February 27, 2017 E-Pearl of the Week: Supplementary sensorimotor area seizures

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February 27, 2017

Supplementary sensorimotor area seizures

Supplementary sensorimotor area (SSMA) located in the mesial posterior frontal region is responsible for coordination, initiation and integration of sequential movements. SSMA seizures are usually nocturnal with preserved consciousness, unilateral or bilateral asymmetric or symmetric tonic posturing, gross movements involving the proximal extremities, and speech arrest. SSMA seizures are classically associated with the “fencer's posture”. Episodes are often confused with non-epileptic seizures due to bilateral gross movements, intact awareness, and normal routine EEG findings. Unilateral posturing was thought to be representative of a contralateral SSMA seizure focus, however, recent studies demonstrate that even a classic ictal pattern may not be a reliable localizing indicator. These seizures are often refractory to AEDs, needing surgical management.


  1. Bass N, Wyllie E, Comair Y, et al. Supplementary sensorimotor area seizures in children and adolescents. J Pediatr 1995. 126: 537-544.
  2. Aghakhani Y, Rosati A, Olivier A, et al. The predictive localizing value of tonic limb posturing in supplementary sensorimotor seizures. Neurology 2004. 62: 2256-2261.

 Submitted by Aravindhan Veerapandiyan, MBBS - Pediatric Neurology Fellow, Rutgers University, New Jersey Medical School.

Dr. Veerapandiyan reports no disclosures.

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