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This article provides a detailed description of clinical and electroanatomical characteristics of epilepsy in patients suffering from epileptic trances – a rare type of focal motor seizures with ambulatory automatism manifesting as an unplanned travel. We reviewed the currently available data on the nature of psychical seizures in patients with epilepsy and the role of social and legal expertise for this disease. We developed the criteria for differential diagnosis between epileptic trances and other conditions with similar manifestations (for example, epileptic fugues) and identified a diagnostic minimum. We also proposed a hypothesis of ictal spatial migration. We emphasized the efficiency of surgical treatment in the case of compliance with a proper diagnostic algorithm.

Abstract: the article presents a review of world literature on significance of various clinical lateralizing signs in temporal lobe epilepsy, such as dystonic posturing, limb automatisms, ictal and postictal aphasia, ictal nystagmus, head turning, periiktal headache, etc. The results of current research are compared with previously published reports. The ictal dystonic unilateral limb posturing (possibly isolated in a hand, foot, predominantly in distal parts of limbs) is still one of the most informative lateralizing signs and it is lateralized in contralateral hemisphere in 100% of cases. It is shown that the “early” and “late” head turning, and unilateral limb automatisms are the most important and convincing lateralizing signs, which must be considered in connection with the EEG data to determine the epileptogenic focus in patients with temporal lobe epilepsy.