Localized pain associated with seizures originating in the parietal lobe.
OBJECTIVE
Ictal pain is a rare symptom of seizures. Epileptic pain may be experienced unilaterally (lateral/ peripheral), cephalically, or in the abdomen. Painful seizures have been associated with seizure origin in both the parietal and the temporal lobes. We report on the different types of epileptic pain and discuss its etiology and possible localizing value.


METHODS
We reviewed the records of patients referred to our epilepsy program over the last 6 years. Eight (1.4%) of 573 patients had pain as an early prominent symptom of their seizures.


RESULTS
Pain was predominantly unilateral in three patients, cephalic in two, and abdominal in three patients. Seizure onset was in or involving the parietal lobe in all patients, and when the painful symptoms were lateralized, they were contralateral to the side of seizure origin. Parietal lobe seizure origin was determined by both intracranial EEG recording and neuroimaging [magnetic resonance imaging (MRI), ictal single photon emission computed tomography (SPECT)] in five patients, and by both scalp EEG and neuroimaging in three patients.


CONCLUSIONS
We conclude that ictal pain is a rare symptom of parietal lobe seizure origin with lateralizing potential.
Dartmouth-Hitchcock Medical Center, Section of Neurology, Lebanon, New Hampshire 03756, USA.
A M
AM
Siegel
P D
PD
Williamson
D W
DW
Roberts
V M
VM
Thadani
T M
TM
Darcey
D015746:Abdominal Pain / Q000175:diagnosis / Q000503:physiopathology; D000328:Adult; D004827:Epilepsy / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006261:Headache / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis* / Q000503:physiopathology; D010296:Parietal Lobe / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015899:Tomography, Emission-Computed, Single-Photon