient sample., Conclusion: The lateralization of upper limb automatisms in TLE has a good lateralizing value if the lateralization of IEDs were also taken into consideration., (Wiley Periodicals, Inc. © 2010 International League Against Epilepsy.)

One of the most unusual ictal automatisms reported is whistling. Two patients, both males, are described who had prominent whistling as a component of their complex partial seizures. Both had temporal lobe epilepsy with resolution of seizures after a temporal lobectomy. Ictal whistling appears to localize to the temporal lobe but may not be useful for lateralization.

Purpose: Upper extremity automatisms are considered to be an ipsilateral seizure lateralizing sign in temporal lobe epilepsy (TLE). Herein we describe different types of contralateral upper extremity automatisms (CUEAs)., Methods: One hundred ninety-three video-(electroencephalography) EEG recordings of 59 patients were reviewed. Other than two patients who refused surgery, all patients underwent standardized temporal lobectomy with favorable postoperative outcome. Fifty-seven seizures of 21 patients were selected with CUEAs. We evaluated their electroclinical characteristics and their relation to other lateralizing motor symptoms., Results: Two types of CUEAs were observed. Nonmanipulative, proximal upper extremity automatisms were seen unilaterally and contralaterally to the operated side. These automatisms were rhythmic; repetitive; and often occurred with a circulatory component resembling waving, flaunting, circling, or stirring movements. They occurred in 29 seizures (15%) of 11 patients (19%), in most seizures in the first half of the seizure, and never postictally, in various time sequences and combined with dystonic/tonic posturing or limb immobility. Manipulative/distal type of CUEAs occurred in 11 seizures (6%) of 7 patients (12%) on the unexpected contralateral side. These CUEAs were seen in all phases of the seizures, including in the postictal state., Discussion: Nonmanipulative unilateral proximal upper extremity automatism is a reliable lateralizing sign to the contralateral hemisphere in TLE. This sign may be pathophysiologically related to dystonic/tonic posturing. Manipulative distal automatisms have less lateralizing value.

Oro-alimentary automatisms such as chewing movements, lip-smacking, repeated snuffling, swallowing and retching have been reported with seizures usually of temporal lobe origin. Throat clearing, usually along with other vegetative signs, has been reported in patients with temporal and rarely extra-temporal lobe epilepsy. We report a case of a 93-year-old woman admitted with acute right temporo-occipital stroke. Repeated throat clearing episodes raised suspicion for complex partial seizures. Video-EEG recording confirmed frequent right hemispheric focal seizures originating from the right posterior temporal area concordant with her cortical stroke. The value of throat clearing as a sign of complex partial seizures of temporal lobe origin and its lateralizing and localizing value is discussed.

Dopamine is an essential neurotransmitter for many brain functions, and its dysfunction has been implicated in both neurological and psychiatric disorders. Parkinson's disease is an archetypal disorder of dopamine dysfunction characterised by motor, cognitive, behavioural, and autonomic symptoms. While effective for motor symptoms, dopamine replacement therapy is associated not only with motor side-effects, such as levodopa-induced dyskinesia, but also behavioural side-effects such as impulse control disorders (eg, pathological gambling and shopping, binge eating, and hypersexuality), punding (ie, abnormal repetitive non-goal oriented behaviours), and compulsive medication use. We review clinical features, overlapping molecular mechanisms, and a specific cognitive mechanism of habit learning that might underlie these behaviours. We integrate these mechanisms with the emerging view of the basal ganglia as a distributive system involved in the selection and facilitation of movements, acts, and emotions.

