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09.11.2019 | Case Report - Functional Neurosurgery - Epilepsy | Ausgabe 12/2019

Acta Neurochirurgica 12/2019

Ictal swearing network confirmed by stereoencephalography: a case report

Acta Neurochirurgica > Ausgabe 12/2019
Huaqiang Zhang, Di Wang, Liankun Ren, Xiaotong Fan, Yongzhi Shan, Guoguang Zhao
Wichtige Hinweise
This article is part of the Topical Collection on Functional Neurosurgery - Epilepsy


Huaqiang Zhang et al. are providing us with the interesting case report of an epileptic patient presenting with ictal swearing bringing argument in favor of the frontoorbital origin of this semiology or at least the involvement of this cortical region. It is well known that correlating univocally one clinical symptom to a specific area of the brain is always a dangerous exercise due to the network organization of the brain. Swearing is also a key symptom in a different neurological disease which is the Tourette syndrome. Sudden, stereotypic explosive coprolalic short sentences are likely to involve subcortical motor scheme.
Like pointed by the authors in Tourette syndrome several studies have underlined both the role of prefrontal cortex and cortical-basal ganglia circuit abnormalities 1. The VIP1 area in the hypothalamic area in connection with the tegmental periaqueductal area has been demonstrated in diverse animals to generate vocalization 2. The activation of the equivalent of this hypothalamo-mesencephalic circuitry in human has been suspected to play a role in the ictal laugh observed frequently in hypothalamic hamartomas
Jean Régis
Marseille, France
1.Worbe Y, Lehericy S, Hartmann A. Neuroimaging of tic genesis: present status and future perspectives. Mov Disord 2015; 30:1179-1183.
2.Celio MR, Babalian A, Ha QH, et al. Efferent connections of the parvalbumin-positive (PV1) nucleus in the lateral hypothalamus of rodents. J Comp Neurol 2013;521:3133-3153.

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Ictal swearing, characterized by episodic utterance of deistic, visceral and other taboo words and phrases, is a rare manifestation of epilepsy. Limited manifestation of that elucidate neural network about manifestation of. Here we report a 43-year-old right-handed man who has suffered from refractory epilepsy manifestation of ictal swearing. The stereoencephalography(SEEG) investigation located the seizure onset zone in left orbito-frontal cortex and the involvement of left orbito-frontal and right hippocampus in the propagation of epileptic activities. Surgical resection has made the patient seizure-free. The present case gives us better understanding of these ictal phenomena and helps to optimize the placement of SEEG electrodes in refractory epilepsy patient with ictal swearing.

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