Ictal kissing: occurrence and etiology

Localization of ictal Islamic rituals: Study of epilepsy center in Makkah

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.

Ictal coughing: Clinical features and differential diagnoses

PURPOSE

To describe a series of patients with ictal coughing to estimate its occurrence and characterize the clinical features and differential diagnoses.

METHODS

We retrospectively reviewed all the long-term video-EEG reports from Jefferson Comprehensive Epilepsy Center over a 7-year period (2010-2016) for the occurrence of the term "cough" in the text body. All the extracted reports were reviewed and patients with at least one documented ictal coughing at the epilepsy monitoring unit (EMU) were included in the study.

RESULTS

During the study period, 2487 patients were investigated at our EMU. Seven patients (0.28%) had at least one documented seizure accompanied by coughing. Four patients (0.16%) had epilepsy and three patients (0.12%) had psychogenic nonepileptic seizures (PNES). All patients with epilepsy had focal onset epilepsy; ictal coughing was not associated with any particular localization or lateralization.

CONCLUSION

We add to the literature on ictal coughing by providing additional information on its differential diagnosis and clinical features. Ictal coughing is a rare finding among patients evaluated at the EMUs. The differential diagnoses for ictal coughing include epilepsy and PNES. Epileptic ictal coughing is a rare semiological finding in patients with epilepsy and when present, it is invariably associated with focal epilepsy.