Abstracts

Rationale: Ictal incontinence is a common feature in generalized seizures; it is less frequent in partial seizures. The objective of this study is to evaluate the localizing value of the ictal urination and of the ictal urge to urinate without urination.Methods: In the series of patients explored for a surgical treatment in Rennes, we found partial seizures with ictal urination recorded in 7 patients, urge to urinate without urination was recorded in 2. The recorded seizures were the patients’ usual seizures. Every patient had an MRI and an ictal SPECT. In 5 patients with ictal urination depth electrode exploration was performed using the SEEG method with tailored implantation. In 1 patient the urination was the only clinical manifestation of most of the seizures. Surgery was performed in 5 patients with urination and the 2 with urge to urinate.Results: All the patients with ictal urination had a frontal orbital involvement (7 out of 7 patients). When a SEEG was performed, this frontal area was the primary onset zone in 4 and temporo-frontal propagation was recorded in 1. After surgery 4 of these patients are in Engel’s class Ia; one is class III (from 2 to 17 years follow-up). In the 2 patients with ictal urge to urinate, no SEEG was performed; we found a right temporal lobe involvement in both, with secondary involvement of the insula in 1 patient. They were operated in the temporal lobe; only 1 patient is Engel’s class Ia. The other patient had no more urge to urinate, but simple partial seizures with auditory hallucinations.Conclusions: Urination is a coordinated automatic behavior involving mainly brain stem and spinal circuitry. The frontal orbital area (dominant or not) seems to have a major role in the control of these sub-cortical urinary centers and may release urination. Urge to urinate may be seen in temporal onset seizures, but as it is a rare symptom in the temporal lobe seizures, it may involve the adjacent insular cortex.