Ictal Fear in Children: Localizing Value and Insights Into the Mechanisms of Fear in the Developing Brain

Rigorously documented ictal fear is infrequent, and its anatomoclinical correlations remain poorly defined. We aim to determine its localizing value and provide novel evidence of the clinical importance and theoretical meaning about ictal fear and emotional processes in children.

Of 1624 consecutive pediatric patients assessed, we identify seven with carefully defined and strict video-electroencephalography (EEG)-recorded ictal fear (130 seizures), two with additional intracerebral stereo-EEG and electrical brain stimulation examinations. A comprehensive study of EEG and semiology is performed, comprising synchronized analysis of seizure origin and propagation and supported by neuroimaging.

Despite activation of distinctive anatomically distributed regions in different patients, a common clinical picture emerges. Ictal fear seems more frequent in girls, and a right hemispheric predominance is observed. Additionally, a particular common state of fear was documented, suggesting that such event is embodied by the activation of a specific neural network of elements scattered about different areas.

We describe a common clinical setting for ictal fear in children, clarifying diagnosis, localizing value, and medical/surgical prognosis. We delineate the variable underlying networks implicated in ictal fear, including highly interconnected structures (the insula, hypothalamus, and parietal lobe), integrating our findings into the modern theories of fear.