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Localization of ictal Islamic rituals: Study of epilepsy center in Makkah
Amal M Alkhotani1, Hanadi Abualela2
1Department of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; Department of Neurology, King Abdullah Medical City, Makkah, Saudi Arabia.
Insights
Ictal Islamic rituals, such as religious speech and specific movements, are rare seizure phenomena. This study found these unique ictal events consistently localize to the right temporal lobe in epilepsy patients.
Area of Science:
- Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Ictal semiology is crucial for diagnosing seizure types.
- Epilepsy monitoring units (EMUs) are often necessary for accurate epilepsy diagnosis.
- Unusual ictal phenomena can indicate psychogenic seizures, but also have specific localizing value.
Purpose of the Study:
- To investigate the diagnostic and localizing value of ictal Islamic rituals.
- To determine if specific Islamic rituals during seizures correlate with particular brain regions.
Main Methods:
- Retrospective review of patients admitted to an epilepsy monitoring unit (EMU).
- Inclusion criteria: patients exhibiting ictal Islamic rituals between 2017 and 2021.
- Data collection focused on the semiology and origin of seizures.
Main Results:
- Nine out of 279 EMU patients displayed ictal Islamic rituals.
- Observed rituals included religious speech, tahseen (self-immunization), and shahada movements.
- All nine patients with these rituals had seizures originating from the right temporal lobe.
Conclusions:
- Ictal Islamic rituals are rare but distinct ictal phenomena.
- These rituals demonstrate significant localizing value, consistently indicating a right temporal lobe origin.
- Further research into rare ictal semiologies can refine epilepsy diagnosis.
Background:
Ictal semiology is important to aid the diagnosis of seizure type. Patients frequently require admission to an epilepsy monitoring unit (EMU) to reach a correct diagnosis of epilepsy type. Some patients may exhibit unusual ictal phenomena that can lead to the diagnosis of psychogenic seizures. Unusual ictal phenomena include ictal kissing, praying, and drinking. Ictal religious speech and praying are other examples of unusual ictal phenomena. This study aims to assess the localization value of ictal Islamic rituals.
Methods:
We retrospectively reviewed all patients admitted to the EMU at King Abdullah Medical City in Makkah between 2017 and 2021. Patients with ictal Islamic rituals were included in the study.
Results:
Nine out of the 279 cases admitted to the EMU have different ictal Islamic rituals. Some patients exhibited multiple Islamic rituals during their seizures. Six patients performed Islamic religious speech, including asking Allah to help, asking for forgiveness, and making basmala (in the name of Allah). Three patients exhibited self-immunization patterns (tahseen). Three patients repeatedly raised their right index fingers (shahada movements). All nine patients had seizures originating from the right temporal lobe.
Conclusions:
Islamic rituals are rare ictal phenomena localized to the right temporal lobe.
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Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types: