How are automatisms characterized in complex partial seizures (focal impaired awareness seizures)?

Updated: Jun 03, 2019
  • Author: Elizabeth Carroll, DO; Chief Editor: Selim R Benbadis, MD  more...
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Automatisms are nonpurposeful, stereotyped, and repetitive behaviors that commonly accompany focal impaired awareness seizures (in the semiologic classification, they define automotor seizures). The behavior is inappropriate for the situation. Patients are usually amnestic to their automatisms. Verbal automatisms range from simple vocalizations, such as moaning, to more complex, comprehensible, stereotyped speech.

The most common automatisms, at least in temporal lobe epilepsy, are oral (eg, lip smacking, chewing, swallowing) and manual (eg, picking, fumbling, patting [2] ). Unilateral manual automatisms accompanied by contralateral arm dystonia usually indicates seizure onset from the cerebral hemisphere ipsilateral to the manual automatisms.

Automatisms can also be more elaborate, coordinated movements involving bilateral extremities. Examples of complex motor automatisms are cycling movements of the legs and stereotyped swimming movements. Bizarre automatisms, such as alternating limb movements, right-to-left head rolling, or sexual automatisms, may occur with frontal lobe seizures.

Automatisms may also occur during nonepileptic states of confusion (eg, metabolic encephalopathy), after ictus, and during absence seizures, especially when prolonged.

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