Coprolalia as a manifestation of epileptic seizures

Andreu Massot-Tarrús; Seyed Reza Mousavi; Carin Dove; Susan Hayman-Abello S; Brent Hayman-Abello; Paul A Derry; David C Diosy; Richard S McLachlan; Jorge G Burneo; David A Steven; Seyed M Mirsattari

doi:10.1016/j.yebeh.2016.04.040

Coprolalia as a manifestation of epileptic seizures

Epilepsy Behav. 2016 Jul:60:99-106. doi: 10.1016/j.yebeh.2016.04.040. Epub 2016 May 16.

Affiliations

¹ Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.
² Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Physiology and Pharmacology, Western University, London, Ontario, Canada.
³ Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Medical Imaging, Western University, London, Ontario, Canada.
⁴ Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
⁵ Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Physiology and Pharmacology, Western University, London, Ontario, Canada; Department of Medical Imaging, Western University, London, Ontario, Canada; Department of Psychology, Western University, London, Ontario, Canada. Electronic address: smirsat2@uwo.ca.

PMID: 27195785
DOI: 10.1016/j.yebeh.2016.04.040

Abstract

Objective: The aim of this study was to investigate the lateralizing and localizing value of ictal coprolalia and brain areas involved in its production.

Methods: A retrospective search for patients manifesting ictal coprolalia was conducted in our EMU database. Continuous video-EEG recordings were reviewed, and EEG activity before and during coprolalia was analyzed using independent component analysis (ICA) technique and was compared to the seizures without coprolalia among the same patients.

Results: Nine patients were evaluated (five women), eight with intracranial video-EEG recordings (icVEEG). Four had frontal or temporal lesions, and five had normal MRIs. Six patients showed impairment in the language functions and five in the frontal executive tasks. Two hundred six seizures were reviewed (60.7% from icVEEG). Ictal coprolalia occurred in 46.6% of them, always associated with limbic auras or automatisms. They arose from the nondominant hemisphere in five patients, dominant hemisphere in three, and independently from the right and left hippocampus-parahippocampus in one. Electroencephalographic activity always involved orbitofrontal and/or mesial temporal regions of the nondominant hemisphere when coprolalia occurred. Independent component analysis of 31 seizures in seven patients showed a higher number of independent components in the nondominant hippocampus-parahippocampus before and during coprolalia and in the dominant lateral temporal region in those seizures without coprolalia (p=0.009). Five patients underwent surgery, and all five had an ILAE class 1 outcome.

Significance: Ictal coprolalia occurs in both males and females with temporal or orbitofrontal epilepsy and has a limited lateralizing value to the nondominant hemisphere but can be triggered by seizures from either hemisphere. It involves activation of the paralimbic temporal-orbitofrontal network.

Keywords: Epilepsy; Independent component analysis; Lateralization; Semiology; Surgery; Video-EEG.

MeSH terms

Adult
Automatism
Electroencephalography
Epilepsy / psychology*
Epilepsy / surgery
Epilepsy, Frontal Lobe / psychology
Epilepsy, Frontal Lobe / surgery
Epilepsy, Temporal Lobe / psychology
Epilepsy, Temporal Lobe / surgery
Female
Humans
Male
Neuropsychological Tests
Retrospective Studies
Seizures / psychology*
Seizures / surgery
Social Behavior*
Temporal Lobe / physiopathology
Temporal Lobe / surgery
Treatment Outcome
Young Adult