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Ictal pain in focal non-convulsive status epilepticus
  1. Sara Casciato,
  2. Alessandra Morano,
  3. Jinane Fattouch,
  4. Martina Fanella,
  5. Mariarita Albini,
  6. Anna Teresa Giallonardo,
  7. Carlo Di Bonaventura
  1. Epilepsy Unit, Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
  1. Correspondence to Dr Carlo Di Bonaventura, Department of Neurology and Psychiatry, University of Rome ‘Sapienza’ Viale dell’Università, 3000185 Rome, Italy; c_dibonaventura{at}


We report an adult with acute unilateral pain as isolated manifestation of acute symptomatic focal non-convulsive status epilepticus. Pain is rarely a manifestation of epileptic seizures. Traditionally, painful seizures have been thought to originate in either the parietal or temporal lobes, but their localising value is debatable. Recent functional neuroimaging studies and electrophysiological findings obtained by using intracerebral recordings have shown the involvement of the insular cortex along with several other brain structures in the processing of painful inputs, comprising a more widespread anatomo-functional network. Despite their rarity as a distinct clinical entity, especially in adults, painful somatosensory seizures can be disabling and misdiagnosis or delayed diagnosis is common; it is therefore essential to consider epilepsy as a possible cause of paroxysmal pain to ensure proper assessment and appropriate treatment.

  • ictal pain
  • epilepsy
  • painful seizures
  • NCSE
  • Video-EEG

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  • Contributors CDB, SC and ATG conceived the study and helped to draft the manuscript. JF, MA and MF contributed to clinical, EEG and neuroimaging data collection. SC, CDB and AM participated in writing the manuscript. All authors agreed to accept equal responsibility for the accuracy of the content of the paper. All authors read and approved the final version of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained

  • Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Robert Powell, Swansea, UK.

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