title: The significance of ear plugging in localization-related epilepsy.
abstract: OBJECTIVE
  The localizing value of ear plugging in the treatment of auditory onset partial seizures, to our knowledge, has not been previously described. We propose that ear plugging is a clinical response to a sensory seizure manifested as an auditory hallucination and a tool for identifying the seizure focus in the auditory cortex on the superior temporal gyrus.
  
  
  METHODS
  We report on three children who had prior epilepsy surgery for recurrent symptomatic localization-related epilepsy and who, subsequent to their surgery, displayed stereotyped unilateral or bilateral ear plugging at the onset of partial seizures. We studied scalp video electroencephalography (VEEG), magnetoencephalography (MEG), and magnetic resonance imaging (MRI) in all three. Additionally, we used electrocorticography (ECoG) in two patients, intracranial VEEG monitoring in one patient, and functional MRI language mapping in two patients.
  
  
  RESULTS
  All three patients plugged their ears with their hands during auditory auras that localized to the superior temporal gyrus and were followed by partial seizures that spread to a wider field, as shown on scalp and intracranial VEEG. All three patients had MEG interictal discharges in the superior temporal gyrus. One patient who was nonverbal and unable to describe an auditory phenomenon plugged the ear contralateral to where temporal lobe-onset seizures and MEG interictal discharges occurred. CONCLUSIONS; Ear-plugging seizures indicate an auditory aura and may also lateralize seizure onset to the contralateral temporal lobe auditory cortex. Stereotyped behaviors accompanied by epileptic seizures in children who have poor communication skills are important in the seizure semiology of localization-related epilepsy.
authors.affiliation: Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
authors.forename: Dave F
authors.initials: DF
authors.lastname: Clarke
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Otsubo
authors.forename: Shelly K
authors.initials: SK
authors.lastname: Weiss
authors.forename: Shiro
authors.initials: S
authors.lastname: Chitoku
authors.forename: Sylvester H
authors.initials: SH
authors.lastname: Chuang
authors.forename: William J
authors.initials: WJ
authors.lastname: Logan
authors.forename: Mary-Lou
authors.initials: ML
authors.lastname: Smith
authors.forename: Irene
authors.initials: I
authors.lastname: Elliot
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Pang
authors.forename: James T
authors.initials: JT
authors.lastname: Rutka
authors.forename: O Carter
authors.initials: OC
authors.lastname: Snead
mesh_terms: D000293:Adolescent; D001303:Auditory Cortex / Q000503:physiopathology*; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000503:physiopathology; D002648:Child; D002658:Developmental Disabilities / Q000175:diagnosis / Q000503:physiopathology; D004292:Dominance, Cerebral / Q000502:physiology*; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D020937:Epilepsy, Partial, Sensory / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D006212:Hallucinations / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D015225:Magnetoencephalography; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012683:Sensory Deprivation / Q000502:physiology*; D013239:Stereotyped Behavior / Q000502:physiology*; D013702:Temporal Lobe / Q000503:physiopathology* / Q000601:surgery; D014741:Video Recording