Genital automatisms in complex partial seizures

Universitätsklinik für Neurologie, Vienna, Austria.
Neurology (Impact Factor: 8.3). 05/1999; 52(6):1188-91. DOI: 10.1212/WNL.52.6.1188
Source: PubMed

ABSTRACT To determine which brain region is responsible for the generation of sexual automatisms.
Ninety consecutive patients with medically refractory focal epilepsy (74 with temporal lobe and 16 with frontal lobe epilepsy) referred to an epilepsy monitoring unit were studied. The occurrence of the following sexual automatisms was assessed during prolonged video-EEG monitoring: 1) repeatedly grabbing or fondling the genitals and 2) pelvic or truncal thrusting or similar movements.
Five patients repeatedly fondled or grabbed their genitals during or immediately after some of their seizures. All five had temporal lobe epilepsy, as evidenced from prolonged video-EEG monitoring, high-resolution MRI, and good to excellent outcome after epilepsy surgery. Sexual automatisms did not occur with frontal lobe epilepsy.
Sexual automatisms cannot be related exclusively to frontal lobe seizures. As previously proposed, apparently sexual hypermotoric pelvic or truncal movements are common in frontal lobe seizures, but this study suggests that discrete genital automatisms, like fondling and grabbing the genitals, are more common in seizures evolving from the temporal lobe.

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    • "For instance, temporal lobe epilepsy may induce orgasmic auras (Janszky et al., 2004; Fadul et al., 2005), while temporal lobe resection aimed to resolve the epileptic seizures frequently causes hypersexuality (Baird et al., 2002). Frontal lobe deficiency is also linked to increased sexual behaviour (Aloni & Katz, 1999), including hyperactive pelvic thrusting as a result of frontal lobe epilepsy (Leutmezer et al., 1999). In men suffering from erectile dysfunction (ED), administration of apomorphine resolved the ED and, most importantly, caused a down-regulation of activity in frontal and temporal lobes (Montorsi et al., 2003). "
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    ABSTRACT: Genital and sexual manifestations represent rare clinical phenomena during or after focal seizures. The semiology of these types of automatisms is controversial. In particular, it is unclear whether temporal or frontal structures are involved in their generation and whether these clinical manifestations have a potential lateralizing value. In this view, from a population of 212 consecutive patients with drug resistant focal epilepsy referred to us for presurgical assessment, we retrospectively identified 24 patients with genital ictal manifestations. We evaluated the incidence of these behaviours, the clinical semiology, the associated symptoms/signs with the corresponding ictal EEG findings and their potential role in lateralizing the epileptogenic zone. Our results indicate that ictal genital automatisms are possible in seizures originating from temporal lobe and they cannot be attributed exclusively to frontal lobe seizures. In particular, the most frequent genital automatisms consist in subtle phenomena while hypermotoric behaviour, such as pelvic rhythmic movements are quite rare. No lateralizing value for genital automatisms was disclosed.
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