Chronological progression of a language deficit appearing to be postictally reversible in a patient with symptomatic localization‐related epilepsy

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Abstract
A language deficit occurring interictally, with chronological progression, and postictally in a patient with symptomatic localization‐related epilepsy, which began at 1.6 years of age, is reported. The patient was a 30‐year‐old right‐handed man whose seizures seemed to originate from the left frontal lobe and to involve the left temporal lobe. The deficit in oral language consisted mainly of features of motor aphasia, including delayed initiation of speech with great effort, echolalic and palilalic tendencies, and word‐finding difficulty, but he also showed features of sensory aphasia. Written language had agraphia observed in sensory aphasia, including well‐formed letters, paraphasias, neologisms, and paragrammatism. Postictally, the language deficit appeared to be superficially reversible, and evolved from mutism through non‐fluent jargon to the interictal level of language. Analysis of the patient’s diaries from 10 to 26 years of age disclosed chronologically progressive deterioration of language with paragrammatism, showing an increase of grammatical errors, neologismus, literal and verbal paraphasias and misconstruction of sentences. The results suggest that localization‐related epilepsy of presumably left frontal lobe origin causes not only a postictal language deficit but also a slowly progressive deficit of language function.