ABSTRACT

We evaluated the value of postictal nose wiping observed during video-EEG monitoring in determining the laterality and localization of seizures.

We retrospectively reviewed 426 patients who underwent video-EEG monitoring. Patients who exhibited postictal nose wiping were evaluated with regard to interictal and ictal EEGs, neuroradiologic findings, postoperative histopathologic diagnoses, and prognosis.

Video-EEG monitoring showed temporal lobe epilepsy (TLE) in 71 patients. Eleven patients (7 females, 4 males; mean age 27.5 years; range 13 to 40 years) exhibited postictal nose wiping. Of these, 10 patients (91%) had TLE, and one patient had extratemporal lobe e p i l e p s y. Postictal nose wiping was ipsilateral to the focus in seven patients (70%) and contralateral in two patients. In one patient, it was either ipsilateral or contralateral during diverse seizures, regardleş of the ictal EEG patterns. One patient with extratemporal lobe epilepsy manifested postictal nose wiping ipsilateral to the onset of seizures. Three patients with ipsilateral postictal nose wiping underwent anterior temporal lobectomy and amigdalohipp o c a m p e c t o m y. Pathologic diagnosis was hippocampal sclerosis in two patients and astrocytoma in one patient. These three patients were seizure-free postoperatively.

Postictal nose wiping is much more common in patients with TLE than in those with extratemporal lobe epilepsy and is more often ipsilateral to the seizure focus.

Keywords: Automatism; electroencephalography; epilepsy, temporallobe/diagnosis; laterality/physiology; mucus/secretion; nasal mucosa/secretion; nose; temporal lobe/physiology; video recording