Ictal nausea with vomiting as the major symptom of simple partial seizures: electroencephalographic and magnetoencephalographic analysis

Autonomic symptoms and signs rarely occur as isolated phenomena without impaired consciousness. Ictal nausea with vomiting is a rare clinical manifestation of seizures. Ictal vomiting is considered a localizing sign in patients with partial seizures of temporal origin. We encountered two patients with simple partial seizures that produced nausea with vomiting as the sole symptom, and we describe the interictal electroencephalographic and magnetoencephalographic findings. The episodes were paroxysmal and stereotypical in nature, and patients showed symptomatic response to a trial of antiepilepsy medication. In both patients, the diagnosis was simple partial seizures with autonomic symptomatology. Although interictal electroencephalography did not reveal focal spikes and focal slowing, estimated magnetoencephalographic dipoles were clustered in the parietal lobe. Interictal magnetoencephalographic foci may serve only as subsidiary evidence for the parietal origin of the episodes. However, our findings provide evidence of additional involvement of the parietal lobe in ictal vomiting.