Bilateral lingual epilepsy following traumatic brain injury

Lingual seizures are an uncommon form of focal motor epilepsy. Although classically associated with infective, neoplastic or vascular causes, it may follow traumatic brain injury. A 37-year-old man had sustained a severe brain injury when aged 2 years. Following a generalised tonic-clonic seizure at the age of 9 years, he subsequently had brief and recurrent episodes of bilateral lingual twitching that persisted into adulthood. These events were refractory to carbamazepine, lacosamide and valproate. MR brain imaging showed cystic encephalomalacia of the left frontal operculum. Electroencephalography showed irregular and sharpened left-sided slow waves but no epileptiform activity, even during episodes of lingual twitching. Bilateral lingual seizures in this patient implied that the left operculum cortex innervated both hypoglossal nuclei.