We have evaluated useful lateralizing signs in 28 patients with medial temporal lobe epilepsy who were seizure-free after anterior temporal lobectomy by reviewing videotapes during video-EEG monitoring. The most frequent types of aura were epigastric sensation and psychic symptom in 8, respectively, both of which did not predict lateralization of the focus. Of the motor signs, early head deviation and unilateral upper extremity automatism predicted an ipsilateral focus in 72 and 80%, respectively. On the other hand, late head deviation(< 15 seconds before secondarily generalized seizure) and unilateral upper extremity dystonic posturing predicted a contralateral focus in 80 and 100%, respectively. Twelve of the patients displayed oroalimentary automatism which did not predict focus lateralization. Three patients with ictal speech demonstrated a seizure focus contralateral to their language-dominant hemisphere. In medial temporal lobe epilepsy, several clinical seizure manifestations such as: early and late head deviation, unilateral upper extremity automatism and dystonic posturing were not a little noted and provided additional information as to the side of seizure origin.