Post-Ictal aphasia in focal Epilepsy: Speech-language pathologist Perspectives and insights

To evaluate the prevalence and speech characteristics of post-ictal aphasia (P-IA) in people with epilepsy (PWE) undergoing long-term video-EEG (VEEG) monitoring (LTM). To investigate the relationship between anatomical and electroclinical data and specific post-ictal speech deficits.

A multidisciplinary team reviewed the medical records of PWE admitted to the Epilepsy Monitoring Unit between 2017-2020, selecting those who experienced at least one seizure during LTM and underwent postictal speech assessment. Clinical data were compared between patients with and without P-IA. In P-IA group, speech analysis was conducted by transcribing communicative interactions to identify specific language deficits and explore their associations with clinical data.

From a pool of 114 PWE we included a total of 811 recorded events belonging to 77 patients. Adequate speech analysis was possible in 46 of these patients, and 20 of them exhibited P-IA. Patients with P-IA more frequently presented seizures with impaired awareness, a temporal lobe epileptogenic zone, ictal EEG patterns with contralateral diffusion and unilateral post-ictal focal slowing. With more thorough evaluation the detection rate rose from 26% in the overall cohort to 43.5%, reflecting improved diagnostic accuracy rather than a true increase in prevalence.

The likelihood of detecting P-IA increases with comprehensive post-ictal language testing. P-IA in current study showed no clear lateralizing value. The contralateral spread of seizure was the most relevant finding correlated with P-IA. More than four post-ictal language deficits were correlated with onset in the temporal lobe.