Quantitative and qualitative analysis of ictal vocalization in focal epilepsy syndromes. (August 2018)

• Record Type: Journal Article
• Authors: Hartl, E.; Knoche, T.; Choupina, H.M.P.; Rémi, J.; Vollmar, C.; Cunha, J.P.S; Noachtar, S.
• Is Part Of: Seizure. Volume 60(2018)
• Page Start: 178
• Page End: 183
• Publication Date: 2018-08
• Subjects: ACG anterior cingulate gyrus -- EEG electroencephalography -- ECoG electrocorticography -- SMA supplementary motor area; Ictal vocalization -- Ictal cry -- Ictal sound -- Audio analysis -- Semiology; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2018.07.008
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: Ictal vocalization occurs in nearly 40% of focal seizures. It increases the localizing value of automatisms. Vocalization during automatisms identifies temporal seizures with a sensitivity of 92% and a specificity of 70%. An observer independent vocalization intensity analysis was established for the first time. Intensity characteristics help to distinguish frontal from temporal lobe seizures. Abstract: Purpose: To investigate the frequency, localizing significance, and intensity characteristics of ictal vocalization in different focal epilepsy syndromes. Methods: Up to four consecutive focal seizures were evaluated in 277 patients with lesional focal epilepsy, excluding isolated auras and subclinical EEG seizure patterns. Vocalization was considered to be present if observed in at least one of the analyzed seizures and not being of speech quality. Intensity features of ictal vocalization were analyzed in a subsample of 17 patients with temporal and 19 with extratemporal epilepsy syndrome. Results: Ictal vocalization was observed in 37% of the patients (102/277) with similar frequency amongst different focal epilepsy syndromes. Localizing significance was found for its co-occurrence with ictal automatisms, which identified patients with temporal seizure onset with a sensitivity of 92% and specificity of 70%. Quantitative analysis of vocalization intensity allowed to distinguish seizures of frontal from temporal lobe origin based on the intensity range (p = 0.0003), intensity variation (p < 0.0001), as well as the intensity increase rate at the beginning of the vocalization (p = 0.003), which were significantly higher in frontal lobe seizures. No significant difference was found for mean intensity and mean vocalization duration. Conclusions: Although ictal vocalization is similarly common in different focal epilepsies, it shows localizing significance when taken into account the co-occurring seizure semiology. It especially increases the localizing value of automatisms, predicting a temporal seizure onset with a sensitivity of 92% and specificity of 70%. Quantitative parameters of the intensity dynamic objectively distinguished frontal lobe seizures, establishing an observer independent tool for semiological seizure evaluation.