Localizing value of verbal automatisms, vocal automatisms, singing, and humming: A systematic review

Vsiansky V, Pail M, Brazdil M.

Epileptic Disord. 2026 Aug 1. doi: 10.1002/epd2.70361. Epub ahead of print. PMID: 42541352.

Q3

14 Aug 2026

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Objective: We performed a systematic review of the localizing and lateralizing value of verbal automatisms, vocal automatisms, ictal singing, and humming in focal epilepsy with the view to summarize the state-of-the-art clinico-anatomical correlations in the field and help guide interpretation of ictal semiology within the framework of presurgical evaluation.

Methods: A systematic review of the published evidence according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement was conducted. We performed a database search in PubMed and Embase with keywords vocalizations, vocal automatisms, verbal automatisms, singing, and humming combined with seizure or epilepsy. Obtained studies that met the eligibility criteria were evaluated for risk of bias in a QUADAS2-based approach and assessed for epileptogenic zone and lateralization confidence level. Relevant data from these studies were meta-analyzed using a random-effects model.

Results: A total of 44 studies consisting of video-EEG series, surgical series, case reports and case series were included in this review. Vocal automatisms were significantly more common in frontal lobe epilepsy (summary proportion = 0.41, 95% CI = 0.36-0.47) compared to temporal lobe epilepsy (0.30, 95% CI = 0.22-0.37; p = 0.019). 


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