title: Peri-ictal water drinking and other ictal vegetative symptoms: Localizing and lateralizing the epileptogenic zone in temporal lobe epilepsy? Two case reports and review of the literature.
abstract: Peri-ictal behavior disorders can be helpful in localizing and lateralizing seizure onset in partial epilepsies, especially those originating in the temporal lobe. In this paper, we present the case of two right-handed women aged 36 and 42 years who presented with partial seizures of mesial temporal type. Both of the patients had drug resistant epilepsy and undergone presurgical evaluation tests including brain magnetic resonance imaging, video-EEG monitoring and neuropsychological testing. The two patients had hippocampal sclerosis in the right temporal lobe and exhibited PIWD behavior concomitant with right temporal lobe discharges documented during video-EEG recordings. Anterior temporal lobectomy was performed in one case with an excellent outcome after surgery. The patient was free of seizures at 3 years follow-up. We reviewed other publications of peri-ictal autonomic symptoms considered to have a lateralizing significance, such as peri-ictal vomiting, urinary urge, ictal pilo-erection. Clinicians should search for these symptoms, even if not spontaneously reported by the patient, because they are often under-estimated, both by the patients themselves and by physicians. Additionally, patients with lateralizing auras during seizures have a significantly better outcome after epilepsy surgery than those without lateralizing features.
authors.affiliation: Department of Clinical Neurophysiology, Hôpital des Spécialités Centre Hospitalier Ibn Sina, Rabat Institut BP 6220, Rabat, Maroc; Laboratory of physiology, faculty of medicine and pharmacy of Rabat, university Med V Souissi, Rue Lamfadel Cherkaoui, Rabat Institut BP 6527, Rabat, Maroc. Electronic address: lerrguig@hotmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Errguig
authors.forename: F
authors.initials: F
authors.lastname: Lahjouji
authors.forename: H
authors.initials: H
authors.lastname: Belaidi
authors.forename: M
authors.initials: M
authors.lastname: Jiddane
authors.forename: A
authors.initials: A
authors.lastname: Elkhamlichi
authors.forename: T
authors.initials: T
authors.lastname: Dakka
authors.forename: R
authors.initials: R
authors.lastname: Ouazzani
mesh_terms: D000328:Adult; D004326:Drinking / Q000502:physiology*; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D062706:Prodromal Symptoms; D020521:Stroke / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D013702:Temporal Lobe / Q000473:pathology*; D013894:Thirst / Q000502:physiology
keywords: Ictal vegetative symptoms; Localizing and lateralizing ictal symptoms; Peri-ictal water drinking; Sensation de soif péri-critique; Surgical treatment; Symptômes critiques localisateurs et latéralisateurs; Symptômes neurovégétatifs péri-critiques; Temporal lobe epilepsy; Traitement chirurgical; Épilepsie du lobe temporal