The underlying pathophysiology of ictal dystonia in temporal lobe epilepsy

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Abstract
Background: Unilateral dystonic posturing of limbs occurs frequently in medial temporal lobe epilepsy (MTLE) but its underlying anatomic basis is still unknown. Objective: To investigate the pathophysiology of dystonic posturing, we examined the relation between the occurrence of dystonia and interictal cerebral metabolic abnormalities using fluorodeoxyglucose (FDG)-PET in MTLE patients. Methods: Video recordings of 30 patients with documented MTLE were reviewed to assess the presence of ictal dystonic posturing. Interictal FDG-PET was performed in all patients. Results: Eighteen patients exhibited dystonic posturing-contralateral to the seizure focus in 16 cases, bilateral in one, and ipsilateral in one. Dystonia was statistically associated with more severe hypometabolism in the striatal and in the orbitofrontal regions ipsilateral to the seizure focus. Conclusion: Hypometabolism observed in the striatal region of patients with ictal dystonic posturing suggests that the basal ganglia are involved in the generation of ictal dystonic posturing in MTLE.