Ictal Speech Manifestations in Temporal Lobe Epilepsy: A Video‐EEG Study

Abstract

To evaluate ictal speech manifestations in complex partial seizures (C PS), we reviewed videotapes of 68 consecutive patients who underwent anterior temporal lobectomy (ATL) for treatment of intractable epilepsy in Taiwan. In all, 261 CPS were collected from their video-EEG (VEEG) recordings. Cerebral speech dominance was determined by intracarotid injection of sodium amobarbital (Wada test) in all cases. Ictal speech manifestations, classified as verbalization or vocalization, occurred in 32 patients (47.1%) with 96 seizures (36.8%). Ictal verbalization occurred in 10 patients (14.7%). Ictal vocalization was observed in 28 patients (41.2%); including 6 patients who also had ictal verbalization. Thirty-six patients (52.9%) had no seizure with ictal speech manifestations. Ictal verbalization had significant lateralization value: 90% of patients with this manifestation had seizure focus in the nondominant temporal lobe (p = 0.049). Seizures of patients with ictal vocalization were not more likely to arise from either temporal lobe. We also observed bilingual patients who exclusively spoke in their mother tongue (Taiwanese) rather than the acquired language (Mandarin) in 72.2% of seizures with verbalization. This finding is significant and contrary to a commonly held notion that the acquired language is used in seizures associated with speech behaviors.

Clinical and eeg analysis of mesial and lateral temporal lobe seizures

“…Ictal speech occurred mainly during right temporal seizures as reported by others 18,34 suggesting nondominant temporal EA 18,26,35,36 . It seems to result of functional nondominant temporal lobe impairment by epileptic discharges and consequent hyperfunction of the dominant hemisphere for language 35 .…”

Foreign language ictal speech automatisms in nondominant temporal lobe epilepsy

“…1,2,4 This lateralization also seems to apply to foreign language ISA as suggested by our three patients who all had right (nondominant) TLE, and by the two other studies that reported FLISA in a total of five unilingual patients who all had right TLE. 6,7 Intracerebral EEG data were available in only one of these five other patients, and demonstrated hippocampal seizure onset. 7 However, as directly confirmed by the authors of this study, no electrode was implanted in the amygdala.…”

“…[2][3][4][5] Foreign language ISA (FLISA) is a rare phenomenon that has been reported in only five unilingual right-handed men so far, all of whom had right TLE. 6,7 We report three additional French unilingual right-handed men who presented English spoken and emotionally salient ISA, benefited from an extensive intracerebral EEG investigation showing right amygdala seizure onset, and achieved long-term seizure freedom following right temporal lobectomy. Our data, together with previous reports, suggest that FLISA are generated by an epileptic network centered over the nondominant amygdala, and reflect the specific sexual dimorphism described in that structure for emotional processing.…”

Mesial Temporal Lobe Epilepsy: A Distinct Electroclinical Subtype of Temporal Lobe Epilepsy

“…The presence or absence of speech is Downloaded by [New York University] at 13:56 21 July 2015 important. If speech occurs during the seizure, the seizure focus lateralizes to the nondominant hemisphere (most often the right hemisphere) (Yen et al 1996). Conversely, postictal aphasia or dysphasia points to involvement of the dominant hemisphere (most often the left hemisphere) (Gabr et al 1989).…”