Epilepsia Open (Mar 2023)

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

  • Yuhei Tanno,
  • Takashi Matsudaira,
  • Naotaka Usui,
  • Hiroshi Ogawa,
  • Kentaro Tokumoto,
  • Norihiko Kawaguchi,
  • Akihiko Kondo,
  • Takuji Nishida,
  • Yukitoshi Takahashi

DOI
https://doi.org/10.1002/epi4.12690
Journal volume & issue
Vol. 8, no. 1
pp. 173 – 182

Abstract

Read online

Abstract 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.

Keywords