Localized pain associated with seizures originating in the parietal lobe

Purpose: Ictal pain is a rare symptom of seizures. Epileptic pain may be ex perienced unilaterally (lateral/peripheral), cephalically, or in the abdome n. Painful seizures have been associated with seizure origin in both the pa rietal and the temporal lobes. We report on the different types of epilepti c pain and discuss its etiology and possible localizing value. Methods: We reviewed the records of patients referred to our epilepsy progr am over the last 6 years. Eight (1.4%) of 573 patients had pain as an early prominent symptom of their seizures. Results: Pain was predominantly unilateral in three patients, cephalic in t wo, and abdominal in three patients. Seizure onset was in or involving the parietal lobe in all patients, and when the painful symptoms were lateraliz ed, they were contralateral to the side of seizure origin. Parietal lobe se izure origin was determined by both intracranial EEG recording and neuroima ging [magnetic resonance imaging (MRI), ictal single photon emission comput ed tomography (SPECT)] in five patients, and by both scalp EEG and neuroima ging in three patients. Conclusions: We conclude that ictal pain is a rare symptom of parietal lobe seizure origin with lateralizing potential.