Recurrent Utterance as a Verbal Automatism in a Patient with Temporal Lobe Epilepsy

Analysis of Ictal Depth EEG

Abstract

We analysed recurrent utterances recorded four times during the simultaneous video-EEG monitoring in a candidate for the temporal lobe resection because of intractable temporal lobe epilepsy. The recurrent utterances occured as a manifestation of complex focal seizures and belonged to the type II verbal automatism. The analysis revealed several distinct features of the recurrent utterances: the recurrent utterances did not consist of simple reiteration of the same phrase, but recurred again and again in a variety of combination; neologisms were mixed with the recurring phrases; the verbal automatisms alwa ys ended in the recurring phrases; the staring phrases of verbal automatism were sometimes echolalia of the preceding conversations, which could perseverate during the course of verbal automatism; right hippocampal tonic discharge in depth EEC, electrodes corresponded with the recurrent utterances. These features contradicted Critchley's view of ictal speech manifestation as “tics audibles” and indicated the striking similarity between aphasic recurrent utterrance and the epileptic recurrent utterance.We proposed the disinhibition of the automatic use of words in aphasia and the stimulation of the automatic use of words in verbal automatism as a possible mechanism underlying recurrent utterances.