Ictal kissing: Electroclinical features of an unusual ictal phenomenon

Abstract

Ictal kissing is mainly associated with right TL and female gender, although association with left TL may also occurs, possibly related to the circuits involving temporo-insular structures.

Ictal kissing in a patient with right frontal lobe epilepsy

“…This might reflect the ability to respond to the surrounding environment and react to external cues ( e.g . blowing kisses towards a technician who has asked the patient to follow a command, or trying to kiss a nearby family member) or the activation of more widespread network connections with bilateral temporal lobe involvement and resemblance of a Klüver‐Bucy syndrome with hyperorality and a more sexualized kissing behaviour (Özkara et al ., 2016; Rashid et al ., 2010). It has also been proposed that a faster spread of ictal discharges to both temporal lobes might be responsible for a self‐initiated kissing behaviour ( e.g .…”

“…The epileptogenic zone was considered to be on the right temporal lobe in 17 cases and on the left temporal lobe in four cases; in five cases, the localization was unclear due to normal or bilateral MRI and EEG findings. The patient with the parietal lesion had ictal discharges propagating to the right temporal lobe at an early phase (Özkara et al ., 2016). In the case reported by Alsemari et al ., the MRI showed “right frontal small cortical and subcortical lesions”, but eventually subdural EEG recording, covering the right frontal and temporal lobes, showed that seizures started at the right mesial temporal lobe contacts.…”

“…Automatisms may be seen in focal seizures and in absence seizures. Ictal kissing is an automatism very rarely observed during focal seizures (Alsemari et al ., 2013; Özkara et al ., 2016). In a cohort of 5,133 patients, the prevalence of ictal kissing was 0.02%, corresponding to a single patient (Alsemari et al ., 2013).…”

“…At our centre, we have performed video‐EEG monitoring on 350 adult patients from 2012 to 2018, and the patient presented is the only one who presented with this semiological feature. To the best of our knowledge, there are 26 cases reported in the literature (Alsemari et al ., 2013; Özkara et al ., 2016). The kissing pattern may not be stereotypical among seizures in the same patient (Özkara et al ., 2016).…”

“…Ictal kissing fits this last category as it is observed very rarely and its localizing and lateralizing value are hard to establish. Ictal kissing has previously been reported in patients with definite or presumed temporal lobe epilepsy (Alsemari et al ., 2013; Özkara et al ., 2016; Asadi‐Pooya and Fletman, 2017). We present a patient in whom ictal kissing was a consistent feature of ictal semiology and all available data pointed towards a right frontal lobe epileptogenic zone.…”