Epilepsy Research 43 (2001) 125 – 133 Lateralizing value of unilateral motor and somatosensory manifestations in frontal lobe seizures J. Janszky a,b, *, A. Fogarasi a,c , H. Jokeit a , A. Ebner a,1 a Epilepsy Center Bethel, Mara Krankenhaus, Maraweg 21, Bielefeld 33617, Germany b Epilepsy Center, National Institute of Psychiatry and Neurology, 1 Neurologia, Hu ¨ o ¨so ¨lgyi ut 116, Budapest 1021, Hungary c Bethesda Children’s Hospital, Budapest, Hungary Received 10 March 2000; accepted 10 September 2000 Abstract Purpose: To evaluate the lateralizing value of unilateral somatosensory aura, unilateral tonic posturing, head version, non-forced head turning, ictal cloni, dystonic posturing, and postictal nose wiping in seizures originating in the frontal lobe. Methods: We included patients who had consecutively undergone presurgical evaluation with ictal video-EEG monitoring at our institution, had had resective epilepsy surgery involving the frontal lobe, and had remained seizure-free 1 year after operation. Twenty-seven patients aged 1 – 42 years (mean 18) met the inclusion criteria. Fifteen patients had right-sided, 12 patients had left-sided epileptogenic regions. Seizures recorded during EEG-video monitoring were re-evaluated by two investigators in order to identify lateralization signs in frontal lobe seizures. One of the investigators was blind to patients’ clinical data. Results: We analyzed 153 seizures of 27 patients. The most common unilateral phenomenon was the unilateral tonic posturing occurring in 48% of all the patients and in 25% of all seizures. Somatosensory aura and head version appeared exclusively contralateral whereas clonus occurred in 92% and unilateral tonic posturing in 89% of seizures contralateral to the epileptogenic region. Ictal non-forced head turning and postictal nose wiping showed no lateralizing significance. Dystonic posturing did not occur. Conclusions: Somatosensory aura, head version, ictal cloni, and tonic posturing are reliable lateralizing signs in frontal seizures. These signs may help in identifying the epileptogenic region during presurgical evaluation of patients suffering from frontal lobe epilepsy. © 2001 Elsevier Science B.V. All rights reserved. Keywords: Frontal lobe epilepsy; Lateralization; Video-EEG; Tonic posturing; Epilepsy surgery www.elsevier.com/locate/epilepsyres 1. Introduction The significance of ictal clinical lateralizing signs has increased during past years, adding fur- ther information to the localization of the epilep- togenic focus, which is especially useful in presurgical investigation of intractable epilepsy. * Corresponding author. Tel.: +36-1-3915435; fax: +36-1- 3915438. E-mail addresses: janszky@opni.hu (J. Janszky), ae@mara.de (A. Ebner). 1 Tel.: +49-52-11443697; fax: 49-52-11445246. 0920-1211/01/$ - see front matter © 2001 Elsevier Science B.V. All rights reserved. PII:S0920-1211(00)00186-8