Abstracts

Ictal spitting is considered to be a rare event in epileptic seizures , being most frequently observed in patients with temporal lobe epilepsy (TLE). It may represent a lateralizing sign of non-dominant temporal lobe seizures . Ictal spitting may, however, be observed in seizures originating in the dominant temporal lobe ¹. We report three cases of right-handed patients with TLE, with ictal spitting in seizures originating in the left temporal lobe, as confirmed by video-EEG monitoring. We reviewed charts from all patients with TLE submitted to pre-surgical evaluation, which included high resolution MRI and prolonged video-EEG monitoring, during a two-year period (2003-2004). We searched for patients who presented ictal spitting during monitoring. Three patients fulfilled the criteria above. All three reported spitting automatisms in the initial clinical evaluation. The first patient was a twenty-nine year-old right-handed man with seizures since the age of two. MRI showed a severely atrophic left hippocampus. During video-EEG with scalp-sphenoidal electrodes, twelve seizures were recorded, with ictal onset clearly lateralized to the right temporal lobe. In one seizure he presented ictal spitting. Due to discordance between neurophysiologic and imaging data, the patient was submitted to a new video-EEG monitoring with foramen ovale (FO) electrodes. He had three seizures with ictal onset in the contacts of the left FO electrode, which confirmed the hypothesis of false lateralization in surface EEG, and was submitted to left anterior temporal lobectomy; after 18 months of follow-up, he is seizure-free. The second patient was a nineteen year-old right-handed man with history of febrile seizures at the age of two, and onset of epileptic seizures at the age of nine. MRI revealed left hippocampal sclerosis (HS). The patient had six seizures during video-EEG monitoring, all with ictal onset over the left temporal lobe; in all seizures he had spitting automatisms. The third patient was a twenty-six year-old right handed woman with onset of epilepsy at the age of sixteen. MRI showed left HS. She had three seizures during video-EEG monitoring, with ictal onset localized over the left temporal lobe. In one of the seizures, she presented ictal spitting. Spitting is an uncommon automatism in temporal lobe seizures. As we have shown in this work, it should not be considered a lateralizing sign to nondominant temporal lobe, since it may occur as a clinical manifestation of seizures originating in the left temporal lobe. (Supported by FAPESP (Funda[ccedil][atilde]o de Amparo [agrave] Pesquisa do Estado de S[atilde]o Paulo) and CAPES (Coordena[ccedil][atilde]o de Aperfei[ccedil]oamento de Pessoal de N[iacute]vel Superior)/CNPq (Conselho Nacional de Desenvolvimento Cient[iacute]fico e Tecnol[oacute]gico).)