title: Ictal pallor is associated with left temporal seizure onset zone in children.
abstract: 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.
authors.affiliation: Epilepsie-Zentrum Bethel, Bielefeld, Germany; Epilepsy Center, Bethesda Children's Hospital, H-1146-Budapest, Bethesda Street 3, Hungary. fogarasi@bethesda.hu
authors.forename: András
authors.initials: A
authors.lastname: Fogarasi
authors.forename: József
authors.initials: J
authors.lastname: Janszky
authors.forename: Ingrid
authors.initials: I
authors.lastname: Tuxhorn
mesh_terms: 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*