Unusual Ictal Foreign Language Automatisms in Temporal Lobe Epilepsy

Abstract

The distinct brain regions could be specifically involved in different languages and the differences in brain activation depending on the language proficiency and on the age of language acquisition. Speech disturbances are observed in the majority of temporal lobe complex motor seizures. Ictal verbalization had significant lateralization value: 90% of patients with this manifestation had seizure focus in the non-dominant temporal lobe. Although, ictal speech automatisms are usually uttered in the patient's native language, ictal speech foreign language automatisms are unusual presentations of non-dominent temporal lobe epilepsy. The release of isolated foreign language area could be possible depending on the pattern of ictal spreading of non-dominant hemisphere. Most of the case reports in ictal speech foreign language automatisms were men. In this case report, we observed ictal foreign language automatisms in middle age Korean woman. IntroductionOver 50% of the world's population has been reported to be bilingual (i.e., theoretically presenting equal fluency in two languages). 1The epilepsy affects 1% of the population by age 20 and 3% of the population by age 75.2 Consequently, the epilepsy patients are not uncommon in bilingual population. Among the patients with epilepsy, temporal lobe epilepsy (TLE) is the most common symptomatic partial epilepsy in adolescents and adults. It represents almost two thirds of cases of intractable epilepsy managed surgically. A history of febrile seizures (especially complex febrile seizures) is common in TLE and is frequently associated with mesial temporal sclerosis (the commonest form of TLE). 3Speech disturbances are observed in the majority of temporal lobe complex motor seizures. Types of language disturbances include vocalizations, abnormal speech, ictal speech, and postictal aphasia. With verbal automatism, increased verbal outputs are often linguistically correct, reiterative, and occur spontaneously.5 It is frequently associated with seizures originating in the temporal lobe, arising from the language non-dominant side. 6 Seizure auras occur in many TLE patients and often exhibit features that are relatively specific for TLE but few are of lateralizing value. Automatisms, however, often have lateralizing significance. Careful study of seizure semiology remains invaluable in addressing the search for the seizure onset zone. 3 Our case report of foreign language ictal speech automatisms is a rare ictal sign in temporal lobe epilepsy arising from the nondominant hemisphere. CaseA 45-year-old (right-handed) Korean woman presented an abrupt motionless stare looking, altering her ability to interact with her environment and speak of foreign language. These episodes lasted a few minutes and were preceded by aura (feeling of dream and floating of the body). Furthermore, she did not remember these events during the postictal period. She has been diagnosed as complex partial seizures since 2 nd grade of middle school age. Her seizures came out 2 to 3 times per month on combin...