Ictal pallor is associated with left temporal seizure onset zone in children.
OBJECTIVE
To describe the frequency, localizing and lateralizing value of ictal pallor (IP) in children with focal epilepsy.


METHODS
A retrospective review of medical charts and 514 archived seizures from 100 children < or =12 years old was performed. All patients had a history of therapy-resistant partial epilepsy and a seizure-free postoperative outcome. The presence and attributes of IP were analyzed.


RESULTS
No IP was detected by reviewing the archived seizures. According to medical charts, IP was reported in 11/100 children (six girls) aged 14 months to 12 (mean 5.5+/-4.1) years. Ten of them had temporal lobe epilepsy (p=0.046) - including nine temporo-medial and one temporo-lateral cases - while only one child had an extratemporal (parietal lobe) seizure onset zone. All but one children had left-sided operation (p=0.01). Presence of IP had a positive predictive value of 91% for both lateralizing (left) and localizing (temporal lobe) the seizure onset zone. History of IP was neither age-, epilepsy onset-, nor gender-related.


CONCLUSIONS
Ictal pallor is a frequently reported autonomic symptom during childhood focal seizures but difficult to assess purely by video-monitoring. It has a high predictive value to localize the seizure onset zone to the left temporal region already in very young patients.
Fogarasi
András
A
Epilepsie-Zentrum Bethel, Bielefeld, Germany; Epilepsy Center, Bethesda Children's Hospital, H-1146-Budapest, Bethesda Street 3, Hungary. fogarasi@bethesda.hu
Janszky
József
J
Tuxhorn
Ingrid
I
D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000187:drug effects; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007223:Infant; D008297:Male; D010167:Pallor / Q000209:etiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012640:Seizures / Q000503:physiopathology*