Ictal Urinary Urge: Further Evidence for Lateralization to the Nondominant Hemisphere

Abstract

Summary:Purpose: To determine the lateralizing value of ictal urinary urgency.Methods: A retrospective database search was performed for patients with ictal urinary urgency admitted to the Epilepsy Monitoring Unit at the Cleveland Clinic between 1994 and 2001.Results: Six patients were identified; intracarotid amytal test demonstrated left hemispheric speech dominance in five cases.The sixth patient continued to speak during right temporal seizures. EEG and imaging data supported right temporal or frontotemporal epilepsy in all six cases. Two patients were seizure free after focal right hemispheric resection.Conclusions: Ictal urinary urge appears to be a lateralizing sign for nondominant temporal lobe epilepsy. Key Words: Ictal urinary urge-Temporal-Lateralizing sign-Nondominant.Ictal "desire to void" was first described by Feindel and Penfield in 1954 (1). The frequency of this autonomic manifestation in temporal lobe epilepsy (TLE) ranges from 0.3 to 8% (1-3). Recently a series of six patients with an aura of ictal urinary urge was described (4). Four of these patients underwent intracarotid amytal testing (IAT) and were found to have seizures arising from the either right or left, but always nondominant temporal lobe. METHODSMedical records of 3,446 patients who underwent video-EEG monitoring at the Cleveland Clinic between 1994 and 2001 were reviewed for the presence of ictal urinary urge. The patient population consisted of 75% with focal epilepsy (temporal, 48%; extratemporal, 19%; nonclassifiable focal, 8%), 5% with generalized epilepsy, 1% with multifocal epilepsy, and 19% with nonepileptic seizures.Clinical history, interictal and ictal video-EEG recordings with scalp and sphenoidal electrodes, and imaging studies were reviewed. Trained EEG/epilepsy technologists and nurses tested the patients during and after seizures to determine level of consciousness and reactivity. Only patients with repeated seizures with ictal urinary urge were included. RESULTSSix patients were identified (0.4% of all patients with TLE). The results are summarized in Table 1. In all cases, patients reported an urge to void at the onset of clinical seizures, usually accompanied by other types of auras. None of these patients had urinary incontinence. In one patient (case 5), urinary urgency was the first symptom of impending seizures. The IAT revealed left hemispheric speech dominance in five patients studied. The sixth patient was right-handed and had ictal speech during right-hemispheric EEG seizures. In all cases, ictal and interictal EEG suggested localization of the seizure onset to the nondominant, right temporal region. In two patients, seizures originated independently from the left and right temporal regions; however, only the right temporal seizures were associated with ictal urinary urge. In all cases with documented left hemisphere speech dominance, neuroimaging revealed abnormalities involving the temporal lobe, often extending to the insula or inferior frontal regions. In two cases, right anterior temporal resectio...

Cingulate Epilepsy

“…The aura of urge to urinate has been reported in relationship to the anterior cingulate, 26 but it has also been linked to the non-dominant temporal lobe. 30 Notably, a positron emission tomography study in healthy volunteers demonstrated hypometabolism involving the anterior cingulate gyrus during voluntary retention. 31 …”

Current View of Autonomic Findings During Epileptic Seizures

“…Disinhibition of subcortical centers, which control the micturition reflex, is thought to cause an increase in intravesical pressure and enuresis (58). Ictal urinary urge is rarely seen in focal seizures and its prevalence varies between 0.4% and 3% in TLE (29,59,60). In previous studies, ictal urinary urge has been reported in non-dominant hemisphere, especially in temporal lobe onset seizures (59,60).…”

“…Ictal urinary urge is rarely seen in focal seizures and its prevalence varies between 0.4% and 3% in TLE (29,59,60). In previous studies, ictal urinary urge has been reported in non-dominant hemisphere, especially in temporal lobe onset seizures (59,60). In another study with few cases, ictal urinary urge has been reported not to be important in lateralization of seizure activity (29).…”

The clinical presentation and diagnosis of epileptic autonomic auras

“…Вместе с тем указывается, что аура в виде императивного позыва на мо-чеиспускание обусловлена раздражением височного палео-кортекса субдоминантного полушария [17]. На очаг в субдо-минантном полушарии указывает сочетание абдоминаль-ной ауры с иктальной рвотой [18].…”