Abstracts

Preservation of speech during a complex partial seizure strongly supports seizure localization to the non-dominant hemisphere ([italic]Neurology[/italic] 1988;38:634; [italic]Ann Neurol[/italic] 1989;25:82). We previously reported a small group of patients who had ictal speech despite seizure origination in the left, language-dominant temporal lobe ([italic]Neurology[/italic] 1995;45 (Suppl 4):A180). To better explain these exceptions to the rule, we reviewed seizure propagation patterns obtained during intracranial monitoring in one of the reported patients and two patients monitored subsequently. We reviewed records of 83 patients from our 1987-2002 database who met the following criteria: (1) language-dominant, left temporal lobe determined by Wada test, (2) ictal EEG onset from the left temporal lobe with resolution of seizures following epilepsy surgery. The video/EEG telemetry records of all patients were reviewed for the presence of ictal speech. Speech was defined as clear, comprehensible words. Patients who spoke only during the aura or the post-ictal period were not included. Ictal speech was observed in six out of 83 (7%) patients (including the four reported previously). Three patients required intracranial recordings for localization. During the intracranial recordings, one patient[rsquo]s seizures demonstrated rapid propagation of the ictal discharges to the contralateral temporal area where the seizure evolved. The left temporal discharges abated quickly. The other two patients had ictal discharges that remained confined to the left inferior and medial temporal areas for approximately 120 seconds after the seizure onset without spread to classical language areas. Ictal speech is very rare in patients with complex partial seizure arising from the language-dominant, left temporal lobe. When it occurs, it is likely explained by the preservation of language areas due to unusual seizure propagation patterns.