Foreign language ictal speech automatisms in nondominant temporal lobe epilepsy

Background: Foreign language ictal speech automatism (FLISA) is a rare ictal sign that has been hitherto reported in five unilingual patients, all right handed men with right temporal lobe epilepsy (TLE), only one of whom has benefited from an intracerebral EEG investigation. Methods: We report three unilingual French patients who consistently presented English spoken ictal speech automatisms and were investigated with intracerebral EEG recordings. Results: All three patients were right-handed men with nondominant TLE originating in the right amygdala. However, FLISA only occurred when the ictal EEG discharge spread to the ipsilateral temporal neocortex or frontal operculum. In addition, FLISA were emotionally salient, referring to the patient's parents or to the intensity of the ongoing seizure. Conclusion: Our findings, together with previously published data, suggest that foreign language ictal speech automatisms are more likely to occur in men with nondominant amygdala onset seizures, an observation that might reflect the sexual dimorphism observed in the right amygdala during emotional processing. Neurology (R) 2008; 71: 1579-1585