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PURPOSE: Ictal verbal help-seeking has never been systematically studied before. In this study, we evaluated a series of patients with ictal verbal help-seeking to characterize its frequency and underlying etiology. METHODS: We retrospectively reviewed all the long-term video-EEG reports from Jefferson Comprehensive Epilepsy Center over a 12-year period (2004-2015) for the occurrence of the term "help" in the text body. All the extracted reports were reviewed and patients with at least one episode of documented ictal verbal help-seeking in epilepsy monitoring unit (EMU) were studied. For each patient, the data were reviewed from the electronic medical records, EMU report, and neuroimaging records. RESULTS: During the study period, 5133 patients were investigated in our EMU. Twelve patients (0.23%) had at least one episode of documented ictal verbal help-seeking. Nine patients (six women and three men) had epilepsy and three patients (two women and one man) had psychogenic nonepileptic seizures (PNES). Seven out of nine patients with epilepsy had temporal lobe epilepsy; six patients had right temporal lobe epilepsy. CONCLUSION: Ictal verbal help-seeking is a rare finding among patients evaluated in epilepsy monitoring units. Ictal verbal help-seeking may suggest that seizures arise in or propagate to the right temporal lobe.

Ictal kissing is a rare semiological manifestation in patients with epilepsy. We tried to estimate its occurrence and characterize the underlying etiology. We retrospectively reviewed all video-EEG reports from Jefferson Comprehensive Epilepsy Center over a 12-year period (2004-2015) for the occurrence of the term "kiss". We then searched the electronic database PubMed on September 21, 2016 using the following search terms in the English language: "ictal" OR "seizure" OR "epilepsy" AND "kiss" OR "kissing". Relevant original studies were included. During the study period, 5133 patients were investigated in our epilepsy monitoring unit. One patient (0.02%) had one episode of documented ictal kissing. He had drug-resistant right mesial temporal lobe epilepsy. In total, five studies met the criteria for inclusion in the review. These studies described nine patients with drug-resistant focal epilepsy and ictal kissing behavior. Six out of ten patients with ictal kissing had hippocampal sclerosis. We add to the literature on ictal kissing by providing additional information on its frequency and etiology. The most common underlying etiology for ictal kissing is hippocampal sclerosis. However, this semiological ictal phenomenon is not pathognomonic for any etiology or localization.

PURPOSE: We analyzed a series of patients with ictal pain to estimate its occurrence and characterize the underlying etiologies. METHODS: We retrospectively reviewed all the long-term video-EEG reports from Jefferson Comprehensive Epilepsy Center over a 12-year period (2004-2015) for the occurrence of the term "pain" in the text body. All the extracted reports were reviewed, and patients with at least one documented episode of ictal pain in the epilepsy monitoring unit (EMU) were included in the study. RESULTS: During the study period, 5133 patients were investigated in our EMU. Forty-six patients (0.9%) had at least one documented episode of ictal pain. Twenty-four patients (0.5%) had psychogenic nonepileptic seizures (PNES), 10 patients (0.2%) had epilepsy, 11 patients (0.2%) had migraine, and one woman had a cardiac problem. Pain location was in the upper or lower extremities (with or without other locations) in 80% of the patients with epilepsy, 33% of the patients with PNES (p=0.01), and none of the patients with migraine. CONCLUSION: Ictal pain is a rare finding among patients evaluated in EMUs. Psychogenic nonepileptic seizures are the most common cause, but ictal pain is not specific for this diagnosis. Location of the ictal pain in a limb may help differentiate an epileptic cause from others.

Despite the complexity and methodological difficulties in defining the concept consciousness, it is a central concept in epileptology, and should thus be tractable for scientific analysis. In the present article, a two-dimensional model consisting of concepts related to the level and the contents of consciousness will be presented. This model has been found to be well suited for the description of seizure-induced alterations of consciousness, and is supported both by findings from neuroimaging and electrophysiological studies as well as from phenomenological studies. Further, we will review both traditional introspective methods as well as methods that have recently been developed or utilized in epilepsy research, summarize the main findings concerning first person experiences during epileptic seizures acquired with some of these methods, and discuss their strengths and weaknesses.

