Ictal pain: occurrence, clinical features, and underlying etiologies
Ali A Asadi-Pooya1, Marjan Asadollahi1, Michael R Sperling1
1Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
Epilepsy & Behavior : E&B
|June 18, 2016
Summary
Ictal pain is rare in epilepsy monitoring units, occurring in less than 1% of patients. While psychogenic nonepileptic seizures are a common cause, limb pain may indicate an epileptic origin.
Area of Science:
- Neurology
- Epileptology
- Pain Medicine
Background:
- Ictal pain, or pain occurring during a seizure, is an uncommon symptom.
- Understanding the prevalence and causes of ictal pain is crucial for accurate diagnosis and treatment.
Purpose of the Study:
- To determine the occurrence of ictal pain in patients undergoing long-term video-electroencephalography (EEG) monitoring.
- To characterize the etiologies associated with ictal pain.
Main Methods:
- Retrospective review of 12 years of video-EEG reports from a comprehensive epilepsy center.
- Inclusion criteria: patients with documented ictal pain episodes in the epilepsy monitoring unit (EMU).
Main Results:
- Out of 5133 patients, 46 (0.9%) experienced ictal pain.
- Etiologies included psychogenic nonepileptic seizures (PNES) (0.5%), epilepsy (0.2%), migraine (0.2%), and cardiac issues (one patient).
- Limb pain was more frequent in epilepsy patients (80%) compared to PNES patients (33%) (p=0.01).
Conclusions:
- Ictal pain is a rare finding in EMU evaluations.
- While PNES is a frequent cause, ictal pain is not exclusive to this diagnosis.
- Pain localized to a limb may suggest an epileptic etiology over other causes.
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