1043-3155 Pediatr Neurol Briefs pedneurbriefs Pediatr Neurol Briefs Pediatric Neurology Briefs Pediatr Neurol Briefs 2166-6482 1043-3155 2166-3155 Pediatric Neurology Briefs Publishers Chicago, IL, USA PNB-24-63 10.15844/pedneurbriefs-24-8-7 Seizure Disorders Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant Diagnostic Utility of the Ictal Cry http://orcid.org/0000-0002-0173-7931 Millichap J. Gordon MD 1 2 * Division of Neurology, Children's Memorial Hospital, Chicago, IL Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Correspondence: Dr. J. Gordon Millichap, E-mail: jgmillichap@northwestern.edu 08 2010 01 01 2016 24 8 63 64 Copyright: © 2010 The Author(s) 2010 This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The diagnostic utility of the ictal cry

Consecutive video-EEGs of 20 adult patients with generalized tonic-clonic (GTC) seizures and 20 with psychogenic nonepileptic seizures (PNES) were reviewed from the archives at University of South Florida, Tampa General Hospital, and the audio components of the recordings were analyzed and compared for all vocalizations.

 Psychogenic Nonepileptic Seizures Generalized Tonic-Clonic Guttural Clonic Vocalization

Consecutive video-EEGs of 20 adult patients with generalized tonic-clonic (GTC) seizures and 20 with psychogenic nonepileptic seizures (PNES) were reviewed from the archives at University of South Florida, Tampa General Hospital, and the audio components of the recordings were analyzed and compared for all vocalizations. The ictal cry was defined as a prolonged tonic expiratory laryngeal vocalization, or a deep guttural clonic vocalization. The typical laryngeal sound had high sensitivity (85%) and specificity (100%) for epileptic GTC seizures and was not heard in any of the psychogenic cases. PNES utterances were weeping, moaning, and coughing. The ictal cry was strongly associated with epileptic GTC and warrants inquiry when taking the history from witnesses of a patient’s seizure.

In the group with epilepsy (mean age 40.2 years), 7 of 20 (41%) patients had left temporal lobe epilepsy, 4 (23%) right temporal lobe epilepsy, 3 (11%) frontal lobe epilepsy, 2 (10%) primary generalized epilepsy, and one (5.8%) symptomatic generalized epilepsy. Three GTC events without a cry were of temporal lobe origin (2 right and 1 left). [1]

COMMENT. In a history of epilepsy in Chinese traditional medicine, cited by the authors, the ictal cry was documented by scribes [2]. In centers using video-EEG, the presence or absence of an ictal cry should be of value in diagnosis of GTC vs PNES. Compared to tongue biting and urinary incontinence, having sensitivities of 23-25% for GTC (refs cited by authors), the ictal cry is of greater diagnostic value.

William Gordon Lennox, in his “Epilepsy and Related Disorders” (Boston; Little, Brown & Co, 1960, vol 1, p186), paraphrasing Gowers (1901), recounts “the epileptic cry has been compared to the scream of a distracted peacock. Only the larynx of the bird can imitate it. A parrot in the National Hospital, London, could make the nurses come running with its scream.” These descriptions aside, audio recordings of children captured in generalized tonic seizures during video-EEG might be of interest.

Elzawahry H Do CS Lin K Benbadis SR The diagnostic utility of the ictal cry Epilepsy Behav 2010 Jul 18 3 306 7 10.1016/j.yebeh.2010.04.041 20627816 Lai CW Lai YH History of epilepsy in Chinese traditional medicine Epilepsia 1991 May-Jun 32 3 299 302 2044493