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the temporal half of a homonymous eld defect Curiously, a seizure arising in one occipital lobe may cause momentary blindness in both elds It has been noted that lesions on the lateral surface of the occipital lobe (Brodmann s areas 18 and 19) are likely to cause a sensation of twinkling or pulsating lights More complex or formed visual hallucinations are usually due to a focus in the posterior part of the temporal lobe, near its junction with the occipital lobe, and may be associated with auditory hallucinations The localizing value of visual auras has been con rmed recently by Bien and colleagues in a group of 20 surgically treated patients with intractable seizures They found that elementary visual hallucinations and visual loss were typical of occipital lobe epilepsy but could also occur with seizure foci in the anteromedial temporal and occipitotemporal regions Auditory hallucinations are infrequent as an initial manifestation of a seizure Occasionally a patient with a focus in one superior temporal convolution will report a buzzing or roaring in the ears A human voice, sometimes repeating unrecognizable words, or the sound of music, has been noted a few times with lesions in the more posterior part of one temporal lobe Vertiginous sensations of a type suggesting a vestibular origin may on rare occasions be the rst symptom of a seizure The lesion is usually located in the superoposterior temporal region or the junction between parietal and temporal lobes In one of the cases reported by Pen eld and Jasper, a sensation of vertigo was evoked by stimulating the cortex at the junction of the parietal and occipital lobes Occasionally with a temporal focus, the vertigo is followed by an auditory sensation Giddiness, or light-headedness, is a frequent prelude to a seizure, but this symptom, as discussed in Chap 15, has so many different connotations that it is of little diagnostic value Olfactory hallucinations are often associated with disease of the inferior and medial parts of the temporal lobe, usually in the region of the parahippocampal convolution or the uncus (hence Jackson s term uncinate seizures, pages 199 and 398) Usually the perceived odor is exteriorized, ie, projected to someplace in the environment, and is described as disagreeable or foul, though otherwise unidenti able Gustatory hallucinations have also been recorded in proven cases of temporal lobe disease (see page 201) and with lesions of the insula and parietal operculum; salivation and a sensation of thirst may be associated Electrical stimulation in the depths of the sylvian ssure, extending into the insular region, has produced peculiar sensations of taste Vague and often inde nable visceral sensations arising in the thorax, epigastrium, and abdomen are among the most frequent of auras, as already indicated Most often they have a temporal lobe origin, although in several such cases the seizure discharge has been localized to the upper bank of the sylvian ssure; in a few others, the focus was located in the upper or middle frontal gyrus or in the medial frontal area near the cingulate gyrus Palpitation and acceleration of the pulse at the beginning of the attack have also been related to a temporal lobe focus.

Complex Partial Seizures (Psychomotor Seizures, Temporal Lobe Seizures)

These differ from the major generalized and absence seizures discussed above in that (1) the aura (ie, the initial event in the seizure) may be either a focal seizure of simple type or a hallucination or perceptual illusion, indicating (usually) a temporal lobe origin, and

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