Queston #9745Note

The imaging provided is an example of left anterior temporal sharp waves. This is suggestive of left temporal lobe epilepsy. There is a phase reversal at F7. The “F” in F7 is falsely localizing to the frontal lobe to those without a great understanding of 10-20 electrode placement. F7 actually is located over the anterior temporal lobe. Typical semiology with temporal lobe seizures includes manual automatisms (lip-smacking, chewing, rubbing fingers together, or repetitive hand motions) and contralateral dystonic arm posturing. They may also experience an aura of an unusual smell or taste, but this is actually uncommon in clinical practice. Brief, myoclonic jerks can be seen in juvenile myoclonic epilepsy. Frontal lobe seizures are brief and typically present in sleep with hyperkinetic movements, hand clapping, or “bicycling” of the legs. Brief episodes of axial flexion, also known as spasms, are the classic seizure semiology of West syndrome. Hemifacial twitching, excessive salivation, and inability to speak are classically seen in patients with benign epilepsy with centrotemporal spikes.