title: Ictal vocalizations occur more often in temporal lobe epilepsy with dominant (left-sided) epileptogenic zone.
abstract: OBJECTIVE
  To investigate the lateralization value of ictal vocalizations in temporal lobe epilepsy (TLE).
  
  
  METHODS
  We reviewed video-recordings of 97 patients who had undergone presurgical evaluation programs with video-EEG (electroencephalography)-recorded complex partial seizures (CPS) and high-resolution magnetic resonance imaging (MRI). All patients had surgery due to TLE and became seizure-free. In 57 patients, determination of speech dominance was necessary by using Wada tests or functional MRI (fMRI). To reevaluate the archived seizures, we reviewed one to three consecutively recorded CPS of each patient. Altogether 223 archived seizures were analyzed. Ictal vocalization was considered to be present in a particular patient if it occurred in at least one of the recorded seizures.
  
  
  RESULTS
  Ictal vocalizations occurred in 22 patients. They occurred in 37% of left-sided and in 11% of right-sided patients with TLE (p = 0.003). In patients with determined speech lateralization, ictal vocalizations occurred in 37% of the dominant and in 14% in patients with nondominant epileptogenic zone (p = 0.04). In patients with ictal vocalizations, epilepsy began at age 8.7 +/- 6, whereas in the remaining patients, epilepsy started at age 14.0 +/- 9 (p = 0.017). Logistic regression showed that both hemispheric dominance and age at onset were independently associated with pure ictal vocalization (PIV).
  
  
  CONCLUSIONS
  Ictal vocalization is a frequent phenomenon, occurring in 23% of patients with TLE. It is more often associated with left-sided and early onset TLE. Our results may improve the lateralization of the epileptogenic zone and suggest that nonspeech vocalizations in humans are related to the dominant (left-sided) hemisphere. Our study is a further argument that there are different subtypes of TLE depending on the age at onset.
authors.affiliation: Department of Neurology, University of Pécs, Pécs, Hungary.
authors.forename: Reka A
authors.initials: RA
authors.lastname: Horvath
authors.forename: Andras
authors.initials: A
authors.lastname: Fogarasi
authors.forename: Reinhard
authors.initials: R
authors.lastname: Schulz
authors.forename: Gabor
authors.initials: G
authors.lastname: Perlaki
authors.forename: Zsuzsa
authors.initials: Z
authors.lastname: Kalmar
authors.forename: Vanda
authors.initials: V
authors.lastname: Tóth
authors.forename: Norbert
authors.initials: N
authors.lastname: Kovács
authors.forename: Alois
authors.initials: A
authors.lastname: Ebner
authors.forename: Jozsef
authors.initials: J
authors.lastname: Janszky
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001931:Brain Mapping; D004569:Electroencephalography / Q000379:methods; D004833:Epilepsy, Temporal Lobe / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D012189:Retrospective Studies; D014741:Video Recording / Q000379:methods; D055815:Young Adult
chemical_list: D010100:Oxygen