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Ictal Forced Repetitive Swearing in Frontal Lobe Epilepsy: Case report and review of the literature

100%
Dolatshahi M., Yankovsky A.
Journal of Epileptology
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2014
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vol. 22
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issue 2
113-119
EN
Introduction. Dominant presentation of ictal forced repetitive swearing has been rarely addressed and could be misdiagnosed. Case report. We report a 45-year-old man with a long history of right frontal lobe epilepsy (FLE) who developed forced repetitive swearing during hypermotor seizures. His seizures were refractory to different antiepileptic drugs (AEDs). Scalp video-EEG telemetry suggested a right frontal epileptic focus. Magnetic resonance imaging (MRI) suggested focal cortical dysplasia (FCD) in the right mesial frontal lobe. Intracranial implantation with video-EEG recordings confirmed seizures originating from the MRI lesion. Patient underwent right frontal lobe resection followed by seizure freedom in the last five years on a single AED. Neuropathology confirmed FCD type IIB. Discussion. The following aspects of the case are discussed: FLE and ictal vocalization, swearing, FLE and aggression. We emphasize the differences among ictal vocalisation, verbal automatism and ictal speech. We propose that ictal swearing might fit a verbal automatism definition. Conclusion. Ictal forced repetitive swearing can be a manifestation of hypermotor seizures in FLE and should not be misdiagnosed.
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Neurobiological and clinical predictors of remission and antiepileptic treatment efficacy in partial epilepsies

63%
Kalinin V. V., Zemlyanaya A. A., Zheleznova E. V., Sokolova L. V.
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vol. 21
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issue 1
15-25
EN
Introduction.The current knowledge of significance of some neurobiological and clinical variables in the prediction of remission length and seizures reduction in partial epilepsies remains sparse and even controversial. Aim. The current study has been carried out in order to evaluate the possible relationship between epilepsy forms, gender, focus lateralization and handedness with therapeutic remission and seizures reduction during antiepileptic treatment in persons with partial forms of epilepsy. Material and methods. One hundred and eight patients were studied. Handedness was evaluated using the Annett's scale. Focus lateralization was detected by use of the EEG. Of the patients studied temporal lobe epilepsy (TLE) was diagnosed in 61 cases and frontal lobe epilepsy (FLE) in 47 cases. There were 44 men and 64 women, of which 83 were right-handed and 25 were left-handed. A left-sided focus was detected in 59 persons whilst a right-sided focus was noted in 49 persons. MANOVA was used for the analysis of interrelationship between four nominal fixed factors (epilepsy forms, gender, handedness, and focus laterality) and dependent variables of therapeutic remission and percentage seizures reduction. Results. A favorable prognostic significance of FLE vs TLE was observed. In contrast gender, handedness, and focus laterality had no influence on the dependent variables when analyzed separately. However, when two, three and four independent variables were combined an influence on the dependent variables was observed; and some combinations may be used for prediction purposes of therapeutic remission and percentage in seizure reduction. The FLE in the men with the right-handedness and the left focus (FLE • M • Rh • LF) resulted in the maximal length of therapeutic remission and maximal seizures reduction, while the other combinations have resulted in less favorable treatment results. The TLE • M • Rh • RF and TLE • M • Lh • LF were the worst combinations for the remission length and TLE • Fe • Lh • LF for the seizures reduction. Conclusions. The current study revealed the significance of combinations of some neurobiological and clinical variables in prediction of therapeutic remission and percent of seizures reduction irrespective of used antiepileptic drugs. These results may be used so as to aid patient selection before drug treatment in order to form the homogenous groups of persons.
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