A combination of temporo-limbic hyperperfusion and extratemporal hypoperfusion was observed during complex partial seizures (CPS) in temporal lobe epilepsy (TLE). To investigate the clinical correlate of perfusion changes in TLE, we analyzed focal seizures of increasing severity using voxel-based analysis of ictal SPECT. We selected 26 pre-operative pairs of ictal-interictal SPECTs from adult mesial TLE patients, seizure-free after surgery. Ictal SPECTs were classified in three groups: motionless seizures (group ML, n=8), seizures with motor automatisms (MA) without dystonic posturing (DP) (group MA, n=8), and seizures with DP with or without MA (DP, n=10). Patients of group ML had simple partial seizures (SPS), while others had CPS. Groups of ictal-interictal SPECT were compared to a control group using statistical parametric mapping (SPM). In ML group, SPM analysis failed to show significant changes. Hyperperfusion involved the anteromesial temporal region in MA group, and also the insula, posterior putamen and thalamus in DP group. Hypoperfusion was restricted to the posterior cingulate and prefrontal regions in MA group, and involved more widespread associative anterior and posterior regions in DP group. Temporal lobe seizures with DP show the most complex pattern of combined hyper-hypoperfusion, possibly related both to a larger spread and the recruitment of more powerful inhibitory processes.

Background: Automatisms are well recognized to occur in complex partial seizures; however, their occurrence in generalized epilepsies is not always appreciated. There has been considerable debate regarding the nature, triggers, and timing of automatisms in absence seizures., Objectives: To examine the frequency and nature of automatisms in new-onset absence seizures and assess the influence of the state of arousal, provocation, age, and epilepsy syndrome on the presence and type of automatisms., Design: Analysis of absence seizures through video electroencephalogram (EEG) recordings., Setting: British Columbia's Children's Hospital, Vancouver, British Columbia, Canada., Patients: Seventy consecutive children with new-onset untreated absence seizures in idiopathic generalized epilepsy recruited between January 1, 1992, and June 30, 1997., Main Outcome Measures: Each seizure was analyzed for the presence and characteristics of automatisms. The influence of the following variables on the presence of automatisms was statistically analyzed: state of arousal (awake, drowsy, asleep), provocation (hyperventilation, photic stimulation), age, and epilepsy syndrome., Results: Automatisms occurred in 163 of 405 seizures (40%) in 53 of 70 children (76%). Automatisms were more likely in longer seizures and hyperventilation. Only 23% of spontaneous awake seizures had automatisms. Automatisms were similar for an individual child; however, automatisms were not present in all their seizures. Age, epilepsy syndrome, or state of alertness had no effect on the presence of automatisms., Conclusions: Automatisms are frequently seen during childhood absence seizures. The high frequency of automatisms during EEG recordings is predominantly due to the effect of hyperventilation. Their preponderance during longer seizures may relate to opportunity for automatisms to occur. The characteristic pattern of automatisms suggests a reactive phenomenon to internal and external stimuli.

Hypermotor seizures are considered to be characteristic of frontal lobe epilepsy, with only rare occurrence in temporal lobe epilepsy. After noting hypermotor seizures in several patients with lesions involving the pole of the temporal lobe, we investigated whether temporal pole lesions were associated with hypermotor seizures. We systematically reviewed medical records, MRI images and pathological findings in consecutive patients who underwent epilepsy surgery over the preceding 10 years in our institution and identified eight patients with temporal pole lesions and intractable complex partial seizures. We analyzed all recorded seizures for semiology, classifying seizures as hypermotor or typical "psychomotor." Four patients exhibited hypermotor seizure semiology and four patients manifested typical psychomotor seizure characteristics. In patients with hypermotor seizures, scalp EEG tended to demonstrate lateral anterior temporal ictal onset, with lesser involvement of the sphenoidal electrode, while the patients with psychomotor seizures had initial inferomesial temporal rhythmic theta activity. Two patients with hypermotor seizures had implanted frontal and temporal subdural grids demonstrating orbitofrontal spread before hypermotor behavior. Patients underwent either anterior temporal lobectomy or lesionectomy. All improved considerably, with six patients seizure-free since surgery. We conclude that hypermotor seizures occur frequently in patients with temporal pole lesions. A search for temporal pole pathology is recommended for patients with hypermotor seizures and temporal epileptiform discharges. Modification of the surgical approach to include this region should be considered in patients who exhibit hypermotor seizures.

