2025/07/12 by Ming‐Chen Tsai, Ching‐Po Lin, Anthony L. Fine +4 · 1 voice
Medicine · #Epilepsy research and treatment #Psychosomatic Disorders and Their Treatments #Pharmacological Effects and Toxicity Studies
paper · pdf · doi:10.1002/epi4.70097
openalex publication_date 2025/07/12 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/27
OBJECTIVE: To assess the localization and lateralization values of ictal emotional features and ictal defensive behaviors in pediatric and young adult patients with frontal lobe epilepsy (FLE). METHODS: Children and young adults with FLE were identified from a single institution's epilepsy surgery database. Two epileptologists determined by consensus the presence of ictal emotional features (positive- smile, laughter, humming, singing; negative- fear, crying, anger, disgust, contempt, sadness) and ictal defensive behaviors (freezing with a fearful facial expression, shielding the face with hands, burying the face in a pillow, or exhibiting hyperkinetic motor behaviors like attempting to escape from bed or resisting restraint) in each patient's first video EEG (vEEG). Historic seizure semiology and vEEG reports were compared with the consensus vEEG analysis. Longitudinal changes in ictal emotional features were defined by the emergence or resolution of ictal emotional features between historic seizure semiology and re-review of presurgical vEEG analysis. Subgroup analyses were conducted according to the seizure lateralization (left vs. right) and sublobar localization (precentral, medial, lateral, extensive) based on surgical extent. RESULTS: Twenty-three FLE patients were included (female 39%; mean age at vEEG analysis: 11.28 years, range 1.75-20.17). The inter-rater reliability was very good for both ictal emotional features (κ = 0.81, 95% CI: 0.59-1) and ictal defensive behaviors (κ = 0.91, 95% CI: 0.79-1). Ictal emotional features were observed in 10 patients (43.4%), with negative emotions present in 70% (7/10) of these cases. vEEG reports lacked documentation of ictal emotional features in two patients. Although ictal emotional features showed no statistical correlation by sublobar regions, ictal defensive behaviors were consistently seen in medial compared to lateral FLE (100% vs. 16.6%; p = 0.004). Longitudinal changes in ictal emotional features were observed in 8 (34.7%) patients. SIGNIFICANCE: Ictal emotional features were common in pediatric and young adult FLE patients and were mainly negative. Ictal defensive behaviors were more likely associated with medial FLE. Longitudinal changes in ictal emotional features occurred in about a third of pediatric and young adult patients with FLE. PLAIN LANGUAGE SUMMARY: This study examined emotional features and defensive behaviors during seizures in children and young adults with FLE. Negative emotions were commonly seen during seizures. Ictal defensive behaviors were more frequently observed in patients with medial FLE, and recognizing these signs could help clinicians localize the seizures. Changes in emotional features were seen over time in about one-third of children and young adult patients.