title: Five pediatric cases of ictal fear with variable outcomes.
abstract: OBJECTIVE
  Ictal fear is an uncommon condition in which fear manifests as the main feature of epileptic seizures. The literature has suggested that ictal fear is generally associated with poor seizure outcomes. We wanted to clarify the variability in seizure outcome of children with ictal fear.
  
  
  METHODS
  We identified five pediatric patients with ictal fear who were followed up on at Okayama University Hospital between January 2003 and December 2012. We retrospectively reviewed their clinical records and EEG findings.
  
  
  RESULTS
  The onset age of epilepsy ranged from 8 months to 9 years and 10 months. The common ictal symptoms were sudden fright, clinging to someone nearby, and subsequent impairment of consciousness, which were often accompanied by complex visual hallucinations and psychosis-like complaints. Ictal fear, in four patients, was perceived as a nonepileptic disorder by their parents. Ictal electroencephalograms (EEG) of ictal fear were obtained in all patients. Three showed frontal onset, while the other two showed centrotemporal or occipital onsets. Two patients were seizure free at last follow-up, while seizures persisted in the other three. A patient with seizure onset during infancy had a favorable outcome, which was considered to be compatible with benign partial epilepsy with affective symptoms.
  
  
  CONCLUSIONS
  Ictal fear is not always associated with a symptomatic cause or a poor seizure outcome. It is quite important to make a correct diagnosis of ictal fear as early as possible to optimize treatment.
authors: Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan; Department of Pediatrics, National Hospital Organization, Minami-Okayama Medical Center, Japan. Electronic address: waka_mari@nifty.com.
authors: Mari
authors: M
authors: Akiyama
authors: Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: Katsuhiro
authors: K
authors: Kobayashi
authors: Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: Takushi
authors: T
authors: Inoue
authors: Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: Tomoyuki
authors: T
authors: Akiyama
authors: Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: Harumi
authors: H
authors: Yoshinaga
mesh_terms: D017668:Age of Onset; D001921:Brain / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D005239:Fear / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy
keywords: Benign partial epilepsy with affective symptoms; Childhood; Frontal lobe epilepsy; Ictal fear