Pilomotor seizures: Two additional cases without neoplasms

We report two additional cases of pilomotor seizures of 5 and 10 years' duration in a 63- and a 34-year-old male with simple/complex partial seizures. Both had ictal electrographic discharges localized to the right temporal lobe, associated with right-sided piloerection and altered affective state, but without impaired consciousness. With longer seizures, piloerection became bilateral. Computed tomography (CT) has always been normal, except for one scan during a flurry, which showed abnormal enhancement in the right mesial temporal region. Magnetic resonance imaging studies also have been normal. Antiepileptic drugs have reduced the frequency of the pilomotor and complex partial seizures. Pilomotor seizures appear to be rare but are not always associated with neoplastic lesions. The right temporal lobe seems to be preferentially involved, with presumed projection through the ipsilateral hypothalamus and sympathetic system. The transient CT finding in one case may suggest the involvement of mesial temporal structures.