Consecutive video-EEGs of 20 adult patients with generalized tonic-clonic (GTC) seizures and 20 with psychogenic nonepileptic seizures (PNES) were reviewed from the archives at University of South Florida, Tampa General Hospital, and the audio components of the recordings were analyzed and compared for all vocalizations. The ictal cry was defined as a prolonged tonic expiratory laryngeal vocalization, or a deep guttural clonic vocalization. The typical laryngeal sound had high sensitivity (85%) and specificity (100%) for epileptic GTC seizures and was not heard in any of the psychogenic cases. PNES utterances were weeping, moaning, and coughing. The ictal cry was strongly associated with epileptic GTC and warrants inquiry when taking the history from witnesses of a patient’s seizure.

In the group with epilepsy (mean age 40.2 years), 7 of 20 (41%) patients had left temporal lobe epilepsy, 4 (23%) right temporal lobe epilepsy, 3 (11%) frontal lobe epilepsy, 2 (10%) primary generalized epilepsy, and one (5.8%) symptomatic generalized epilepsy. Three GTC events without a cry were of temporal lobe origin (2 right and 1 left). [1]

COMMENT. In a history of epilepsy in Chinese traditional medicine, cited by the authors, the ictal cry was documented by scribes [2]. In centers using video-EEG, the presence or absence of an ictal cry should be of value in diagnosis of GTC vs PNES. Compared to tongue biting and urinary incontinence, having sensitivities of 23-25% for GTC (refs cited by authors), the ictal cry is of greater diagnostic value.

William Gordon Lennox, in his “Epilepsy and Related Disorders” (Boston; Little, Brown & Co, 1960, vol 1, p186), paraphrasing Gowers (1901), recounts “the epileptic cry has been compared to the scream of a distracted peacock. Only the larynx of the bird can imitate it. A parrot in the National Hospital, London, could make the nurses come running with its scream.” These descriptions aside, audio recordings of children captured in generalized tonic seizures during video-EEG might be of interest.