Ictus emeticus

Kramer, Ronald E.; Lüders, Hans; Goldstick, Lawrence; Dinner, Dudley S.; Morris, Harold H.; Lesser, Ronald P.; Wyllie, Elaine

doi:10.1212/wnl.38.7.1048

Cited by 105 publications

(79 citation statements)

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“…Involvement of mesiotemporal limbic structures in patients with ictal vomiting is well established (32) and has been described in patients with idiopathic photosensitive seizures (40). Some studies have shown an association of ictal vomiting with right-sided discharges (41,42), which may be relevant to the right-sided preponderance of occipital paroxysms reported here.…”

Section: Vomitingsupporting

confidence: 57%

Early‐Onset Benign Occipital Seizure Susceptibility Syndrome

Ferrie¹,

Beaumanoir²,

Guerrini³

et al. 1997

Epilepsia

127

123

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Summary:Purpose: Childhood epilepsy with occipital paroxysms (CEOP) is characterised by ictal visual hallucinations and occipital epileptiform activity on interictal EEG. A variant has been described with nonvisual symptoms including tonic head and eye deviation, vomiting, and episodes of partial status epilepticus. We fully documented the electroclinical features of such patients to determine whether classification separate from CEOP is justified.Methods: This was a multicentre study with participating investigators submitting details of patients with idiopathic occipital seizures characterised by ictal head or eye deviation and vomiting.Results: One hundred thirteen patients were recruited. Seizures began in early childhood (mean, 4.6 years) and occurred infrequently (mean total seizures, 3); 30% of patients had only a single seizure. Two thirds of seizures were nocturnal. Ictal eye deviation occurred in 79%, vomiting in 70%, and head deviation in 35%. Seizures were predominantly complex partial in type. Partial status epilepticus occurred in 44% of patients. Seventy-four percent of patients had occipital interictal EEG epileptiform activity, predominantly right sided, with fixationoff sensitivity. Extraoccipital EEG abnormalities occurred in 35% of patients. Prognosis was excellent: the mean duration of active seizures was 1 year.Conclusions: Although the two groups shared identical EEG features, the distinct clinical symptoms probably justify separate classification. Early-onset benign occipital seizure syndrome (EBOSS) is suggested as an appropriate name for the variant group. Key Words: Benign epilepsy-Partial seizures-Occipital seizures-Aversive seizures-Status epilepticus.The syndromic approach to the epilepsies has been a major nosologic advance (1,2). In children with and without seizures, occipital spikes that disappear with age were noted by Gibbs et al. more common form of benign CEOP occurring in younger children with infrequent, predominantly nocturnal seizures manifested by tonic deviation of the eyes and vomiting and often first seen as partial motor status epilepticus. Despite similar accounts by others (16-23), recognition of this early-onset variant of CEOP has been delayed. Furthermore, reservations have been expressed about the benign character of CEOP after reports that EEG occipital abnormalities related to the eyes-closed state may also occur in lesional epilepsies (24-26), in the visually impaired (27), and in normal children (28).The purpose of this report is to document fully the clinical features of occipital childhood epilepsy characterised by ictal tonic deviation of the eyes and vomiting, rather than with ictal visual hallucinations, to determine whether these are sufficiently distinctive to warrant classification separate from CEOP. METHODThe study was a collaborative project: Participating investigators collected details of patients with idiopathicoccipital seizures seen over the last 10-to 20-year period. Inclusion criteria were the occurrence of occipital seizures characterise...

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Section: Vomitingsupporting

confidence: 57%

Early‐Onset Benign Occipital Seizure Susceptibility Syndrome

Ferrie¹,

Beaumanoir²,

Guerrini³

et al. 1997

Epilepsia

127

123

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“…Ictal vomiting is a rare symptom during temporal lobe seizures, and only few cases have been reported in the literature (4)(5)(6)(7)(8). In our series, ictal vomiting occurred in 2.8% of 178 patients with documented temporal lobe epilepsy.…”

Section: Discussionmentioning

confidence: 53%

“…Although visceral and autonomic phenomena are frequently encountered symptoms during temporal lobe seizures (1)(2)(3), ictal vomiting is a rare clinical manifestation during seizures originating from the temporal lobes (4)(5)(6)(7)(8). Ictal vomiting is considered a clinical lateralizing sign pointing toward seizure activity within the nondominant temporal lobe (6)(7)(8)(9).…”

Section: Discussionmentioning

confidence: 99%

“…Ictal vomiting is considered a clinical lateralizing sign pointing toward seizure activity within the nondominant temporal lobe (6)(7)(8)(9). Previous authors, by using invasive iting (5-7).…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge this is the first ictal SPECT study in patients with temporal lobe epilepsy with ictal vomiting. Previous authors found a strong association of ictal vomiting with right or nondominant temporal lobe seizure onsets (4)(5)(6)(7)(8) or spread of ictal activity to the right temporal lobe (7,9). Our patient 2 had left mesial temporal lobe epilepsy, but language was represented in the right hemisphere, as evidenced from Wada test results.…”

