Global Aphasia with Seizure Onset in the Dominant Basal Temporal Region

Abstract

A 33-year-old right-handed woman had intractable simple and complex partial seizures (SPS, CPS) that began with global aphasia. EEG closed-circuit TV (EEG-CCTV) monitoring with sphenoidal electrodes showed left inferomesial temporal ictal onset of CPS. Subdural electrodes were implanted over the left frontotemporal convexity, subtemporally and subfrontally. Stimulation of the basotemporal cortex produced global aphasia. A posterolaterotemporal language area was also identified. Spontaneous SPS had focal onset in the basal temporal language area (BTLA). Ictal discharges did not involve the posterotemporal region. This case shows that aphasic speech arrest at seizure onset may be due to seizure discharge in the basotemporal region and that the BTLA is clinically relevant in seizure semiology.

Nonconvulsive status epilepticus presenting as a subacute progressive aphasia

“…Language disturbance associated with electrical stimulation of the BTLA ranges from isolated anomia to global aphasia 14 . Abou-Khalil et al also reported a patient with global aphasia resulting from a seizure focus in the left basal temporal region 16 . An alternative account for the global aphasia might be that the patient had temporal lobe seizures resulting in postictal dysphasia due to the spread of the ictal and postictal dysfunction into the language centers in the left hemisphere.…”

Seizure‐associated aphasia has good lateralizing but poor localizing significance

“…Anatomically, speech areas are located in the dominant frontal and temporal lobe . Not surprisingly, SAA has been reported in frontal and temporal epilepsies (Table ) . However, these studies included mostly patients with temporal and frontal epilepsies.…”