Abstracts

Rationale: To draw attention to this rare seizure symptom mostly causing false diagnosis and treatment, we aimed to present nine patients in whom pain was a prominent initial or early ictal symptom. Methods: We reviewed the records of all available patients experiencing 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 (mean: 18.3 ± 14.8). 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. One of two cases reporting abdominal pain was accompanied by peripherally localized pain and the other one with cephalic pain. Electroencephalography (EEG) revealed epileptic abnormality on the temporoparietal and frontotemporal regions in three patients each. Photosensitive generalized epileptic discharges were detected in one and only diffuse slowing in two other patients. EEG abnormalities were lateralized to the contralateral site of the pain in four patients with strictly localized pain. EEG findings were lateralized to the left in two and to the right in one patient with abdominal and cephalic pain symptoms. Only three patients revealed no abnormality on the cranial MR imaging, whereas the other cases showed supepandimal heterotopia, bilateral hippocampal atrophy, bilateral cortical encephalomalacia, nonspecific white matter sequelae lesions, sequale bleeding findings after posterior fossa cyst operation and perivascular parietal cystic dilatations. Conclusions: Epileptic pain is a rare, but important symptom with localization and lateralization value in the patients with somatosensorial seizures. It occurs mainly peripherally localized, cephalic, or as abdominal pain. Epileptic pain is usually seen in seizures with parietal lobe origin besides being also observed in in temporal lobe seizures and is mostly of symptomatic origin.