Abstracts

Rationale:
Ictal sound or speech manifestations encompass a broad spectrum from intelligible speech to aphasia, dysprosody, or vocalization. Only a few reports available in the literature address their clinical significance. This retrospective observational study aimed to introduce different types of Ictal Vocalizations IVs and study their correlations with different parts of semiology.This will help to establish a relationship between ictal vocalizations and different epileptogenic zones.
Method:
Retrospective vEEGs of 264 patients admitted to the adult monitoring unit at University Hospitals Cleveland Medical Center for management of their refractory epilepsy or for Pre-surgical evaluation between 2010-2019. We assessed 1 random sz with video/ patient. Age: 2-80 YO. Dominant hemisphere was confirmed by WADA, fMRI or history. Only 64 patients(23%) had IVs and were divided according to epileptogenic zones EZs to: Frontal, Temporal , Posterior quadrants and others.
Results:
IVs were divided into(videos of different types of IVS are available):Yelling, Grunting, Moaning, Laughing, Humming, Speech plus,Tonic cry and that was correlated to the most prominent part of semiology as follows: dialeptic, aura, tonic, versive, automotor, complex motor, hypomotor, gelastic. The investigator reliability was found to be significant (kappa 0.8). Tonic and complex motor seizures were the most common semiology associated with IVs. Humming was always associated automotor seizures however using Chi-Square test, the relation was not statistically significant. We wanted to identify association between Vocalization and Epileptogenic Zone. Although the overall p-value was found to be not significant, the p-values for correlation between each vocalization-epileptogenic zone pairs were computed to identify these paris that are statistically significant: Grunting with Frontal lobs seizures.
Conclusion:
- Still in progress; and next step is to determine the significance of the combining both IV and certain types of semiology and see if that determines the EZ. This will help to use IV as a diagnostic tool when evaluating epilepsy patients. Our preliminary observation showed that IV when associated with automotor sz, the EZ is temporal lobe.  -IV was observed in 23.5% of our patients and was more seen in Frontal lobe EZ (40%).-In our study there was no statistical significance for the association between IV and EZ.-Humming, Tonic cry and yelling were the most common IV observed in our study associated with automotor, versive and complex motor szs respectively.
Funding:
:NA