Ictal hypersalivation: A Stereoelectroencephalography exploration

Sumika Ouchida ^1* Armin Nikpour ^1,2 David Neville Wilson ³ Greg Fairbrother ^4,5

• ¹ Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
• ² School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
• ³ Department of Neurosurgery, Royal Prince Alfred Hospital, Sydney, Australia
• ⁴ Sydney Local Health District, Sydney, New South Wales, Australia
• ⁵ Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia

Epilepsy is a chronic neurological condition with various aetiologies, and recurrent unprovoked seizures characterize it. Hypersalivation is a recognized symptom of insularopercular epilepsies. A wide range of symptoms can occur during a seizure, including hypersalivation, autonomic responses, oropharyngeal sensations, visceral sensations, somatosensory disturbances, and emotional manifestations. In this case study, we examine a unique scenario of a patient who experienced predominantly salivary seizures.Hypersalivation, pill-rolling movements, and lip-smacking characterized these seizures.Importantly, the patient became seizure-free after undergoing radiofrequency thermocoagulation (RFTC) with the assistance of Stereoelectroencephalography (SEEG). Our discussion will focus on the treatment approach involving SEEG-guided RFTC and the careful identification of the brain cortex responsible for triggering excessive salivation during seizures.