Abstracts

Rationale: Ictal fear (IF) has been associated with viscerosensory and affective manifestations, mostly evoked by temporal lobe seizures. This is a retrospective analysis of seizure semiology in patients with IF and temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS). Methods: Semiological seizure characteristics were collected from 25 patients and family members. Assessment of the presence of IF included detailed review of medical records, standardized interview and video-EEG recordings. Available recorded simple partial seizures during video-EEG monitoring were shown to patients in order to help recollection of the features of their seizures. IF diagnosis was only confirmed if reported as being concomitant with an epileptic seizure; if it arose spontaneously, out of context; and if it could clearly be distinguished from the fear of a seizure. All patients underwent psychiatric evaluation via formal consultation with a psychiatrist; comorbidity identification was performed according to DSM IV criteria, and only axis I disorders were considered. High-resolution MRI was performed in all patients. Results: Data was collected from 25 patients (21 women), 11 with right MTS, with mean age of 38 years (± 9, range18-52). Duration of epilepsy ranged from 7-49 years, mean of 31 (± 10). First unprovoked seizure occurred before 16 years of age in 75% of patients. Abdominal visceral sensation, present in 16, was the most common associated aura, while other autonomic symptoms were seen in 11. Somatosensory auras occurred in six cases, in two of them as somatosensory illusions. Visual illusion only occurred in one patient, as well as cephalic aura. Visual (11), auditory (3) and olfactory (2) hallucinations were also present with IF. Multisensorial hallucinations reproducing an “experience” occurred in seven patients; in all of them these hallucinations started during childhood (before 14), and in only one patient this characteristic of an “experiential aura” persisted during adulthood. Psychiatric disorders were identified in 15 (60%) cases: depression in 11, social phobia in two, panic disorder, alcohol dependence and psychosis in one each. Anteromesial temporal lobectomy was performed in 19 cases. Regarding surgical outcome 9 became Engel Class IA, 6 IB, one ID, two II and one has only two months of surgical follow up. Two patients had persisting IF after surgery, and both had only mild fear sensations, different than the pre-surgical auras. Conclusions: IF in TLE with MTS can range from mild fear, autonomic symptoms and epigastric sensation, to fear related hallucinations, as well as frightful multisensorial experiences. IF was always related to multiple auras, and this subject still needs further research in order to understand better its clinical significance in MTS. Depression was strongly related to IF. IF during childhood was related to multisensorial hallucinations. As this phenomenon can occur in nonepileptic conditions, differential diagnosis must be carefully considered. Favorable surgical outcome was related to IF.