Ictal spitting in non‐dominant temporal lobe epilepsy: an anatomo‐electrophysiological correlation

Abstract

We report a patient presenting drug‐resistant, non‐dominant temporal lobe epilepsy with ictal spitting and prosopometamorphopsia, both extremely rare semiologies. Second‐phase pre‐surgical monitoring was performed using SEEG due to lesion‐negative imaging and the rare semiology. The seizure onset zone was delimited to the right anterior hippocampus and the temporobasal cortex, with the propagation zone within the entorhinal cortex. Interestingly, direct electrical stimulation to the entorhinal cortex, which was reproduced in a number of trials, evoked spitting without leading to seizures or post‐discharges. After the resection of the epileptogenic zone, the patient remained seizure‐free without AEDs for a follow‐up period of five years (Engel Class 1a). The neuropathology revealed a focal cortical dysplasia type FCD‐Ia. Spectral analysis of intracranial ictal EEG (iEEG) data suggested a possible role of the basal temporal and entorhinal cortex as a necessary node in ictal spitting. [Published with video sequences on http://www.epilepticdisorders.com].

Seizure semiology: ILAE glossary of terms and their significance

“…Spitting is an infrequent symptom reported in 0.3-2% of patients with temporal lobe seizures [296,[307][308][309][310], and several studies implicate non-dominant lateralization [296,[310][311][312]. However, the left temporal lobe has also been involved in case reports [309,313,314].…”

“…In a case report evaluated with invasive EEG electrodes, although the seizure onset zone was in the left mesial temporal lobe, the ictal spitting coincided with the propagation of the ictal discharge to the right temporal lobe, implicating the latter as the symptomatogenic zone [312]. Direct electrical stimulation studies during invasive EEG monitoring have identified the entorhinal cortex as a site involved in ictal spitting [311]. Ictal spitting does not occur in association with ictal vomiting, ictal coughing, or ictal fear, suggesting there are different sites in the brain that mediate these symptoms with unique specificity [308].…”

Ictal Swearing as a Lateralizing Value for the Dominant Hemisphere in Temporal Lobe Epilepsy

“…Ictal swearing is more common among males, with lateralization to the non-dominant hemisphere. 2,4,6 However, Massot-Tarrús et al…”

Temporal lob epilepsisinde semiyolojinin lateralizasyon değeri

“…Quevedo-Diaz ve ark. [10] ilaca dirençli, sağ temporal lob başlangıçlı, iktal tükürme ve prosopometamorfopsi ile başvuran bir hastayı iyi dökümente etmişler ve doğrudan elektriksel stimülasyon ile iktal tükürme oluşturmuşlardır. Ameliyat sonrası 5 yıl nöbetsiz izledikleri olgularında bazal temporal ve entorinal korteksin iktal tükürmede önemli rol oynadığını göstermişlerdir.…”

“…[3][4][5][6][7] Özellikle peri-iktal vejetatif semptomlar ile klinik çalışmalar sınırlı sayıdadır ve çoğu olgu düzeyinde bildirimlerdir. [8][9][10][11][12][13][14][15][16] Bu çalışmanın amacı, hasta çalışmamızda klinik nöbet semptomlarının sıklığını saptamak ve klasik lateralizan değeri yüksek bulgular yanında görece nadir görülen bulguların lateralizasyon değerini belirlemektir. İktal EEG'de iyi lateralize edilmiş TLE'li hasta çalışmasında iktal ve postiktal semiyoloji detaylı incelenmiştir.…”