Coprolalia as a manifestation of epileptic seizures.

OBJECTIVE: The aim of this study was to investigate the lateralizing and localizing value of ictal coprolalia and brain areas involved in its production. METHODS: A retrospective search for patients manifesting ictal coprolalia was conducted in our EMU database. Continuous video-EEG recordings were reviewed, and EEG activity before and during coprolalia was analyzed using independent component analysis (ICA) technique and was compared to the seizures without coprolalia among the same patients. RESULTS: Nine patients were evaluated (five women), eight with intracranial video-EEG recordings (icVEEG). Four had frontal or temporal lesions, and five had normal MRIs. Six patients showed impairment in the language functions and five in the frontal executive tasks. Two hundred six seizures were reviewed (60.7% from icVEEG). Ictal coprolalia occurred in 46.6% of them, always associated with limbic auras or automatisms. They arose from the nondominant hemisphere in five patients, dominant hemisphere in three, and independently from the right and left hippocampus-parahippocampus in one. Electroencephalographic activity always involved orbitofrontal and/or mesial temporal regions of the nondominant hemisphere when coprolalia occurred. Independent component analysis of 31 seizures in seven patients showed a higher number of independent components in the nondominant hippocampus-parahippocampus before and during coprolalia and in the dominant lateral temporal region in those seizures without coprolalia (p=0.009). Five patients underwent surgery, and all five had an ILAE class 1 outcome. SIGNIFICANCE: Ictal coprolalia occurs in both males and females with temporal or orbitofrontal epilepsy and has a limited lateralizing value to the nondominant hemisphere but can be triggered by seizures from either hemisphere. It involves activation of the paralimbic temporal-orbitofrontal network.

A longitudinal study of the effects of seizure symptoms on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical interpretation.

This study investigated whether the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) items reflecting seizure symptoms spuriously inflate MMPI-2 scores in persons with epilepsy. In a repeated measures prospective design, patients with epilepsy completed the MMPI-2 prior to epilepsy surgery and again two years later when they were either seizure-free or not seizure-free. Compared to baseline scores, only seizure-free patients showed a decline in endorsement of seizure items, and only on one scale, Hypochondriasis (Hs). Clinical profiles were not meaningfully different when readministered when seizures were no longer present. Moreover, profiles generated by individuals with and without seizures were not significantly different. We conclude the MMPI-2 is a valid test in an epilepsy population, as seizure content did not alter its clinical interpretation. In using the MMPI-2 in patients with epilepsy, a modest correction on the Hs and Schizophrenia (Sc) scales is warranted in selected cases. In MMPI-2 research, assessing both statistical and clinical significance is recommended.