Ictal urinary urge is a clinical manifestation of intense desire to urinate, which corresponds with ictal EEG changes during that time. Here we present two intractable epilepsy cases that had ictal urinary urge localized by stereo-electroencephalogram (sEEG).

By analyzing both scalp EEG and invasive subdural EEG monitoring, several authors have previously described this ictal urination phenomenon as a lateralizing and localizing sign to the non-dominant temporal lobe. 

The first patient was a 49-year-old female presenting with axial tonic seizures, occasionally associated with fencing posture.  Ictal urinary urgency was triggered during ES of the right mesial frontal region, at the junction of the anterior and mid-cingulate gyrus.  The second patient was a 20-year-old female presenting with seizures preceded by ictal urinary urgency. Urinary urge was triggered by stimulating the dominant hemisphere in the mesial frontal region.  One seizure was triggered with the typical semiology stimulating the left parietal operculum in close proximity to the middle insula.  

To our knowledge, this is the first time that ictal urinary urge has been observed and triggered by stimulation via sEEG in the literature.  In both cases, we were able to reproduce urinary urgency with ES of the mesial frontal region (anterior cingulate); however, in dominant and non-dominant hemispheres.  During ES of the second case we provoked a seizure with typical semiology including urinary urge as the first manifestation after ES at the junction between the parietal operculum/posterior insula with rapid involvement of the mesial frontal/anterior cingulate or contiguous spread to the insula may explain the elicited symptom.

In summary, our study suggests that ictal urinary urgency is not always associated with non-dominant temporal lobe epilepsy as many other locations as above could play an important role in localization. Our findings can provide addition information for epileptologists when planning intracranial implantation in refractory epilepsy cases.