Abstracts

RATIONALE: Only few studies have dealt with the physiology of per-ictal urination. To determine the localizing value of this symptom, we report on Four cases explored in our epilepsy unit.
METHODS: Ictal urination was defined as an urination experienced by the patients during their seizures. Four patients were selected : 3 men and 1 woman. They were explored in a pre surgical unit for drug resistant epilepsy. All patients urination is documented by video-EEG monitoring. Inter ictal and ictal SPECT, high resolution MRI, were performed in every patient and a depth electrode exploration (Stereo Electro Encephalo Graphy) in 3 patients. Epileptic zone (EZ) was mainly determined by the ictal correlations made with video-EEG, SEEG and SPECT.
RESULTS: In 3 patients EZ was located in the orbital part of the right frontal lobe. In 1 patient explored with depth electrodes, the EZ is localized in the left temporal lobe, the seizure involved secondarily the insular cortex and the opercular part of the frontal lobe while slow waves are recorded in the orbital region in the same side.
CONCLUSIONS: Ictal urination seems to be trigged by ictal involvement of the orbital frontal region, mainly in the right hemisphere; this could reflect the primary EZ or a propagation. Insular cortex may be also involved as some temporal lobe seizure may provoke urination. This part of the insular cortex, could be equivalent to a primary viscerosensory area responsible for a filled bladder sensation ( Baumgartner et al; 2000).