Speech Preservation during Language‐dominant, Left Temporal Lobe Seizures: Report of a Rare, Potentially Misleading Finding

Purpose: To evaluate the prevalence and mechanism of ictal speech in patients with language‐dominant, left temporal lobe seizures. Methods: We retrospectively reviewed the video‐EEG telemetry records for the presence of ictal speech in 96 patients with surgically proven left temporal lobe epilepsy and studied the seizure‐propagation patterns in three patients who required intracranial EEG recordings for seizure localization. Results: Ictal speech preservation was observed in five patients. One patient's seizures demonstrated rapid propagation of the ictal discharges to the contralateral temporal area where the seizure evolved, resembling a nondominant temporal lobe seizure. The other two patients had ictal discharges that remained confined to the inferomesial temporal areas, sparing language cortex. Conclusions: Preservation of speech in complex partial seizures of language‐dominant, left temporal lobe origin is rare. Based on intracranial EEG recordings, the likely mechanism underlying this potentially misleading clinical finding is the preservation of language areas due to limited seizure‐propagation patterns.