Ictal Lateralizing Sign in Refractory Epilepsy

Researchers in Cuba and Columbia studied the frequency of ictal dorsiflexion of the great toe and its lateralizing value for the epileptogenic focus in seizures of patients consecutively evaluated at two tertiary centers for epilepsy surgery. Ictal dorsiflexion of the great toe occurred in 15 (9.1%) of 165 patients and in 25 (9.2%) of 272 seizures. The seizure localized to the temporal lobe in 22 (88%) of 25 seizures, > 50% associated with hippocampal sclerosis. Ictal toe dorsiflexion was contralateral to the epileptogenic zone in 72% of the patients with refractory partial epilepsy. [1]