GLOBAL APHASIA WITH SEIZURE ONSET IN THE DOMINANT BASAL TEMPORAL REGION

A 33-year-old right-handed woman had intractable simple and complex pa rtial seizures (SPS, CPS) that began with global aphasia. EEG closed-c ircuit TV (EEG CCTV) monitoring with sphenoidal electrodes showed left inferomesial temporal ictal onset of CPS. Subdural electrodes were im planted over the left frontotemporal convexity, subtemporally and subf rontally. Stimulation of the basotemporal cortex produced global aphas ia. A posterolaterotemporal language area was also identified. Spontan eous SPS had focal onset in the basal temporal language area (BTLA). I ctal discharges did not involve the posterotemporal region. This case shows that aphasic speech arrest at seizure onset may be due to seizur e discharge in the basotemporal region and that the BTLA is clinically relevant in seizure semiology.