POSTICTAL LANGUAGE DYSFUNCTION IN PATIENTS WITH RIGHT OR BILATERAL HEMISPHERIC LANGUAGE LOCALIZATION

Purpose: As shown previously, when temporal lobe complex partial seizu res (TLCPS) originate from the language dominant hemisphere, patients cannot read a test phrase correctly within 60 s of the end of the icta l discharge. We wished to assess whether postictal language testing re sults discordant with this pattern identified patients with non-left ( right hemisphere or mixed) language dominance. Methods: Since 1988, al l patients undergoing video/EEG monitoring at our institution have bee n given a test phrase to read aloud as soon as a seizure is detected. Inclusion criteria for this study were (a) postictal language testing within 60 s of seizure end for at least one TLCPS, (b) >90% seizure re duction after anterior temporal lobectomy with 2-year minimum follow-u p, and (c) language localization by either intracarotid amobarbital te st (IAT) or direct electrical stimulation of left hemisphere cortex. R esults: Two hundred twenty-four seizures in 64 patients were analyzed. Discordant postictal language patterns were noted in 10 of 11 patient s with IAT documented non-left language dominance and in 15 of 53 with left dominance (p = 0.006; sensitivity 90.9%, specificity 71.7%). Con clusions: Postictal language testing accurately identifies patients wi th non-left language dominance and may be useful in selecting appropri ate patients for IAT.