Ictal kissing: a release phenomenon in non-dominant temporal lobe epilepsy

A variety of ictal automatisms with strong emotional elements have been described. Ictal kissing has not been well characterized and may provide useful clinical information and insight into the mechanisms of stereotyped ictal behaviour.

Three of 220 patients (1.4%) admitted for video EEG monitoring between 7/2006 and 6/2009 with ictal kissing were identified. Clinical, neurophysiological and imaging data were reviewed and correlated.

All patients were right-handed women with a longstanding history and findings consistent with right temporal lobe epilepsy (TLE). Multiple habitual events were recorded for each patient, characterized by staring, oral automatisms and amnesia. In addition, partial preservation of responsiveness and speech were seen during seizures in all three patients. The first two patients showed kissing behaviour triggered by interactions during seizure testing. The last patient had six seizures overnight and developed spontaneous kissing behaviour in the ictal and post-ictal period of her later events, associated with hyperorality and sexual disinhibition.

Our series supports the findings of two prior cases, of one male and one female, which reported IK behaviour associated with TLE and lateralizing to the non-dominant hemisphere. This behaviour has not been described in simple partial seizures or seen with electrical cortical stimulation suggesting that it represents a release phenomenon rather than activation of distinct symptomatogenic cortex. This is also supported by the fact that ictal kissing can occur within the spectrum of seizure-induced Kluver-Bucy syndrome and may extend into the post-ictal period.