Abstracts

RATIONALE: Previous studies have reported that lesions in the right cerebral hemisphere can be associated with aprosodia. There has been no study to our knowledge that has described aprosodia as an ictal manifestation during an epileptic seizure.
METHODS: This is a case review of two patients admitted to our video-EEG epilepsy monitoring unit for the presurgical evaluation of epilepsy surgery who exhibited ictal aprosodia during seizures. We compared their baseline speech prosody with that during their seizures. We differentiated speech during seizures from that of epileptic auras by the presence of other clinical manifestation of seizures such as amnesia, focal motor activity, automatisms, or some alteration of awareness.
RESULTS: Patient 1 is a 23 year-old right-handed male. He had no risk factor of epilepsy. His seizure started at 2 years of age. The seizures were preceded by an olfactory aura. His seizures evolved into a stare with an arrest of activity and had some chewing movements of the jaw. During monitoring, his typical seizures were recorded. His mother had described his speech during his seizures as [dsquote]like a robot[dsquote]. The ictal EEG revealed regional seizure onset from right temporal region. He was diagnosed as right temporal lobe epilepsy based on EEG findings and a lesion in the right mesial temporal lobe on MRI.
Patient 2 is a 54 year-old right-handed female. Her seizure started at 42 years of age. Small hemorrhage from an arteriovenous malformation (AVM) in the right posterior operculum region was found. Subsequently, she underwent surgery for removal of an AVM. Eighteen months later, she started to have seizures again. The seizures started with an aura of strange feeling, followed by rapid deep breathing, goose bumps, tachycardia, and urinary urge. During two times of monitoring, her typical seizures were recorded. She was completely aware of her surroundings and her speech was fluent, but she talked as if she was lacking an affect. During these seizures she had other ictal manifestations including right eye blinking, urinary urge, goose bumps, and oral automatism. The invasive ictal EEG revealed focal ictal onset from right mesial temporal region. She was diagnosed as right temporal lobe epilepsy based on invasive EEG findings.
In these two cases, affective prosody was disturbed during ictal period while speech fluency was preserved. This characteristic of speech is considered to be aprosodia. The lateralization of the epileptogenic zone in these two cases was suspected to be in the language nondominant hemisphere although a Wada test was not performed.
CONCLUSIONS: To our knowledge this is the first report of ictal aprosodia during epileptic seizures. This ictal aprosodia was seen in the two patients with right temporal lobe epilepsy. Several lesion studies suggest that affective prosody is lateralized to the right hemisphere. Ictal aprosodia may be a lateralizing sign which suggests that the seizures is arising from nondominant hemisphere.
[Supported by: The Japan Epilepsy Research Foundation]; (Disclosure: Grant - The Japan Epilepsy Research Foundation)