The diagnostic utility of the ictal cry

Epileptic generalized tonic-clonic (GTC) seizures are differentiated from nonepileptic spells primarily by history. The historical features that can aid in making a diagnosis, such as urinary incontinence and tongue biting, are few. One additional piece of information we propose may be of clinical value is the stereotypical "ictal cry." We reviewed audio from 20 consecutive GTC seizures and 20 consecutive psychogenic convulsive nonepileptic spells recorded in our epilepsy monitoring unit. The audio components of the recordings from each group were compared. The typical laryngeal sound was found to have both high sensitivity (85%) and specificity (100%) for epileptic GTC seizures. In none of the 20 psychogenic cases was the typical epileptic vocalization expressed; these cases were mostly associated with other utterances such as weeping, moaning, and coughing. The ictal cry is strongly associated with epileptic GTC seizures and, thus, warrants inquiry when obtaining the history from witnesses of a patient's seizure.