Postictal language function

Abstract

Language function in the postictal state can be successfully assessed and provides valuable information on seizure localization and spread. Several studies have shown that postictal paraphasic errors and ictal speech have value for seizure localization. The Cincinnati method is a simple, repeatable test that involves presenting a single test sentence on a card and asking the patient to read the sentence repeatedly until it is read correctly. It increases the yield of detecting paraphasic errors and ictal speech, and provides a quantitative measure of language recovery known as the postictal language delay, defined as the time from the end of the EEG ictal discharge until the test sentence is read correctly. This language testing method has been used for all patients admitted to the epilepsy monitoring unit at the Cincinnati Epilepsy Center for more than 20 years and has been shown to: (1) lateralize temporal lobe complex partial seizures; (2) identify when temporal lobe complex partial seizures spread to the dominant hemisphere; (3) identify patients with atypical language lateralization; (4) distinguish between temporal and frontal complex partial seizures; and (5) provide some insight into speech prosody changes in nondominant temporal lobe complex partial seizures. The method has some limitations because it requires vigilance of the patient and direct interaction by the technologist, and may be incomplete as a result of patient agitation, but has been successfully completed in more than 80% of patients admitted to the epilepsy monitoring unit. This highly cost-effective test provides important information on seizure localization and spread; is easily taught to technologists, nurses, and family members; and should be added to testing procedures in all epilepsy monitoring units.