Abstracts

Rationale: Ictal Humming constitutes an uncommon critical manifestation of a seizure. It is proposed that humming appears after the activation of a cortical network involving prefrontal cortex, superior temporal gyrus and angular gyrus. We describe the characteristics of 3 patients with this semiology recording during non-invasive videoEEG monitoring. Methods: Three men with focal refractory epilepsy started presurgical evaluation, which included video-EEG continuous monitoring and epilepsy protocol MRI. None expressed specific musical skills. Results: Case 1: male with symptomatic epilepsy due to a left dorsolateral frontal cortical dysplasia. Ictal humming was the initial symptom and duration was brief. In some of the seizures it appeared as the only manifestation. After epilepsy surgery, the patient remained free of new episodes. Case 2: Semiology of seizures included initial visual aura followed by disconnection, manual automatisms and prolonged rhythmic pounding and humming. The critical EEG showed occipital left temporo-occipital activity with anterior spread. MRI showed a left occipital lesion. Surgery was proposed and it is pending. Case 3 suffered from complex partial seizures with semiology and EEG showing a typical left temporo-mesial involvement. One of the episodes was accompanied by humming. MRI showed a left mesial temporal sclerosis. He underwent epilepsy surgery and we was almost free of seizures after surgery (Engel Class I). Conclusions: The initial humming and the presence of a circumscribed lesion as showed case 1 could lead to postulate that the prefrontal region is early involved in this specific manifestation of seizures. Ictal humming probably occurs as a result of propagation of ictal activity to neocortical temporal structures in case 2 and case 3. A deep knowledge in semiology and epileptogenic networks involved remains of high interest in the presurgical evaluation of refractory epileptic patients. Funding: No funding was received in support of this abstract.