Ictal nausea and vomiting – is it left or right?

In the focal epilepsies clinical signs can provide useful information in determining the brain area involved during epileptic seizures, i.e. the symptomatic zone. Amongst various signs, ictal nausea and vomiting, which are found in about 1.9-10% of all patients with temporal lobe epilepsy (TLE) [1–3], have been linked to seizure onset in the non-dominant (i.e., mostly right) hemisphere, suggesting a functional asymmetry for gastrointestinal control [2,4–8]. Specifically, in a case series with 31 TLE patients, the authors reported a “strong correlation between epigastric sensation and ictal vomiting in psychomotor seizures arising from the right but not the left temporal “lobe [2].

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