Speech arrest as an ictal phenomenon can be a part of benign Rolandic epilepsy (77). A seizure of this childhood syndrome may involve movements of the mouth, trembling of the chin and tongue, decreased swallowing with drooling, or difficulty in moving the tongue. Speech arrest may begin at seizure onset or evolve after the utterance of a few words. This can more often reflect a simple motor phenomenon than a language involvement.
Speech can also be affected in other childhood epileptic syndromes such as Landau-Kleffner syndrome and the syndrome of continuous spikes and waves during slow wave sleep (CSWS). Whereas the latter manifests as widespread regression, the former typically begins with auditory verbal agnosia (a dyscognitive
A frontal "pseudo-absence" epileptic seizure. The patient is seen twisting a bottle cap on and off again. He was able to nod and smile or look around appropriately during the seizure. Several subclinical seizures of this nature were recorded lasting 8 to 10 minutes (reproduced from video). The EEG corresponding to the Figure in 4a (at green vertical line) is shown. This seizure started with 10 Hz activity on the left, at Fp1-F7, followed by rapid propagation to the right frontal lobe and left temporal lobe. A dipole source analysis of single spikes suggested a primary focus in the deep left medial frontal region, with a secondary focus that includes the right cingulate providing a better fit in flurries of spikes. LFF = 0.1; HFF = 30 Hz.
seizure). The language disorder may be steadily progressive or become incrementally severe with relapses. The child may be misdiagnosed as hearing impaired or autistic (77).
Sometimes, speech involvement can be quite subtle, as case study #9 illustrates.
Case Study #9. A 9-year-old boy with a previous history of complex partial seizures was brought for evaluation of new onset stuttering. Initially, the differential diagnosis included antiepileptic medication effect, developmental language disorder, or parental anxiety. An EEG was subsequently performed. Bisynchronous centrotemporal spike and wave discharges of 1 to 2 sec duration were corre lated with stuttering. Speech returned to normal in-between discharges.
Aphasic epileptic seizures, which can eminate from either Broca's or Wernicke's area have been described in adults, mistaken initially for TIAs or strokes (78-82). Once again, this may be the only manifestation of a seizure.
On the other hand, phonatory seizures (vocal -1.1.11) can also rarely occur in isolation. This can take the form of speech automatisms. Pallilalic vocalizations, primitive sounds, or single repeated words can arise from frontal or cingulate seizures (64,71). Nonfluent vocalizations can arise from the dominant or nondomi-
This patient with hypermotor seizures including pallilalic vocalizations is seen as she begins to cry out and thrash about (reproduced from video). This seizure began with rhythmic, low-voltage, fast activity in the left frontal area with rapid bilateral propagation. The video picture was taken at the green line.
nant cortex (80), and neologisms can occur (81). If the speech is of a generally fluent nature, the nondominant hemisphere is implicated (24).
Case Study #10. A 55-year-old woman had a history of epileptic seizures controlled since age 35. She also carried a diagnosis of chronic schizophrenia, although she had married, had children, and worked successfully for years before the appearance of a new seizure type. These events, characterized by grabbing her head in her hands, calling out "Oh my, oh my," or other phrases repetitively, and thrashing about were felt to be consistent with nonepileptiform seizures. Video-EEG revealed their true epileptic nature (Figure 3.5a and b).
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