title: Ictal spitting in left temporal lobe epilepsy: report of three cases.
abstract: OBJECTIVE
  Ictal spitting is rarely reported in patients with epilepsy. More often it is observed in patients with temporal lobe epilepsy (TLE) and is presumed to be a lateralizing sign to language nondominant hemisphere. We report three patients with left TLE who had ictal spitting registered during prolonged video-EEG monitoring.
  
  
  METHODS
  Medical charts of all patients with medically refractory partial epilepsy submitted to prolonged video-EEG monitoring in the Epilepsy Unit at UNIFESP during a 3-year period were reviewed, in search of reports of ictal spitting. The clinical, neurophysiological and neuroimaging data of the identified patients were reviewed.
  
  
  RESULTS
  Among 136 patients evaluated with prolonged video-EEG monitoring, three (2.2%) presented spitting automatisms during complex partial seizures. All of them were right-handed, and had clear signs of left hippocampal sclerosis on MRI. In two patients, in all seizures in which ictal spitting was observed, EEG seizure onset was seen in the left temporal lobe. In the third patient, ictal onset with scalp electrodes was observed in the right temporal lobe, but semi-invasive monitoring with foramen ovale electrodes revealed ictal onset in the left temporal lobe, confirming false lateralization in surface records. The three patients became seizure-free following left anterior temporal lobectomy.
  
  
  CONCLUSIONS
  Ictal spitting is a rare finding in patients with epilepsy, and may be considered a localizing sign of seizure onset in the temporal lobe. It may be observed in seizures originating from the left temporal lobe, and thus should not be considered a lateralizing sign of nondominant TLE.
authors.affiliation: Unidade de Pesquisa e Tratamento das Epilepsias, Department of Neurology and Neurosurgery, Division of Neurology, Federal University of São Paulo, R. Napoleão de Barros, 737/13 degrees andar, São Paulo 04024-002, SP, Brazil. locaboclo@ig.com.br
authors.forename: Luís Otávio Sales Ferreira
authors.initials: LO
authors.lastname: Caboclo
authors.forename: Flavia Saori
authors.initials: FS
authors.lastname: Miyashira
authors.forename: Ana Paula Andrade
authors.initials: AP
authors.lastname: Hamad
authors.forename: Katia
authors.initials: K
authors.lastname: Lin
authors.forename: Henrique
authors.initials: H
authors.lastname: Carrete
authors.forename: Américo Ceiki
authors.initials: AC
authors.lastname: Sakamoto
authors.forename: Elza Márcia Targas
authors.initials: EM
authors.lastname: Yacubian
mesh_terms: D000328:Adult; D038481:Anterior Temporal Lobectomy; D001332:Automatism / Q000209:etiology*; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012472:Salivation; D014741:Video Recording