Ictal coprolalia occurs due to the activation of the temporal-orbitofrontal network in patients with epilepsy.

PURPOSE

The aim of this study was to investigate the lateralizing and localizing value of ictal coprolalia.

METHODS

A retrospective study for patients who had ictal coprolalia was conducted. Continuous video-EEG were reviewed, and scalp EEG and intracranial electroencephalography (IEEG) were analyzed.

RESULTS

Five patients with ictal coprolalia were evaluated, four with implantation of intracranial electrodes. Twenty-eight seizures were reviewed, and ictal coprolalia occurred in 25 (89.3%) of them. Scalp interictal EEG showed that spikes appeared in bilateral temporal (n = 4) and in contralateral temporal lobe (n = 1). Scalp ictal EEG showed that epileptic discharges appeared in right temporal (n = 4) or electromyographical artifact in full channels (n = 1). After intracranial electrodes implantation, nineteen seizures were recorded and ictal coprolalia occurred in 15 (78.9%) of the seizures. The IEEG showed that the ictal activity always involved orbitofrontal and/or mesial temporal regions of the right hemisphere, and when coprolalia occurred, the IEEG activity propagated to the left temporal lobe in patients 1, 3, and 4. The period of precoprolalia after IEEG onset was longer (mean 29.1 s) than after scalp EEG onset (mean, 2.8 s). All the patients were seizure-free for 28.8 months at last follow-up.

CONCLUSION

Ictal coprolalia occurs more commonly in temporal or orbitofrontal epilepsy, and it seems to have a limited lateralizing value.