Painful Epileptic Seizures

Out of 858 epileptic patients, 24 had painful seizures. Three distinct groups emerged: (1) those with unilateral pain in the face, arm, leg or trunk (Unilateral Group)--10 cases; (2) a Cephalic Group with pain restricted to the head--11 cases; and (3) an Abdominal Group with central abdominal pain--3 cases. Unilateral pain consistently implicated ictal involvement of the contralateral rolandic region at the time of pain. In most cases it was probably due to involvement of the primary somatosensory cortex (SI). Cephalic pain did not localize the site of seizure origin. In most cases it probably arose by a vascular mechanism. Abdominal ictal pain reflected temporal lobe epileptic activity in our cases. The mechanism of its production is uncertain, but it is unlikely to be due to a peripheral (for example gastrointestinal) mechanism.