Localizing and lateralizing value of behavioral change in childhood partial seizures

OBJECTIVE: To describe clinical characteristics as well as localizing and lateralizing value of behavioral change (BC) at the onset of childhood seizures. METHODS: Five hundred forty-one videotaped seizures of 109 consecutive patients < or = 12 years with partial epilepsy and postoperatively seizure-free outcome were analyzed. Behavioral change (the first clinical feature of a certain seizure with a sudden change in the child's behavior) was evaluated by two independent investigators. RESULTS: Thirty-three (30%) patients showed BC at least once during their seizures. Behavioral changes appeared in arrestive form in 19 and with affective activities in 18 children; four patients produced both kinds of BCs, separately. Arrest-type BC happened in 16 of 50 children with right- and 3 of 59 patients with left-sided seizure onset zone (p < 0.001). Affective-type BC was observed in 17 of 67 temporal lobe epilepsy patients while it happened in only 1 of 42 children with extratemporal lobe epilepsy (p = 0.001). CONCLUSIONS: Arrest-type BC lateralizes to the right hemisphere, while affective-type BC localizes to the temporal lobe in childhood partial seizures. Type of BCs can add important information to the presurgical evaluation of young children with refractory partial epilepsy.