Abstracts

Rationale: Coprolalia is a well-known symptom of Tourette Syndrome, but to the best of our knowledge, only two English language case reports and one short serie of coprolalia associated with seizures have been published. Methods: A retrospective chart review of seven patients with ictal coprolalia has been done. Patients were compared with regard to age at onset, seizure semiology, video EEG findings, neuroimaging, epilepsy etiology, and response to treatment. Results: : 4 woman and 4 men were analyzed. Age at seizure onset ranged from 4 to 23 years. All patients met criteria for medically refractory epilepsy. Ictal coprolalia was always associated with complex partial seizures, but was never the first manifestation of seizure. Continuous scalp video electroencephalograms were available for all patients, while subdural recordings were available for seven. Seizure onset zones were in the temporal or orbitofrontal lobes, right in 5. Three patients had an underlying ganglioglioma, one a temporal cortical dysplasia, while four had normal MRI brain imaging. Five patients underwent surgery with 1A/B Engel outcome in 4. Conclusions: Ictal coprolalia lateralizes to the non-dominant hemisphere, but has poor localization and lateralizing value. We hypothesize that ictal coprolalia is indicative of seizure propagation to the limbic system. An alternative hypothesis is localization to the language network which has also been implicated in Tourette Syndrome.