Automatism

Automatism

Automatisms are complex motor movements occurring in complex motor seizures, which resemble natural movements but occur in an inappropriate setting. These may occur during a state of impaired consciousness during or shortly after an epileptic seizure. There is usually amnesia for the event.
Automatisms occur in about one-third of patients with complex partial seizures, most commonly those of temporal or frontal lobe origin. Although there are qualitative differences between the automatisms seen in seizures arising from these sites, they are not of sufficient specificity to be of reliable diagnostic value; bizarre automatisms are more likely to be frontal.

Automatisms may take various forms:

• Oro-facial movements:
  • for example, lip smacking, chewing, and swallowing movements, salivation (especially temporal lobe origin).
• Gestural:
  • hand fumbling, foot shuffling, tidying, or more complex actions, such as undressing; upper limb movements are said to be more suggestive of temporal lobe origin, lower limb movements (kicking, cycling) of frontal lobe origin; Pelvic thrusting (may also be seen in pseudoseizures).
• Ambulatory:
  • walking or running around (cursive seizures); prolonged wandering may be termed fugue or poriomania.
• Emotional:
  • laughing and, more rarely, crying (gelastic and dacrystic seizures, respectively, although crying may also be a feature of nonepileptic seizures), fear, anger.
• Verbal:
  • humming, whistling, grunting, speaking incoherently; vocalization is common in frontal lobe automatisms.
    Automatic behavior and fugue-like states may also occur in the context of narcolepsy, and must be differentiated from the automatisms of complex partial seizures, on the basis of history, examination and EEG.

References
Delgado-Escueto AV, Bascal FE, Treiman DM. Complex partial seizures on closed circuit television and EEGs: a study of 691 attacks in 79 patients. Annals of Neurology 1982; 11: 292-300
Lüders H, Acharya J, Baumgartner C et al. Semiological seizure classification. Epilepsia 1998; 39: 1006-1013

Cross References

Absence; Aura; Pelvic thrusting; Poriomania; Seizure