Despite being a common sign in focal epilepsies, the exact symptomatogenic zone for oroalimentary automatisms remains largely unknown. We describe a patient with refractory complex partial seizures secondary to a right temporoparietal malformation of cortical development who underwent prolonged video/EEG monitoring with subdural electrodes. During his typical seizures, the patient manifested decreased awareness but never automatisms. However, during electrical cortical stimulation of two electrodes located over the right inferior frontal gyrus, oroalimentary automatisms with preserved consciousness were elicited, with no afterdischarges detected in the adjacent electrodes. These two electrodes were distant from the seizure onset zone and were not involved in seizure propagation. This case provides evidence that fronto-opercular cortex may be involved in the generation of oroalimentary automatisms.

All-round researches of a human being's eye movements in norm and in pathology have been carried out (1967-2006). An analysis of generating of rapid eye movements, those are saccades, has been done. A concept of automaticity of saccades has been formulated. According to the concept a saccade is generated by rhythmo-genesis type, without any external and internal stimuli in their own rhythm. The role of automaticity of saccades in the process of visual perception, and data of impairments of automaticity of saccades in pathology and in uncomfortable visual environment were show.

A biologically detailed computational model is described of how categorization judgments become automatic in tasks that depend on procedural learning. The model assumes 2 neural pathways from sensory association cortex to the premotor area that mediates response selection. A longer and slower path projects to the premotor area via the striatum, globus pallidus, and thalamus. A faster, purely cortical path projects directly to the premotor area. The model assumes that the subcortical path has greater neural plasticity because of a dopamine-mediated learning signal from the substantia nigra. In contrast, the cortical-cortical path learns more slowly via (dopamine independent) Hebbian learning. Because of its greater plasticity, early performance is dominated by the subcortical path, but the development of automaticity is characterized by a transfer of control to the faster cortical-cortical projection. The model, called SPEED (Subcortical Pathways Enable Expertise Development), includes differential equations that describe activation in the relevant brain areas and difference equations that describe the 2- and 3-factor learning. A variety of simulations are described, showing that the model accounts for some classic single-cell recording and behavioral results., (Copyright 2007 APA.)

Purpose: We systematically analyzed the lateralizing value of clinical seizure semiology in patients with frontal lobe epilepsy (FLE)., Methods: We studied the incidence, positive predictive value (PPV), and the lateralizing significance of various clinical symptoms in 228 seizures (s) of 31 patients (p) with medically refractory FLE (17 with left-sided and 14 with right-sided seizure onset). Seizures recorded during prolonged video-EEG monitoring were assessed by two independent reviewers blinded for the patient's clinical data. Analysis was performed both for patients and seizures., Results: Version [16 p (52%); PPV, 94%; p=0.001; 47 s (21%); PPV, 75%; p=0.001], unilateral clonic movements [16 p (52%); PPV, 81%; p=0.021; 32 s (14%); PPV, 81%; p=0.001], unilateral dystonic posturing [eight p (26%); PPV, 75%; p=0.289; 46 s (20%); PPV, 80%; p=0.001], unilateral tonic posturing [10 p (32%); PPV, 80%; p=0.109; 19 s (7.4%); PPV, 79%; p=0.019], and unilateral grimacing [10 p (32%); PPV, 100%; p=0.002; 19 s (8%); PPV, 100%; p=0.001] were of lateralizing significance, indicating a contralateral seizure onset. Asymmetric ending [five p (16%); PPV, 80%; p=0.375; nine s (4%); PPV, 89%; p=0.039] after secondarily generalized tonic-clonic seizures was significantly associated with an ipsilateral seizure onset. Pure ictal vocalizations occurred significantly more frequently in seizures of right hemispheric onset [13 p (42%); PPV, 62%; p=0.581; 63 s (28%); PPV, 73%; p=0. 001], whereas in individual patients, this symptom showed no lateralizing significance. The remaining clinical symptoms (figure 4 sign, unilateral hand automatisms, early head turning, postictal nose wiping, and unilateral eye blinking) were not of lateralizing significance in our patients. The results of clinical seizure lateralization corresponded with the final lateralization of the seizure-onset zone in 81% of our patients., Conclusions: Clinical seizure semiology can provide correct information on the lateralization of the seizure-onset zone in >80% of patients with medically refractory frontal lobe epilepsy.

