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Focal or partial motor seizures are attributable to a discharging lesion of the opposite frontal lobe The most common type, originating in the supplementary motor area, takes the form of a turning movement of the head and eyes to the side opposite the irritative focus, often associated with a tonic contraction of the trunk and limbs on that side This may constitute the entire seizure, or it may be followed by generalized clonic movements; the extension of the seizure may occur just before or simultaneously with loss of consciousness On the other hand, a lesion in one frontal lobe may give rise to a major generalized convulsion without an initial turning of the head and eyes It has been postulated that in both types of seizure, the one with and the one without turning movements, there is an immediate spread of the discharge from the frontal lobe to integrating centers in the thalamic or high midbrain reticular formation, accounting for the loss of consciousness Seizures that begin with forceful, sustained deviation of the head and eyes, and sometimes of the entire body, are referred to as

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versive or adversive Since the turning movements are usually to the side opposite the irritative focus (sometimes to the same side), contraversive and ipsiversive, respectively, would be preferable terms Nonforceful, unsustained, or seemingly random lateral head movements during the ictus do not have localizing value The same is true for the head and eye turning that occurs at the end of the generalized tonic-clonic phase of versive seizures (Wylie et al) Contraversive deviation of only the head and eyes can be induced most consistently by electrical stimulation of the superolateral frontal region (area 8), just anterior to area 6 (see Fig 22-1) Less dependably, the same movements can be obtained by stimulating the more anterior portions of the frontal cortex, or the supplementary motor area, and the temporal or occipital cortex presumably through propagation of the ictal discharge to the frontal contraversive area In seizures of temporal lobe origin, early in the seizure, there may be head turning ipsilaterally followed by forceful, contraversive head (and body) turning These head and body movements, if they occur, are preceded by quiet staring and other automatisms The jacksonian motor seizure begins with a tonic contraction of the ngers of one hand, the face on one side, or the muscles of one foot This transforms into clonic movements in these parts in a fashion analogous to that in a generalized clonic-tonic-clonic convulsion Sometimes a series of clonic movements of increasing frequency build up to a tonic contraction The movements may remain localized or spread ( march ) from the part rst affected to other muscles on the same side of the body In the latter, or classic, jacksonian form, which is relatively uncommon, the seizure spreads from the hand, up the arm, to the face, and down the leg; or, if the rst movement is in the foot, the seizure marches up the leg, down the arm, and to the face, usually in a matter of 20 to 30 s Interestingly, spontaneously occurring focal motor seizures, eg, those beginning in the toes or ngers, may sometimes be arrested (inhibited) by applying a ligature above the affected part or, in the case of focal sensory seizures, by applying a vigorous sensory stimulus ahead of the advancing sensory aura Rarely, the rst muscular contraction is in the abdomen, thorax, or neck In some cases, the one-sided seizure activity is followed by turning of the head and eyes to the convulsing side, occasionally to the opposite side, and then by a generalized seizure with loss of consciousness Consciousness is not lost if the sensorimotor symptoms remain con ned to one side Following convulsions that have a prominent focal motor signature, there may be a transient paralysis of the affected limbs This Todd s paralysis persists for minutes or at times for hours after the seizure, usually in proportion to the duration of the convulsion Continued focal paralysis beyond this time usually indicates the presence of a focal brain lesion as the underlying cause of the seizure A similar phenomenon is found in cases of focal epilepsy that involve the language, somesthetic, or visual areas; here the persistent de cit corresponds to the region of brain affected The high incidence of onset of focal motor epilepsy in the face, hands, and toes is probably related to the disproportionately large cortical representation of these parts The disease process or focus of excitation is usually in or near the rolandic (motor) cortex, ie, area 4 of Brodmann (Figs 3-3 and 22-1); in some cases, and especially if there is a sensory accompaniment, it has been found in the postrolandic convolution Lesions con ned to the motor cortex are reported to assume the form of clonic contractions, and.

And the results of this are in this illustration As in this situation, not the best display but there are many other options within that area Before you attempt zigzag lines, I recommend experimenting with the dimensional profiles and lines first to see if this helps produce a dynamic chart