Verbal Automatism as an Atypical Manifestation of Temporal Lobe Epilepsy: A Case Report

Introduction: Language difficulties, such as verbal simulation and errors in word selection or sound production, are common during non-convulsive seizures in focal epilepsy. However, isolated speech impairment is a rare manifestation of dominant temporal lobe epilepsy (TLE), with only a limited number of cases documented in the literature. This underscores the importance of careful assessment to prevent misdiagnosis and inappropriate treatment, as these symptoms can easily be confused with other neurological or psychiatric conditions.

Methods: A systematic search of PubMed and Scopus was conducted to inform this study to identify relevant studies published up to January 2024. The focus was on cases of speech impairment associated with TLE, examining the ictal manifestations and their clinical correlations.

Results: We present the case of a 33-year-old woman who experienced a psychic aura that progressed to dialeptic seizures with loss of awareness (LOA), ultimately culminating in complex motor seizures also accompanied by LOA. This ictal speech manifestation can serve as a lateralizing sign in epilepsy, particularly when correlated with appropriate anatomical and electroclinical findings.

Conclusion : Recognizing verbal simulation as a potential indicator of TLE is crucial for distinguishing it from other conditions. This awareness can lead to earlier diagnosis and more effective treatment, ultimately improving management strategies for patients who present with speech impairments in the context of epilepsy.