From phenomenological and experimental perspectives, research in schizophrenia has emphasized deficits in "higher" cognitive functions, including attention, executive function, as well as memory. In contrast, general consensus has viewed dysfunctions in basic perceptual processes to be relatively unimportant in the explanation of more complex aspects of the disorder, including changes in self-experience and the development of symptoms such as delusions. We present evidence from phenomenology and cognitive neuroscience that changes in the perceptual field in schizophrenia may represent a core impairment. After introducing the phenomenological approach to perception (Husserl, the Gestalt School), we discuss the views of Paul Matussek, Klaus Conrad, Ludwig Binswanger, and Wolfgang Blankenburg on perception in schizophrenia. These 4 psychiatrists describe changes in perception and automatic processes that are related to the altered experience of self. The altered self-experience, in turn, may be responsible for the emergence of delusions. The phenomenological data are compatible with current research that conceptualizes dysfunctions in perceptual processing as a deficit in the ability to combine stimulus elements into coherent object representations. Relationships of deficits in perceptual organization to cognitive and social dysfunction as well as the possible neurobiological mechanisms are discussed.

Behavioral habits are essential to human and animal life. We consider the many ways that habits - which are normally adaptive - can be expressed as drug use behavior and addiction. Although habit theories of substance use disorders have been proposed (e.g., Tiffany, 1990), the behavioral science and underlying neurobiology of habit development, maintenance, and change is only now being studied. We first define "adapted habit." We then propose that the etiology of an adapted habit represents the combination of: (a) initial "capture" of a habit, (b) development of behavioral action schemata, and (c) an overlay of cognitive expectancies concerning aspects of the habit. This combination conspires to make an intractable adapted habit such as substance abuse and addiction. Many intractable habits change, including substance use disorders such as cigarette smoking. As part of a science of habits, we need a real understanding of how to change habits to avoid or minimize harm.

Rabbit pups display nipple-search behavior in response to maternal odor cues such as the Mammary Pheromone (MP). Here, we assessed in 3 steps whether the activity of the MP is influenced by prandial and/or rhythmic factors during early development. To address this point, the activity of the MP was tested in 690 pups varying in age (day 0, 2, 5 or 10), prandial state (sucked or un-nursed) and period of their 24-h cycle (-6 to +12 h after the daily sucking). In Experiment 1, the responsiveness of d0 pups was high and stable during the whole day, whether they are nursed or deprived of sucking. The MP activity was thus unaffected by colostrum ingestion. Experiment 2 revealed that some differences appear the next days: whereas the responsiveness of d2 pups was also very high during the 24-h cycle (>94%), it decreased in d5-d10 pups immediately after sucking (<48%), with a rapid recuperation in d5 pups. Experiment 3 showed that this postprandial drop in response to the MP disappeared in d5-d10 pups that missed the daily nursing, suggesting that it resulted from post-ingestive/post-absorptive events rather than from rhythm activity-related factors. Taken together, the results show a progressive change in the circadian dynamics of the MP-induced orocephalic response as a function of age modulated by prandial state. This indicates a transition from an automatic response to the MP to a response regulated by physiological factors associated with satiation.

Purpose: To describe a new ictal sign in temporal lobe seizures-rhythmic ictal nonclonic hand (RINCH) motions and to determine its lateralizing significance and other ictal manifestations associated with it., Methods: We identified 15 patients with temporal lobe epilepsy who demonstrated RINCH motions and reviewed video-EEG recordings of all their seizures. We analyzed the epilepsy characteristics and all clinical features of recorded seizures, with particular attention to RINCH motions., Results: RINCH motions were unilateral, rhythmic, nonclonic, nontremor hand motions. RINCH motions were usually followed by posturing, sometimes with some overlap. They involved the hand contralateral to the temporal lobe of seizure onset in 14 of 15 patients., Conclusions: RINCH motions are a distinct ictal sign that could be considered a specific type of automatism. They appear to be a lateralizing contralateral sign and are associated with dystonic posturing in temporal lobe epilepsy.

We report the case of a 49-year-old right-handed woman with brief partial seizures in which the clinical semiology was marked by an early humming automatism. MRI fusion of the registered ictal and interictal single-photon emission computed tomography (SPECT) substraction exhibited a left neural network involving lateral temporal, inferior frontal, and inferior parietal cortices.

