The effect of age and structural lesions on postictal language impairment

The duration of postictal language dysfunction following a temporal lobe complex partial seizure (TLCPS) is longer when the seizure originates in the dominant hemisphere. However, the effects of older age and the presence of a structural lesion ipsilateral to the area of origin of the seizure remain unknown. Postictal language delay (PILD) was analyzed in relation to age and presence of a structural lesion in 47 patients, 28 with dominant TLCPSs and 19 with nondominant TLCPSs (total 173 seizures). Mean ages of the groups were 32.5 years (range: 16-68) and 36.1 years (range: 21-50), respectively. Nonsclerotic structural lesions were found by magnetic resonance imaging in 13 patients, eight with seizures in the dominant hemisphere and five with seizures in the nondominant hemisphere. Age did not affect PILD regardless of the lateralization of the seizures. The presence of a structural lesion significantly prolonged PILD only in the patients with nondominant TLCPS (p = 0.019). In conclusion, the anatomical site of seizure onset may not be the only determinant of the nature of the postictal state. PILD can provide important information on seizure localization and spread.