Ictal spitting in left temporal lobe epilepsy and fMRI speech lateralization

Abstract

Ictal spitting is a “rare” peri-ictal vegetative sign (PIVS) observed n temporal lobe epilepsy (TLE). Some articles analyzing its lateralzing value have demonstrated that ictal spitting indicates a seizure nset in the non-dominant speech hemisphere [1]. Other studies nd case reports have not shown a lateralizing value for ictal spiting, probably because of low incidence and small sample size [2]. n a recent paper, ictal spitting occurred in 1.03% of patients with LE and 0.26% of seizures arising from the non-dominant temporal obe [3]. We report a man with pharmacoresistent epilepsy who ad a dysembryoplastic neuroepithelial tumor (DNET) in the left emporal lobe and who was considered as a surgical candidate. e recorded his typical seizures. His seizures were accompaied by ictal spitting that might suggest seizure origin from the on-dominant temporal lobe, but the fMRI language lateralization evealed speech activation on the left side.