Objectives: To analyse the lateralising value of unilateral manual automatism (UMA), its relation to contralateral dystonia and the hand by which the UMA was performed., Methods: In this retrospective study, we reviewed video recordings of 141 patients (mean age 34.1+/-10) who had consecutively undergone presurgical evaluations with ictal video-EEG recordings and high-resolution MRI, had had epilepsy surgery due to intractable medial temporal lobe epilepsy with complex partial seizures due to unilateral medial temporal lobe lesions. The video recordings were prospectively reviewed by one of the authors blinded to patient's clinical data except the diagnosis of medial temporal lobe epilepsy. Altogether 310 archived seizures were analysed., Results: Hand automatisms occurred in 86.5% of patients. UMA occurred in 53% of patients. If UMA was accompanied by contralateral hand dystonia, it had a high lateralising value to the ipsilateral epileptic focus (EF), it was ipsilateral in 85% of patients. Conversely, if UMA occurred without contralateral dystonia, it had only a limited lateralising value because it was ipsilateral to the EF in only 63% of patients. However, we found that left-sided UMA without dystonia had a high lateralising value to the left hemisphere (ipsilateral to the EF in 82%), while right-sided UMA without dystonia has practically no lateralising value., Conclusions: UMA with contralateral dystonia has a high lateralising value to the ipsilateral hemisphere. Left-sided UMA without contralateral dystonia has a lateralising value to the left hemisphere. Right-sided UMA without contralateral dystonia has no lateralising value.

We describe two cases of complex partial seizures with ictal violent movements arising from the insular cortex. The first patient, a 14-year-old girl, presented with hyperkinetic behavior such as rolling, thrashing, and pedaling, and the second case, a 38-year-old woman, had been suffering from frequent daytime hyperkinetic seizures characterized by bizarre vocalization, jumping, and violent bimanual movements. Both patients showed a slight high signal change in the right posterior ventral insular cortex in fluid-attenuated inversion recovery (FLAIR) studies involving magnetic resonance imaging, and extensive subdural electroencephalographic monitoring revealed EEG seizure onset from the temporal lobe. The posterior ventral insular and lateral temporal cortices were resected, resulting in complete seizure freedom in both cases. The histological diagnoses were focal cortical dysplasia in the first case and gliosis in the second case. There may exist a group of patients with complex partial seizures with ictal violent automatism that can be ameliorated by the resection of epileptogenic lesions in the insular cortex. Careful inspection of the insular cortex is necessary to diagnose this type of epileptic seizure.

Complex motor behaviors differing from typical automatisms were found in 12 of 502 patients with temporal lobe epilepsy. Movements involved proximal limb segments (6) or body axis (6) and were often preceded by auras and followed by automatisms. Seven of 12 patients are seizure free after surgery. The other 5 patients declined surgery.

Subjective manifestations inaugurating frontal seizures are less well known than those observed in temporal seizures. We report eleven consecutive patients who underwent surgery for premotor epilepsy. Six of them had focal cortical dysplasia. Ictal symptomatology was analysed to establish electroclinical correlations. The localisation of the epileptogenic zone was assessed by stereoelectroencephalographic studies. Subjective manifestations were described in all cases, more frequently in a sensory rather than an emotional or psychological fashion. Focal seizures limited to subjective features were recorded in two patients. In one, psychological illusions and visual hallucinations were related to the superior frontal sulcus. Another presented isolated paraesthesia in the left arm with the implication of the supplementary motor area. Electrical stimulation of an electrode located in the premotor area evoked isolated subjective manifestations in three other patients. One patient reported sensory manifestations and another, ideational manifestations. Cephalic sensations and emotional manifestations were associated in one case. Subjective manifestations were observed in all patients, and were proved to be related to a discharge restricted to the premotor area in five. These were non-specific signs, but were always the same in a given patient. Spontaneous, isolated sensations and stimulation data tended to be contradictory. This illustrates the complexity of analyzing subjective signs, as well as the complexity of the neuronal networks participating in the propagation of discharges arising in the premotor frontal area.

