Automatisms with preserved responsiveness: a lateralizing sign in psychomotor seizures.

This is a report of a 1-year prospective study to investigate how often automatisms occur with preserved responsiveness in psychomotor seizures. Responsiveness is usually impaired or lost when automatisms occur during psychomotor seizures. However, there are several anecdotal reports in the literature of patients who have automatisms with preserved responsiveness (APRs). We evaluated 123 patients with temporal lobe epilepsy (57 patients [46%] left-sided, 48 patients [39%] right-sided, and 18 patients [15%] bitemporal) with video/EEG monitoring, testing responsiveness by asking the patient to respond verbally and to follow motor commands. Seven patients (5.6%) had preserved responsiveness in the presence of prominent automatisms (lip smacking, swallowing). In 15 seizures, the responsiveness was adequately tested (3.6 questions per period of automatism). Average seizure duration was 71.6 +/- 14.8 seconds (range, 45 to 100 seconds). Average duration of automatisms was 59.5 +/- 13.5 seconds (range, 40 to 80 seconds). Ictal EEG was localized over the right temporal area in nine seizures, over the right hemisphere in five, and was nonlocalizable in one seizure. APRs never occurred in left-sided psychomotor seizures and occurred in 10% of the right temporal cases. In conclusion, APRs reliably lateralized to the right side in temporal lobe epilepsy.