Ictal kissing: occurrence and etiology.

Ictal kissing is a rare semiological manifestation in patients with epilepsy. We tried to estimate its occurrence and characterize the underlying etiology. We retrospectively reviewed all video-EEG reports from Jefferson Comprehensive Epilepsy Center over a 12-year period (2004-2015) for the occurrence of the term kiss . We then searched the electronic database PubMed on September 21, 2016 using the following search terms in the English language: ictal OR seizure OR epilepsy AND kiss OR kissing . Relevant original studies were included. During the study period, 5133 patients were investigated in our epilepsy monitoring unit. One patient (0.02%) had one episode of documented ictal kissing. He had drug-resistant right mesial temporal lobe epilepsy. In total, five studies met the criteria for inclusion in the review. These studies described nine patients with drug-resistant focal epilepsy and ictal kissing behavior. Six out of ten patients with ictal kissing had hippocampal sclerosis. We add to the literature on ictal kissing by providing additional information on its frequency and etiology. The most common underlying etiology for ictal kissing is hippocampal sclerosis. However, this semiological ictal phenomenon is not pathognomonic for any etiology or localization

Semiological classification of psychogenic nonepileptic seizures.

PURPOSE: We classified patients with psychogenic nonepileptic seizures (PNESs) according to a newly proposed classification system. Then, we investigated the demographic and clinical differences between various classes of the patients. METHODS: We retrospectively investigated all patients with PNESs admitted to the Jefferson Comprehensive Epilepsy Center from 2012 through 2016. We classified the patients into four distinct classes: patients with generalized motor seizures, patients with akinetic seizures, patients with focal motor seizures, and patients with seizures with subjective symptoms. All patients were interviewed by a neuropsychologist and were administered psychological assessment measures, including questions about PNES risk factors. For the statistical analyses, we compared patients who had generalized motor seizures with patients who had nonmotor seizures. RESULTS: Sixty-three patients were studied. Thirty-five (55.6%) patients had generalized motor seizures, 14 (22.2%) had seizures with subjective symptoms, 12 (19%) had akinetic seizures, and two (3.2%) patients had focal motor seizures. Patients with generalized motor seizures (35 patients) demonstrated a trend for later age at onset (p=0.06), more frequently had a history of substance abuse (p=0.001), and more often had loss of responsiveness with their seizures (p=0.04) compared with patients who had nonmotor seizures (26 patients). CONCLUSION: The recently proposed PNES classification system is useful and practical. This proposed classification of PNESs may address proper diagnosis and provide standardization across future studies. This may also potentially shed light on the etiologic understanding and management of various classes of patients affected with PNESs