Despite the complexity and methodological difficulties in defining the concept consciousness, it is a central concept in epileptology, and should thus be tractable for scientific analysis. In the present article, a two-dimensional model consisting of concepts related to the level and the contents of consciousness will be presented. This model has been found to be well suited for the description of seizure-induced alterations of consciousness, and is supported both by findings from neuroimaging and electrophysiological studies as well as from phenomenological studies. Further, we will review both traditional introspective methods as well as methods that have recently been developed or utilized in epilepsy research, summarize the main findings concerning first person experiences during epileptic seizures acquired with some of these methods, and discuss their strengths and weaknesses.

Despite the complexity and methodological difficulties in defining the concept consciousness, it is a central concept in epileptology, and should thus be tractable for scientific analysis. In the present article, a two-dimensional model consisting of concepts related to the level and the contents of consciousness will be presented. This model has been found to be well suited for the description of seizure-induced alterations of consciousness, and is supported both by findings from neuroimaging and electrophysiological studies as well as from phenomenological studies. Further, we will review both traditional introspective methods as well as methods that have recently been developed or utilized in epilepsy research, summarize the main findings concerning first person experiences during epileptic seizures acquired with some of these methods, and discuss their strengths and weaknesses.

Objective: Seizures with an aura of a "sensed presence," a religious emotion, or feelings of euphoria (ecstatic seizures) are characterized by heightened self-awareness. A previous case report on a patient with epilepsy and "sensed presence" as an aura described hypoperfusion in both temporal lobes and a local ictal increase in the left frontoparietal area. A reexamination of the data was suggested by a recent study of patients with ecstatic seizures, which proposed that hyperactivation of the left anterior insula might be a potential cause. Methods: We reanalyzed the laboratory data on the case with "sensed presence" aura using a fusion of SPECT and MR images of the brain, which had not previously been available, and a close examination of the subdural ictal EEG registrations. Results: Examination of the ictal EEG recordings from subdural strip electrodes implanted subtemporally and temporally on both sides showed that seizure activity occurred first at the most medial subtemporal electrode on the left side. From an anatomical point of view, this electrode position is close to the ventral aspect of the left anterior insula, and it is possible that the seizure activity was initiated there. Reexamination of the SPECT data after fusion with contemporary MR images clearly indicated that the region of strong hyperactivation overlies the left anterior insula. Hyperactive regions also appear on the midinsula bilaterally. Together with the neurophysiological ictal EEG, this evidence supports a reinterpretation that this aura of "sensed presence" can be attributed to hyperactivation of the left anterior insula. Conclusion: The present findings support the proposal that ecstatic seizures or "sensed presence" auras can originate from the left anterior insula, a region that has been suggested to engender self-awareness associated with positive feelings.

Despite the complexity and methodological difficulties in defining the concept consciousness, it is a central concept in epileptology, and should thus be tractable for scientific analysis. In the present article, a two-dimensional model consisting of concepts related to the level and the contents of consciousness will be presented. This model has been found to be well suited for the description of seizure-induced alterations of consciousness, and is supported both by findings from neuroimaging and electrophysiological studies as well as from phenomenological studies. Further, we will review both traditional introspective methods as well as methods that have recently been developed or utilized in epilepsy research, summarize the main findings concerning first person experiences during epileptic seizures acquired with some of these methods, and discuss their strengths and weaknesses.

Despite the complexity and methodological difficulties in defining the concept consciousness, it is a central concept in epileptology, and should thus be tractable for scientific analysis. In the present article, a two-dimensional model consisting of concepts related to the level and the contents of consciousness will be presented. This model has been found to be well suited for the description of seizure-induced alterations of consciousness, and is supported both by findings from neuroimaging and electrophysiological studies as well as from phenomenological studies. Further, we will review both traditional introspective methods as well as methods that have recently been developed or utilized in epilepsy research, summarize the main findings concerning first person experiences during epileptic seizures acquired with some of these methods, and discuss their strengths and weaknesses.