Ictal impending danger--"sixth sense seizures"--in patients with benign focal epileptic seizures of adolescence

PURPOSE: We describe nine consecutive patients with diagnosis of benign focal epileptic seizures of adolescence (BFSA), who experienced an ictal sensation of impending danger. MATERIALS AND METHODS: We collected nine BFSA patients after a comprehensive clinical and laboratory investigation, video-EEG analysis and neuroimaging study. RESULTS: All patients displayed a distinct electro-clinical pattern of seizures characterized by a peculiar subjective feeling of impending danger coming from behind, followed by a coordinated behavior of "head-turning" toward the danger. This feeling was described in all patients as "a shadow behind me on one side" or "something or someone behind me". All of our patients explained that, at the beginning of their seizures, they felt an early warning of a high-risk situation. Electrophysiologic data favored a frontal origin of these seizures. CONCLUSION: We have described for the first time a distinct electro-clinical pattern of seizures in the context of BFSA, characterized by the ictal feeling of early warning of a high-risk situation, which we thought to term "sixth sense seizure". In the light of current neuro-anatomical knowledge, seizure discharge within anterior cingulate cortex (ACC) structures is the likely explanation for this situation. Further studies are needed to establish if this is an electroclinical variant of BFSA or a new distinct epileptic syndrome.