The localizing value of hypersalivation and postictal coughing in temporal lobe epilepsy

Analysis of ictal semiology is essential to presurgical evaluation of epilepsy patients providing information on seizure origin. To assess the significance of hypersalivation and postictal coughing for seizure origin in temporal lobe epilepsy (TLE), we analyzed video/EEG monitoring documented seizures of 107 adult patients for these seizure elements with respect to frequency and sequence of occurrence in relation to epileptogenic origin, comparing mesial versus extra-mesial and left versus right. Hypersalivation was rare, but occurred exclusively in seizures of mesial origin (9.4%). Comparison between left (11.4%) and right (6.9%) mesial origin was statistically insignificant. Postictal coughing also occurred exclusively in seizures of mesial onset (6.3%). Again, comparison between left (5.7%) and right (6.9%) mesial seizure onset was statistically insignificant. Thus, hypersalivation and postictal coughing are rare seizure phenomena in TLE, but their occurrence strongly support mesial seizure origin.