Abstracts

Rationale: We investigated how ictal and postictal aphasia are distributed among focal epilepsy syndromes. Methods: We retrospectively analyzed the EEG-video-monitoring-data of 1204 patients with epilepsy who underwent continuous EEG-video-monitoring. Statistical analysis included chi-square-analysis or Fisher's exact test. Results: We identified 104 of 1204 patients (8.5%) in whom ictal aphasia or postictal aphasia was part of their recorded seizures or who reported aphasia by history. In 59 patients (4.9%) aphasia was recorded during EEG-video-monitoring. Of these patients, 41 had aphasic seizures and 18 postictal aphasia. The remaining 43 patients (3.6%) reported aphasia by history only. Aphasic seizures occurred more often (94.3% vs. 5.7%; p<0.001) in patients with epileptic seizures originating in the left hemisphere. Most of the patients with recorded aphasic seizures (58.5%) had temporal lobe epilepsy, 22% focal epilepsy, 9.8% frontal lobe epilepsy, 7.3% parietal lobe epilepsy and 2.4% occipital lobe epilepsy. The distribution among the epilepsy syndromes was statistically significantly different (p<0.005). 423 of all patients had temporal lobe epilepsy. In 24 (5.7%) of these patients aphasic seizures were recorded, 7 (1.7%) had postictal aphasia and 21 (5%) reported aphasia by history only. Among 190 frontal lobe epilepsy patients 4 (2.1%) showed an aphasic seizure in EEG-video-monitoring, 1 (0.5%) had postictal aphasia and 8 (4.2%) aphasia in history. 477 patients were diagnosed as focal epilepsy. In 9 (1.9%) of those aphasic seizures were recorded, 9 (1.9%) had postical aphasia and 11 (2.3%) mentioned aphasia in history. 18 patients had occipital lobe epilepsy. In one patient (5.6%) an aphasic seizure occurred and one patient (5.6%) reported aphasia in history. Among 15 parietal lobe epilepsy patients 3 patients (20%) had aphasic seizures and one patient (6.7%) postictal aphasia. 2 of 81 patients (2.5%) with generalized epilepsies reported aphasia in history. There was no significant difference among the occurrence of postictal aphasia in different epilepsy syndromes (p=0.058) but most of the patients with postictal aphasia f had temporal lobe (38.9%) epilepsy. Conclusions: In conclusion, ictal and postictal aphasia occur most frequently in temporal lobe epilepsy, especially when arising from the left hemisphere. The presence of aphasia in medical history can add useful information in detecting temporal lobe epilepsy but it has to be taken into account that aphasia can be easily confused by laymen with impaired consciousness or postictal confusion of the patient (4.7% had generalized epilepsy). This study demonstrates that aphasic seizures can significantly help to identify patients with temporal lobe epilepsy.