Epileptic Disorders

, Volume 14, Issue 1, pp 32–40 | Cite as

Clinical patterns and pathophysiology of hypermotor seizures: an ictal SPECT study

  • Hiroshi Masuda
  • Erum Shariff
  • John Tohyama
  • Hiroatsu Murakami
  • Shigeki Kameyama
Original Article


Hypermotor seizures (HMS) can include different forms of hypermotor behaviour due to various mechanisms associated with generation of ictal automatisms. Despite the varied location of seizure onset, similar semiologic features during seizures may exist. Ictal single-photon emission tomography (SPECT) apparently reflects not only the origin of epileptic discharge but also the spread to adjacent cortical areas. Taking this benefit of SPECT studies into account, preoperative SPECT results from 13 patients with HMS who underwent epilepsy surgery were analysed. The radioisotope 99mTc-ECD was injected in all patients within five seconds after seizure onset. Group analysis was performed with statistical parametric mapping (SPM) of paired ictal-interictal SPECTs in order to identify regions of significant ictal hyperperfusion. Hyperperfused regions with a corrected cluster-level significance p-value of <0.002 were considered significant. Seizure onset at implanted subdural electrodes was defined as the epileptic focus in 12 of 13 patients. Two patterns were recognized: HMS-1 with marked agitation and HMS-2 with mild agitation. Ictal hyperperfusion images revealed significant hyperperfusion in the anterior cingulate cortex, orbito-frontal gyrus, lentiform nucleus, midbrain and pons. These hyperperfused areas represent the symptomatogenic zone which was different from the epileptogenic zone, asconfirmedby the favourable outcomes after surgical resection. The present findings suggest that a network, including frontal and possibly extrafrontal brainstem and limbic structures, is involved in the genesis of the complex epileptic manifestations of HMS. Moreover, ictal SPECT analysed by SPM is a useful method for studying the neural networks of different types of seizures.

Key words

anterior cingulate cortex frontal lobe epilepsy hypermotor seizures statistical parametric mapping (SPM) symptomatogenic zone 


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Copyright information

© John Libbey Eurotext and Springer 2012

Authors and Affiliations

  • Hiroshi Masuda
    • 1
  • Erum Shariff
    • 1
    • 3
  • John Tohyama
    • 2
  • Hiroatsu Murakami
    • 1
  • Shigeki Kameyama
    • 1
  1. 1.Department of NeurosurgeryNishi-Niigata Chuo National HospitalNiigataJapan
  2. 2.Department of PediatricsNishi-Niigata Chuo National HospitalNiigataJapan
  3. 3.Department of Functional Neurosurgery, Epilepsy CentreNishi-Niigata Chuo National HospitalNiigata City, NiigataJapan

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