Palilalia, echolalia, and echopraxia–palipraxia as ictal manifestations in a patient with left frontal lobe epilepsy

Abstract

Palilalia is a relatively rare pathologic speech behavior and has been reported in various neuro-logic and psychiatric disorders. We encountered a case of palilalia, echolalia, and echopraxia-palipr-axia as ictal phenomena of left frontal lobe epilepsy. A 55-year-old, right-handed man was admitted because of frequent episodes of rapid reiteration of syllables. Video-electroencephalog-raphy monitoring revealed stereotypical episodes of palilalia accompanied by rhythmic head nodding and right-arm posturing with ictal discharges over the left frontocentral area. He also displayed echo-lalia or echopraxia-palipraxia, partially responding to an examiner's stimulus. Magnetic resonance imaging revealed encephalomalacia on the left superior frontal gyrus and ictal single photon emission computed tomography showed hyperperfu-sion just above the lesion, corresponding to the left supplementary motor area (SMA), and sub-cortical nuclei. This result suggests that the neuro-anatomic substrate involved in the generation of these behaviors as ictal phenomena might exist in the SMA of the left frontal lobe. Palilalia is an unsolicited reiteration of utterances recognized as a kind of motor perseveration involving the speech mechanism, frequently occurring with stereotypic prosody, accelerated rate, elevated pitch, or decreasing volume (palilalia aphone), whereas echolalia is defined as involuntary repetition of others' utterances (Duffy, 1995; Dietl et al., 2003; Christman et al., 2004). Although rarely reported, repetitive speech behaviors such as palilalia and echolalia have occurred as ictal or postictal manifestations in seizure disorders. However, the neuroanatomic correlates of those speech behaviors as ictal phenomena have not been determined. We present a case with ictal palilalia, echolalia, and echopraxia-palipraxia arising from the left frontal lobe, which was successfully documented by video-elec-troencephalography (EEG) monitoring and neuroimaging modalities. Case A 55-year-old, right-handed man was admitted to the neurology department complaining of frequent episodes of rapid repetition of meaningless syllables. Medical history was unremarkable except for chronic alcohol addiction , and he had head trauma with scalp laceration in a drunken state 6 years ago. He did not lose consciousness or show any neurologic disturbance, such as confusion or aphasia, at that time. The patient had experienced an episode of generalized tonic-clonic seizure 7 months prior to admission, but he refused medical examination at that time and continued drinking. Four months before admission , he began to have stereotypical bouts of repetition of syllables or words, three to four times daily. A diagnosis of conversion disorder and alcohol withdrawal syndrome was made at that time by his family physician; however, the spells became more frequent and had been occurring more than 10 times daily at the time of admission. During the interictal period, the patient was fully awake, and bedside neurologic examination did not show any significant n...

Complex epileptic palilalia: A case report

“…An fMRI task of words generation, in fact, showed a normal activation pattern of primary language areas, supporting their integrity. Thus in keeping with previous interpretations, 3 we speculate that ictal activity arising from the left SMA causes a disconnection between this region and the motor speech area, altering normal reciprocal interactions between the two regions during speech processes and inducing palilalia. More specifically, we hypothesize that the story telling sequence started correctly in the language area, which is substantially intact, but disconnection from the SMA prevented the completion of the speech, triggering a continuous loop, like a 'jammed disc'.…”

“…Ictal single photon emission computed tomography detected hyperperfusion above the lesion, corresponding to the left SMA and subcortical nuclei. 3 Moreover, palilalia and echolalia were reported as a post-ictal manifestation combined with transcortical aphasia due to a left frontal parasagittal meningioma resection. 12 Consistent with literature, we believe that the epileptic focus is more reliably localized in the left SMA, rather than in the language area in our patient.…”

“…In these cases of epileptic palilalia repetition of single words or simple syllables has been reported. [1][2][3] Here we present the first case of symptomatic 'complex' epileptic palilalia in a 71-year-old patient with a previous history of intracerebral haemorrhage in the left fronto-temporal region.…”

Spontaneous synchronization of arm motion between Japanese macaques

“…Therefore, it is likely that these areas of the brain are involved in the coordination of actions. Damage to the anterior inferior part of the frontal lobe causes severe behavioural dysfunction (echopraxia or echolalia), triggering automatic gestural or vocal imitation of another person3031. These inappropriate imitations, which can also be initiated by the mirror system, might occur because of the lack of a suppression mechanism in the middle and inferior frontal cortex in these patients32.…”

Mirror Neurons, Theory of

“…In spoken discourse, for example, a natural tendency to imitate what one hears must be suppressed to sustain effective communication. A compulsive tendency to repeat heard utterances, known as echolalia, is sometimes observed, and attributed to frontal lobe deficits (e.g., Grossi et al, 2013;Cho et al, 2009). A number of studies have shown that when people are instructed to make simple finger movements in response to neutral cues, their movements are inhibited when videos of incompatible movements are presented simultaneously with the cues (e.g., Cross et al, 2013;Stürmer et al, 2000).…”