Recurrent focal seizures as a feature of status epilepticus presenting as a peri-ictal water drinking

Peri-ictal Water Drinking in an Omani Patient with Bilateral Mesial Temporal Sclerosis

Peri-ictal water drinking (PIWD) is a rare vegetative manifestation of temporal lobe epilepsy without a definite lateralisation value. We report a case of PIWD in a 22-year-old Omani male patient with post-concussion syndrome and epilepsy presented to a tertiary care hospital in Muscat, Oman, in 2021 for evaluation of paroxysmal events. His behaviour of PIWD was misinterpreted by his family until characterised in the epilepsy-monitoring unit as a manifestation of epilepsy that was treated medically. To the best of the authors' knowledge, this is the second reported case in the region.

Periictal water drinking revisited: Occurrence and lateralizing value in surgically confirmed patients with focal epilepsy

OBJECTIVE

Periictal water drinking (PIWD), which is a rare seizure-related autonomic behavior, has been reported in temporal lobe epilepsy (TLE) but only rarely in extra-TLE. Additionally, the lateralizing value of PIWD is controversial. We aimed to clarify the occurrence and lateralizing value of PIWD in patients with focal epilepsy.

METHODS

This retrospective study included 240 focal epilepsy patients aged >10 years with a favorable postoperative seizure outcome (Engel class I). PIWD was defined as water drinking behavior during a seizure or within 2 min in the postictal phase. The occurrence of PIWD documented on video-electroencephalogram monitoring was assessed. The lateralizing value of PIWD was analyzed among patients whose language dominant hemisphere was identified.

RESULTS

Twenty-three (9.5%) patients exhibited PIWD. PIWD occurred more frequently in frontal lobe epilepsy (FLE; eight of 41 patients, 19.5%) than in TLE (15 of 188 patients, 8%). The occurrence of PIWD was significantly different between FLE and extra-FLE (P = 0.035), with a low positive predictive value (34.8%). In FLE with PIWD, all but one patient underwent resective surgery involving the medial frontal lobe. In 194 patients whose language dominant hemisphere was determined, the lateralizing value of PIWD in FLE and TLE showed no statistical significance (P = 0.69 and P = 0.27, respectively).

SIGNIFICANCE

Periictal water drinking occurred more often in FLE than TLE. Thus, PIWD might not be a specific periictal symptom in TLE. There was no evidence for the lateralizing value of PIWD in FLE and TLE. These findings can provide useful clinical clues for preoperative evaluations to estimate the epileptogenic zone based on seizure semiology and allow for a better understanding of pathophysiological insights into PIWD.

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.

A Young man with Peri-ictal water drinking

Neuro-vegetative features have been linked to epilepsy arising from the temporal lobe, which can be seen during ictal events and play an important role in determining the focal side of the lesion. Among the rare known features is peri-ictal water drinking (PIWD). Here, we present the case of a 31-year-old male with refractory temporal epilepsy, having episodes of PIWD. The patient was considered a candidate for resective surgery and was investigated accordingly, including long-term video electroencephalogram (EEG), brain magnetic resonance imaging (MRI), and neuropsychology assessment, which pointed towards a lesioned temporal lobe over the non-dominant hemisphere. The patient had an excellent outcome following right anterior temporal lobectomy. The lateralization significance of PIWD has not yet been established definitively in the literature, partly due to a limited number of published cases. This case highlights the previously observed association between PIWD and the involvement of the non-dominant hemisphere in epilepsy patients.