Purpose: Spitting as an ictal automatism has been rarely reported. We aimed to establish its potential lateralizing and localizing significance.
Methods: Review of patients undergoing surgery for intractable epilepsy at two comprehensive epilepsy centers.
Results: Five patients were found who had spitting as a stereotyped automatism of their complex partial seizures. All had evidence of right temporal ictal onset and underwent resective surgery. Two had tumors; one, a cavernous angioma; one, hippocampal gliosis, and one, hippocampal sclerosis. We found no instances of ictal spitting in patients with left hemisphere onset.
Conclusions: Spitting as an automatism in complex partial seizures, although uncommon, may be a localizing sign to the nondominant temporal lobe.