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We performed a comprehensive literature search (Medline, EMBASE, Cochrane, Scopus) for patient\u2010level studies, following a PRISMA and QUADAS2 approach. Patients with focal epilepsy displaying mimic automatism, defined as \u201cstereotyped mimicry or behavior that resembles the usual way one expresses oneself to reflect an affect and that is not accompanied by the corresponding emotion\u201d were included. Patients with subjective emotional experiences during a seizure, which the patient is aware of, were excluded. Analysis included 936 patients from 104 studies. Gelastic semiology was primarily associated with hypothalamic hamartomas (HH), and secondarily with frontal (cingulate; superior frontal gyrus), temporal (hippocampus; amygdala; pole; parahippocampal and fusiform gyri), insular, and orbitofrontal involvement, without consistent hemispheric lateralization. Dacrystic semiology was associated with HH, as well as temporal lobe seizure onset (mesial and anterior), followed by the less frequent involvement of orbitofrontal (anterior; baso\u2010lateral), insular, and frontal regions; also without consistent hemispheric lateralization. Fearful ictal semiology was equally associated with frontal (cingulate; superior frontal gyrus), orbitofrontal (mesial; posterior), and temporal (hippocampus; amygdala) involvement; most often, but not exclusively, of right hemispheric lateralization. Ritualistic behavior was associated with the temporal lobe origin (hippocampus; amygdala; pole), with strong right hemispheric lateralization. Kissing ictal behavior was associated with temporal lobe origin (pole; hippocampus; amygdala), and secondarily with the frontal lobe (cingulate); most often, but not exclusively, of right hemispheric lateralization. Our systematic review\u2010derived localization of the various manifestations of mimic automatisms supports anatomo\u2010clinical correlations and helps guide interpretation of ictal semiology within the framework of pre\u2010surgical evaluation in focal epilepsies.<\/jats:p>","DOI":"10.1002\/epd2.70004","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T18:38:31Z","timestamp":1741718311000},"page":"358-373","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The localizing value of mimic ictal semiology: A systematic review of the spectrum"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4309-5455","authenticated-orcid":false,"given":"Vasileios","family":"Kokkinos","sequence":"first","affiliation":[{"name":"Comprehensive Epilepsy Center Northwestern Memorial Hospital  Chicago Illinois USA"},{"name":"Department of Neurology, Feinberg School of 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