The expression of interictal, preictal, and postictal facial-wiping behavior in temporal lobe epilepsy: a neuro-ethological analysis and interpretation

By videotape recordings analysis we investigated the frequencies of interictal, preictal, and postictal wiping or rubbing movementstargeting the face region (face wiping, FW) in 17 right and 13 left mesial temporal lobe epilepsy (MTLE) patients. Patientsdata were compared with FW frequencies obtained in 22 healthy controls listening to a presentation. Results showed that: (1) FWmovements were present in both controls and patients; however, the patient groups showed lower interictal and preictal FW ratesrelative than controls; (2) right and left temporal lobe seizures were followed by a marked increase in the expression of wipingactivities directed to the nose as well as to other face regions with respect to the interictal–preictal period; (3) during the first 5 minpostictal FW was performed preferentially with the hand ipsilateral to the seizure focus; (4) postictal examination of the patient byan observer, especially if of the opposite sex, resulted in a higher incidence of FW acts. After temporal lobe seizures there is anexaggerated expression of movements targeting the face region, and not exclusively directed to the nose. According to an ethological interpretation of the FW behavior as a motor behavior present throughout the phylogenetic scale, from rodents to primates, we suggest the postictal emergence of an innate action pattern modulated by external emotional–cognitive stimuli.