Temporal lobe seizures are characterized by behavior arrest and impaired awareness. Automatisms are common during a temporal lobe seizure and include oral and/or manual automatisms. There may be sensory (auditory, emotional (fear), cognitive, (deja vu) or autonomic features (epigastric sensation, tachycardia, color change) prior to onset of impaired awareness. Postictal confusion typically occurs.
Specific features suggest seizure onset in the dominant or non-dominant temporal lobe. Ictal speech, spitting, vomiting, drinking, urge to urinate and automatisms with preserved consciousness suggest seizure onset in the non-dominant temporal lobe. Postictal speech disturbance suggests a dominant temporal lobe seizure. Upper limb dystonia is a useful lateralizing feature, lateralizing the seizure to the contralateral hemisphere. Conversely, manual automatisms usually occur on the ipsilateral side.
