{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T11:04:55Z","timestamp":1779879895959,"version":"3.53.1"},"reference-count":57,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epileptic Disorders"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Clinical observation of autonomic signs during seizures can aid in localizing the epileptogenic zone (EZ). We performed a systematic review and meta\u2010analysis to evaluate the localizing value of ictal cutaneous phenomena\u2014piloerection, sweating, pallor, and flushing\u2014in focal epilepsy and their relevance to presurgical evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA guidelines, a systematic search of PubMed and EMBASE was conducted up to June 1, 2025. We included studies describing spontaneous ictal cutaneous signs identified via video\u2010EEG in patients with focal epilepsy. We assessed risk of bias using QUADAS\u20102, confidence in EZ localization, and certainty of evidence using GRADE. A meta\u2010analysis was performed to calculate summary odds estimates where data were available.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Piloerection (31 studies; 100 patients) exhibited the most robust evidence, with 92% of patients showing temporal lobe involvement (High GRADE evidence). Ictal pallor (3 studies; 13 patients) was strongly associated with temporal lobe epilepsy (76.9%), showing a specific tendency toward left\u2010sided lateralization and favorable post\u2010surgical outcomes. Flushing (4 studies; 9 patients) was associated with posterior quadrant involvement (High GRADE evidence), whereas evidence linking it to the temporal lobe was of low GRADE. Ictal sweating (9 studies; 11 patients) was primarily observed in temporal lobe cases, but conclusions were limited by insufficient surgical validation and high heterogeneity. Most of the included literature consisted of case reports, with a high risk of selection and assessment bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Ictal cutaneous symptoms offer distinct localizing utility in epilepsy. Piloerection and pallor serve as reliable \u201cred flags\u201d for temporal lobe involvement, whereas flushing is indicative of a posterior quadrant origin. Despite the limitations of current evidence\u2014primarily retrospective case reports\u2014these autonomic signs provide valuable supporting data for multimodal localization of the epileptogenic zone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epd2.70284","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T10:27:08Z","timestamp":1779877628000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Localizing value of cutaneous ictal phenomena: A systematic review"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7345-4300","authenticated-orcid":false,"given":"R.","family":"Rocamora","sequence":"first","affiliation":[{"name":"Epilepsy Reference Center, Department of Neurology, Hospital del Mar Epilepsy Research Group, Hospital del Mar Medical Research Institute (IMIM)  Barcelona Spain"},{"name":"Department of Medicine and Life Sciences Universitat Pompeu Fabra  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Vilella","sequence":"additional","affiliation":[{"name":"Epilepsy Reference Center, Department of Neurology, Hospital del Mar Epilepsy Research Group, Hospital del Mar Medical Research Institute (IMIM)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Panad\u00e9s\u2010De Oliveira","sequence":"additional","affiliation":[{"name":"Epilepsy Reference Center, Department of Neurology, Hospital del Mar Epilepsy Research Group, Hospital del Mar Medical Research Institute (IMIM)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"\u00c1lvarez\u2010G\u00f3mez","sequence":"additional","affiliation":[{"name":"Epilepsy Reference Center, Department of Neurology, Hospital del Mar Epilepsy Research Group, Hospital del Mar Medical Research Institute (IMIM)  Barcelona 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Austria"},{"name":"Department of Neurology, Neurocritical Care and Neurorehabilitation, Christian Doppler University Hospital, Centre of Cognitive Neuroscience Paracelsus Medical University  Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Zucca","sequence":"additional","affiliation":[{"name":"Epilepsy Reference Center, Department of Neurology, Hospital del Mar Epilepsy Research Group, Hospital del Mar Medical Research Institute (IMIM)  Barcelona Spain"},{"name":"Department of Engineering Universitat Pompeu Fabra  Barcelona 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