Abstracts

Temporal lobe epilepsy (TLE) is the most common partial epilepsy in adults.
Several clinical signs, which help lateralize seizure onset, have been reported in TLE. Increased salivation has only occasionally been reported as a manifestation of partial epilpesy. As reported by Penfield, salivation is at least partially localized to the postcentral gyrus just above the lateral sulcus. We sought to determine whether hypersalivation during complex partial seizures of temporal lobe origin help lateralize seizure onset in TLE?.
Of 590 consecutive patients admitted for EEG/Video monitoring, either as a part of a presurgical evaluation of medically intractable epilepsy or for diagnosis and clarification of their paroxysmal symptoms, we identified 10 patients with ictal hypersalivation as a prominent manifestation of complex partial seizures. We reviewed the clinical features, scalp-sphenoidal EEG/Video monitoring, intracarotid amytal (WADA) testing, hippocampal volumetric MRI, and FDG-PET scans of these patients.
Of the 10 patients with ictal hypersalivation, 7 patients had nondominant/right TLE, and 3 patients had dominant/left TLE. All patients had hippocampal atrophy on volumetric MRI. Seven of the 10 patients underwent standard temporal lobectomy with amygdalohippocampectomy (5 right, 2 left). All the operated patients had a seizure free (Engel Class I) outcome, and their hypersalivation resolved. Three patients, who did not undergo surgical treatment, continue to have complex partial seizures with increased salivation.
We conclude that increased salivation as a prominent ictal finding in complex partial seizures of temporal lobe origin is more likely to be of nondominant temporal lobe origin. Further studies with larger numbers pf patients are needed to replicate this finding.