Epilepsyaphasia

Epilepsyaphasia is a clinical phenomenon in which aphasic language disturbances accompany epileptic seizures, most often in people with focal epilepsy affecting language-dominant networks in the left hemisphere. The disturbance may occur ictally (during seizures) or postictally (after seizures) and can range from mild word-finding difficulties to more severe language breakdown.

Common manifestations include sudden anomia, paraphasias, halting or nonfluent speech, impaired naming, and, less frequently, restricted comprehension during the ictal phase. In some cases, fluent speech is preserved but semantic or grammatical content is disrupted. Consciousness level can be preserved, altered, or reduced depending on seizure semiology and spread.

Pathophysiology involves aberrant electrical activity in language-related cortical areas (for example, the left temporal and perisylvian regions) and their connections, which disrupt real-time language processing. Network disruption and spread to adjacent regions may contribute to the spectrum of symptoms.

Diagnosis relies on clinical observation during seizures, supported by video electroencephalography (EEG) to localize ictal activity and MRI to identify structural abnormalities. Neuropsychological testing may assess baseline language function. Differential diagnoses include non-epileptic aphasia, transient ischemic attack, stroke, or psychogenic language disturbance.

Treatment focuses on controlling seizures with antiepileptic drugs, and in selected cases, epilepsy surgery or neuromodulation may improve language outcomes by reducing ictal activity in language networks. Speech-language therapy can address residual language deficits. Prognosis varies with epilepsy type and seizure control; language disturbances often improve with effective seizure management, but persistent deficits may occur in some individuals.