Ictus expectoratus: a sign of complex partial seizures usually of non-dominant temporal lobe origin

Spitting (or expectoration) is rarely seen with seizures. In Western societ y, spitting is a striking behavioral aberration. A 13-year-old child had in termittent agitated behavior, episodes of rage, spitting and confusion last ing up to 2 minutes. He stood up in church and told the preacher to 'shut u p and sit down'. Epilepsy monitoring revealed spitting with polysharp and s pike seizures resolved over the right temporal lobe. Magnetic resonance ima ging revealed a right temporal lobe ganglioglioma. Spitting seizures resolv ed after resection. Ictal expectoration is rare. It may occur with epigastric aura, nausea, che wing, swallowing and fumbling. Literature review disclosed 17 cases, 12 of which arose from the non-dominant hemisphere. Most regressed with surgery a nd anticonvulsants. (C) 1999 EEA Trading Ltd.