Cold shiver and piloerection are rare ictal signs in focal epilepsies. They are often associated with an epileptic seizure focus within the temporal lobe. In rare cases the phenomenon of piloerection has been reported to be confined to body parts ipsilateral to the seizure focus. In this multicentric study epilepsy patients with ictal cold shiver and/or piloerection were retrospectively asked to describe exactly location and spreading patterns of these signs as well as their temporal sequence in relation to other ictal signs. Clinical data, etiology of epilepsy, and seizure focus location were also assessed. In our patient group there was a high relationship to an epileptic focus within the left temporal lobe. Distinct spreading patterns or unilateral piloerection was not indicative of a focus in the ipsilateral temporal lobe as described previously. Our results suggest that phenomena of temperature dysregulation during epileptic seizures may be of value in the presurgical evaluation as they may be indicative of a left temporal lobe seizure focus.