Ictal Bruxism - A Sign of Temporal Lobe Ictal Localization: A Case Series

Ictal bruxism (IB) is a rare oro-alimentary automatism in focal seizures. We report a series of six patients with IB in drug-resistant temporal lobe epilepsy (TLE) treated subsequently with temporal lobectomy. All patients had ictal teeth grinding with semiological features, suggestive of temporal lobe origin. Ictal electroencephalogram (EEG) onset showed artifacts corresponding to bruxism; one patient had a "checkerboard" pattern of EEG artifacts corresponding with lateral jaw movements. Five patients had a lesion in the mesial temporal lobe, while one patient had a neocortical temporal lobe lesion. Right temporal localization was observed in five, while one patient had left temporal localization. At the latest post-surgery follow-up of 3 to 14 years (mean 8.83 ± 3.53 years), all patients were seizure-free. IB is an under-recognized ictal phenomenon of TLE representing oro-mandibular automatisms involving the limbic networks. It is a sign of ictal localization to the temporal lobe but not a lateralizing sign.