Section: Discussionmentioning

confidence: 99%

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Regional Cerebral Blood Flow During Temporal Lobe Seizures Associated with Ictal Vomiting: An Ictal SPECT Study in Two Patients

et al. 1999

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Summary:Purpose: Ictal vomiting represents a rare clinical manifestation during seizures originating from the temporal lobes of the nondominant hemisphere. The precise anatomic structures responsible for generation of ictal vomiting remain to be clarified. Ictal single photon emission computed tomography (SPECT), which allows one to visualize the three-dimensional dynamic changes of regional cerebral blood flow (rCBF) associated with the ongoing epileptic activity, should be useful to study the brain areas activated during ictal vomiting.Methods: We performed ictal Tc-HMPAO SPECT scans in two patients with mesial temporal lobe epilepsy (MTLE) whose seizures were characterized by ictal retching and vomiting. MTLE was documented by typical clinical seizure semiology, interictal and ictal EEG findings, hippocampal atrophy on magnetic resonance imaging (MRI) scan, and a seizure-free outcome after selective amydalohippocampectomy. In both patients, seizures originated in the nondominant temporal lobe.We obtained accurate anatomic reference of rCBF changes visible on SPECT by a special coregistration technique of MRI and SPECT. We used ictal SPECT studies in 10 patients with MTLE who had seizures without ictal vomiting as controls.Results: In the two patients with ictal vomiting, we found a significant hyperperfusion of the nondominant temporal lobe (inferior, medial, and lateral superior) and of the occipital region on ictal SPECT. In patients without ictal vomiting, on the contrary, these brain regions never were hyperperfused simultaneously.Conclusions: Ictal SPECT provides further evidence that activation of a complex cortical network, including the medial and lateral superior aspects of the temporal lobe, and maybe the occipital lobes, is responsible for the generation of ictal vomiting.

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Peri‐ictal yawning: A potential lateralizing sign in temporal lobe epilepsy

Du,

Yao,

Chen

et al. 2024

Epilepsia Open

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ObjectiveThe primary objective of this retrospective analysis was to evaluate the incidence and lateralization value of peri‐ictal yawning (PY) in people with temporal lobe epilepsy (TLE). PY has only occasionally been reported as a manifestation of focal epilepsy. We aimed to determine whether PY could serve as an indicator to help lateralize seizure onset during epileptic seizures.MethodsAmong 236 consecutive TLE patients admitted for video‐EEG monitoring, we analyzed the clinical characteristics, along with scalp video‐EEG, magnetic resonance imaging (MRI), fluorodeoxyglucose‐positron emission tomography (FDG‐PET), Wada test, and stereo EEG (SEEG) in patients with PY.ResultsAmong the 236 patients, 26 (11.0%) exhibited PY, and 36 of 1018 recorded seizures (3.5%) were associated with PY. Of the 26 patients with PY, 19 (73.1%) had non‐dominant TLE, while 7 (26.9%) had dominant TLE. The majority of these patients presented with staring, arrest, and automatisms during their seizures with accompanying vegetative signs. PY occurred either during the ictal or postictal phase in all patients. Exception for 10 seizures (10/36, 27.8%) at the early stage (less than 25% total duration), PY was primarily linked to the late ictal and postictal phases. Surgical intervention was performed in 12 patients, 9 of whom (75%) achieved seizure freedom (Engel class I), with 7 of these 9 (77.8%) having non‐dominant TLE.SignificanceYawning is a physiological phenomenon typically not associated with epilepsy. The present series suggests that PY is relatively uncommon in TLE, but may represent a rare vegetative sign, particularly in cases with non‐dominant TLE. Further investigation with a larger cohort of surgically confirmed cases and using intracranial EEG is essential to deepen our understanding of this phenomenon.Plain Language SummaryYawning is a typical physiological response that is generally not linked to epilepsy. However, it can occasionally indicate seizure activity, particularly in TLE. PY happens more often observed in non‐dominant TLE and usually occurs in the later stages of a seizure or just after it. It may hold potential as a lateralizing marker in TLE.

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Ictus emeticus

Cited by 105 publications

References 0 publications

Early‐Onset Benign Occipital Seizure Susceptibility Syndrome

Early‐Onset Benign Occipital Seizure Susceptibility Syndrome

Regional Cerebral Blood Flow During Temporal Lobe Seizures Associated with Ictal Vomiting: An Ictal SPECT Study in Two Patients

Peri‐ictal yawning: A potential lateralizing sign in temporal lobe epilepsy

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