This article reviews lateralizing semiological signs during epileptic seizures with respect to prediction of the side of the epileptogenic zone and, therefore, presurgical diagnostic value. The lateralizing significance of semiological signs and symptoms can frequently be concluded from knowledge of the cortical representation. Visual, auditory, painful, and autonomic auras, as well as ictal motor manifestations, e.g., version, clonic and tonic activity, unilateral epileptic spasms, dystonic posturing and unilateral automatisms, automatisms with preserved responsiveness, ictal spitting and vomiting, emotional facial asymmetry, unilateral eye blinking, ictal nystagmus, and akinesia, have been shown to have lateralizing value. Furthermore, ictal language manifestations and postictal features, such as Todd's palsy, postictal aphasia, postictal nosewiping, postictal memory dysfunction, as well as peri-ictal water drinking, peri-ictal headache, and ipsilateral tongue biting, are reviewed. Knowledge and recognition of semiological lateralizing signs during seizures is an important component of the presurgical evaluation of epilepsy surgery candidates and adds further information to video/EEG monitoring, neuroimaging, functional mapping, and neuropsychological evaluation.

Ictal behavioral characteristics may provide clues in determining the nature of the epileptic focus. We defined ictal behavioral characteristics in patients with intractable temporal lobe epilepsy (TLE) who underwent anterior temporal lobectomy (ATL) and lived seizure-free for 2 years of follow-up. Video/EEG data on 282 seizures observed in 48 patients who suffered from TLE and underwent ATL were analyzed. All patients were seizure-free after surgery. We divided the patients into two groups on the basis of the pathological examination. Two hundred and two seizures in 35 patients with hippocampal sclerosis (Group 1) and eighty seizures in 13 patients with other pathological findings, such as tumors, cavernoma, and hamartoma (Group 2), were analyzed. Ictal behavior characteristics were evaluated for each of the seizures recorded in the two groups. Behavioral arrest, bilateral hand automatisms, oral and leg automatisms, and ictal aggression were significantly more frequent in Group 2 (P<0.05), whereas contralateral dystonia of the upper extremity (P<0.05), ipsilateral hand automatisms (P<0.05), ipsilateral hand automatisms in the presence of contralateral dystonia of the upper extremity (P<0.001), contralateral forced head deviation (P<0.05), and secondary generalization (P<0.05) were more significant in Group 1. There was no significant difference in vocalization and ipsilateral nonforced head deviation between the two groups (P>0.05). The number of seizures observed during ictal speech, crying, and postictal nose wiping was not large enough, so differences could not be analyzed. It was concluded that although ictal behavioral characteristics differed between the two groups, certain behavioral patterns may be helpful in differentiating between hippocampal sclerosis and other pathology.

We report a case of recurrent partial seizures that were often precipitated by looking up a flight of stairs and included spitting as well as repetitive affectionate kissing automatisms. These seizures were shown by long-term video/EEG monitoring to be of right temporal origin and completely subsided after right temporal lobectomy. This case is unique because: (1) The patient had partial rather than primarily generalized pattern-induced seizures. (2) Affectionate kissing automatisms were a part of his partial seizures and, to our knowledge, have not been reported in the literature before.

Genital and sexual manifestations represent rare clinical phenomena during or after focal seizures. The semiology of these types of automatisms is controversial. In particular, it is unclear whether temporal or frontal structures are involved in their generation and whether these clinical manifestations have a potential lateralizing value. In this view, from a population of 212 consecutive patients with drug resistant focal epilepsy referred to us for presurgical assessment, we retrospectively identified 24 patients with genital ictal manifestations. We evaluated the incidence of these behaviours, the clinical semiology, the associated symptoms/signs with the corresponding ictal EEG findings and their potential role in lateralizing the epileptogenic zone. Our results indicate that ictal genital automatisms are possible in seizures originating from temporal lobe and they cannot be attributed exclusively to frontal lobe seizures. In particular, the most frequent genital automatisms consist in subtle phenomena while hypermotoric behaviour, such as pelvic rhythmic movements are quite rare. No lateralizing value for genital automatisms was disclosed.