S10. Clinical and electroencephalographic correlates of ictal spitting

Abstract

Ictal spitting is a rarely reported, stereotyped non-purposeful automatism behavior which surfaces during a complex partial seizure. It is similar to other behaviors frequently seen in temporal lobe seizures which include lip smacking, swallowing, and chewing movements. The underlying mechanism of both ictal and post ictal automatisms is unclear. It is hypothesized that this occurs as a result of the activation of areas mediating gastrointestinal function and emotional behavior. Such areas include the amygdala and the insula specifically on the non-dominant side due to the functional asymmetry of the central autonomic network. Charts and video-EEGs (Electroencephalograms) of a patient with temporal lobe epilepsy were retrospectively reviewed. Video-EEG recordings were reviewed for clinical events including ictal spitting and temporally associated EEG changes. Patient experienced an aura before the onset of seizures in the form of an epigastric sensation followed by spitting. Examination of the video revealed gross spitting. A clear electroencephalographic correlate preceded the clinical event by 10–25 s. Characteristic predominantly fast, high-amplitude theta (5–7 Hz) waves were seen in the right temporal lobe, the hemisphere of seizure onset. The total duration of the seizure was approximately 60 s. The patient had focal EEG findings consistent with focal epilepsy. No evidence of generalized epilepsy or non-epileptic seizure events was identified. Ictal spitting is a rare feature in epileptic seizures characterized by automatisms. Automatisms are known to have a lateralizing value in temporal lobe epilepsy. The epileptic zone is most frequently found in the right, non-dominant temporal lobe. Extremely rare cases of the seizure involving the left dominant temporal lobe or involving a seizure focus outside of the temporal lobe are reported in literature.