Ictal singing due to left frontal lobe epilepsy: a case report and review of the literature.

Ictal singing has been rarely reported and the neural networks underlying this specific symptom remain unknown. We report a nineteen-year-old man with medically refractory seizures who exhibited ictal singing and laughing. He underwent intracranial stereotactic EEG recording which demonstrated ictal activity in medial and dorsolateral regions of the left frontal lobe in the generation of ictal singing. Thereafter, a left frontal resection of the superior and middle frontal gyri made him seizure-free. Among the previously reported cases of ictal singing, the symptomatogenic zones included bilateral frontal and temporal lobes. The wide variance of ictal onset zones suggests that the mechanism of ictal singing is probably related to the recruitment of music-related neural networks in different regions of both hemispheres rather than activation of a specific cortical region.