Does ictal whistling help to lateralise

We present a right-handed, young female with a history of epilepsy since the age of 11. She also suffered from systemic lupus erythematosus, requiring treatment with hydoxychloroquine. The patient described no warning signs that preceded her seizures. Her seizures were associated with loss of awareness for approximately 1 min followed by post-ictal confusion for 5 min. During some of her seizures, whistling was reported by witnesses. Her seizures clustered around her menstrual cycle. She was treated with different antiepileptic medications, such as carbamazepine, phenytoin, zonisamide, pregabalin, and oxcarbazepine. Her treatment regimen upon admission to the epilepsy monitoring unit included levetiracetam, phenobarbital, and lacosamide. She was admitted for video EEG monitoring for a presurgical evaluation for refractory epilepsy. She experienced two to five seizures per month. Video EEG monitoring with telemetry revealed the timing and symptomatology of her seizures. During the five days of video EEG monitoring, two different types of seizures were recorded. Her seizures were associated with loss of awareness and whistling initiated in the left hemisphere, reaching a maximum onset in the left temporal lobe, specifically at the midtemporal region at T5 electrode. Her second type of seizures, associated with staring and unresponsiveness, were initiated in the right temporal lobe. The left temporal lobe-onset seizures initiated as rhythmic sharp theta waves in the left temporal lobe approximately 10 s after the clinical onset of whistling. The video EEG revealed a spread of the field to the right hemisphere within 10 s, followed by diffuse delta waves. Towards the end of each seizure, delta frequencies exhibited greater amplitude and laterality in the left