title: Localizing and lateralizing value of ictal flatulence.
abstract: OBJECTIVE
  Autonomic seizures have been associated with seizure onset in the temporal or insular lobe and consist of variations in blood pressure and heart rate, sweating, flushing, piloerection, hypersalivation, vomiting, spitting, and alterations in bladder and bowel functions. The aim of this study was to evaluate the localizing and lateralizing value of ictal flatulence.
  
  
  METHODS
  Medical records of patients with focal epilepsies who were monitored at the Interdisciplinary Epilepsy Center Marburg between 2006 and 2009 were reviewed for the occurrence of ictal flatulence. Clinical, electrophysiological, and imaging data were reviewed and compared with data for previously reported cases of ictal flatulence.
  
  
  RESULTS
  Two patients with ictal flatulence were identified (0.6%). In both patients, ictal flatulence was associated with a seizure pattern in the temporal lobe of the dominant hemisphere. Our cases and previously reported cases point toward activation of insular cortex because of such additional autonomic symptoms as unilateral piloerection, tachycardia, profound sweating, and flushing of the face.
  
  
  CONCLUSIONS
  Ictal flatulence is a rare manifestation of autonomic seizures and a localizing sign for temporal or/and insular lobe epilepsies. In general, ictal flatulence seems to have no lateralizing value.
authors.affiliation: Department of Neurology and Interdisciplinary Epilepsy Center, Philipps-University Marburg, Marburg, Germany. adam.strzelczyk@med.uni-marburg.de
authors.forename: Adam
authors.initials: A
authors.lastname: Strzelczyk
authors.forename: Mareike
authors.initials: M
authors.lastname: Nowak
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bauer
authors.forename: Philipp S
authors.initials: PS
authors.lastname: Reif
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Oertel
authors.forename: Susanne
authors.initials: S
authors.lastname: Knake
authors.forename: Hajo M
authors.initials: HM
authors.lastname: Hamer
authors.forename: Felix
authors.initials: F
authors.lastname: Rosenow
mesh_terms: D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology; D003072:Cognition Disorders / Q000150:complications / Q000175:diagnosis; D005260:Female; D005414:Flatulence / Q000150:complications* / Q000175:diagnosis; D007839:Functional Laterality / Q000502:physiology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis; D008579:Meningioma / Q000150:complications / Q000473:pathology; D009483:Neuropsychological Tests; D012640:Seizures / Q000150:complications* / Q000503:physiopathology*