title: Reappraisal of epileptic pain as a rare symptom of seizures.
abstract: OBJECTIVE
  To draw attention to epileptic pain which is a rare seizure symptom mostly causing wrong diagnosis and delayed treatment. We present nine patients in whom pain was a prominent initial or early ictal symptom.
  
  
  METHODS
  We reviewed the records of 4736 patients, and found nine patients who had pain as an aura or an early prominent symptom of their seizures. Seizure semiology, EEG, and cranial imaging features were evaluated retrospectively.
  
  
  RESULTS
  Age at seizure onset ranged from 6 months to 50 years, and the mean age during the study was 37.7±11.9 years. Pain was predominantly peripherally localized in four patients, whereas cephalic pain was detected in three patients, and abdominal pain was detected in two patients. Electroencephalography (EEG) revealed epileptic abnormalities on the temporoparietal and frontotemporal regions in three patients each. Photosensitive generalized epileptic discharges were detected in one and diffuse background slowing in the remaining two other patients. Electroencephalography abnormalities were lateralized to the contralateral site of the pain in four patients with strictly localized pain. Three patients revealed no abnormality on the cranial MR imaging, whereas others showed different types of abnormality such as heterotopias (n:1), mesial temporal lobe atrophy (n:1), white and gray matter sequela lesions (n:1), diffuse white matter lesion (n:1), chronic encephalomalacia and gliosis (n:1), and perivascular space dilatation (n:1).
  
  
  CONCLUSIONS
  Epileptic pain is a neglected, but important, semiologic symptom with localization and lateralization value in the patients with somatosensorial seizures of parietal as well as temporal lobe origin. It occurs mainly as peripherally localized, cephalic, or abdominal pain and is usually associated with a symptomatic etiology. Awareness of epileptic pain is important to avoid misdiagnosis and delayed treatment.
authors.affiliation: Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey. Electronic address: nevinpazarci@yahoo.com.
authors.forename: Nevin
authors.initials: N
authors.lastname: Kuloğlu Pazarcı
authors.affiliation: Istanbul University, Istanbul Medicine Faculty, Istanbul, Turkey.
authors.forename: Nerses
authors.initials: N
authors.lastname: Bebek
authors.affiliation: Istanbul University, Istanbul Medicine Faculty, Istanbul, Turkey.
authors.forename: Betül
authors.initials: B
authors.lastname: Baykan
authors.affiliation: Istanbul University, Istanbul Medicine Faculty, Istanbul, Turkey.
authors.forename: Candan
authors.initials: C
authors.lastname: Gürses
authors.affiliation: Istanbul University, Istanbul Medicine Faculty, Istanbul, Turkey.
authors.forename: Ayşen
authors.initials: A
authors.lastname: Gökyiğit
mesh_terms: D000328:Adult; D000368:Aged; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D004829:Epilepsy, Generalized / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D013702:Temporal Lobe / Q000503:physiopathology
keywords: Epilepsy; Ictal; Pain; Symptomatic seizures