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Ictus emeticus: an electroclinical analysis
R E Kramer1, H Lüders, L P Goldstick
1Department of Neurology, Cleveland Clinic Foundation, OH.
Abstract:
We report 31 episodes of ictal vomiting in nine patients, documented by simultaneous video and EEG recordings. In four patients, chronically implanted subdural electrode arrays recorded the event. Only one patient showed "projectile" vomiting. Amnesia for the episode occurred in eight of the nine patients. Interictal epileptiform abnormalities were maximal in the right temporal region in seven patients and bitemporal in two. Ictal epileptiform abnormalities were lateralized to the right hemisphere and involved temporal lobe structures in all patients. Three of four patients recorded with subdural electrode arrays were seizure-free following right temporal lobectomy, and the fourth continues to have ictus emeticus at a reduced rate. The consistent right hemisphere lateralization of seizures in this series corroborates with earlier reports documenting right-sided lateralization in four of five previous cases. Two features that help delineate paroxysmal vomiting as an ictal event are (1) patient unawareness of vomiting and (2) its association with other ictal phenomena.
Insights
Ictal vomiting, a seizure symptom, is often linked to the right temporal lobe in epilepsy patients. This symptom can be effectively treated with right temporal lobectomy.
Area of Science:
- Neurology
- Epileptology
Background:
- Ictal vomiting, or ictus emeticus, is an uncommon seizure manifestation.
- Understanding its neurological basis and treatment is crucial for patient management.
Purpose of the Study:
- To investigate the characteristics of ictal vomiting.
- To determine the hemispheric lateralization of seizures causing vomiting.
- To evaluate the efficacy of surgical intervention for this condition.
Main Methods:
- Simultaneous video and electroencephalography (EEG) recordings of 31 ictal vomiting episodes in 9 patients.
- Subdural electrode array recordings in 4 patients.
- Analysis of seizure semiology, EEG findings, and post-surgical outcomes.
Main Results:
- All ictal vomiting events were associated with right-hemisphere ictal epileptiform abnormalities, predominantly involving temporal lobe structures.
- Eight of nine patients experienced amnesia for the vomiting episodes.
- Three of four surgically treated patients became seizure-free after right temporal lobectomy.
Conclusions:
- Ictal vomiting is consistently lateralized to the right hemisphere, often involving the temporal lobe.
- Patient unawareness and association with other ictal phenomena are key indicators.
- Right temporal lobectomy can be an effective treatment for refractory ictal vomiting.