title: Postictal language dysfunction in patients with right or bilateral hemispheric language localization.
abstract: OBJECTIVE
  As shown previously, when temporal lobe complex partial seizures (TLCPS) originate from the language dominant hemisphere, patients cannot read a test phrase correctly within 60 s of the end of the ictal discharge. We wished to assess whether postictal language testing results discordant with this pattern identified patients with non-left (right hemisphere or mixed) language dominance.
  
  
  METHODS
  Since 1988, all patients undergoing video/EEG monitoring at our institution have been given a test phrase to read aloud as soon as a seizure is detected. Inclusion criteria for this study were (a) postictal language testing within 60 s of seizure end for at least one TLCPS, (b) > 90% seizure reduction after anterior temporal lobectomy with 2-year minimum follow-up, and (c) language localization by either intracarotid amobarbital test (IAT) or direct electrical stimulation of left hemisphere cortex.
  
  
  RESULTS
  Two hundred twenty-four seizures in 64 patients were analyzed. Discordant postictal language patterns were noted in 10 of 11 patients with IAT documented non-left language dominance and in 15 of 53 with left dominance (p = 0.006; sensitivity 90.9%, specificity 71.7%).
  
  
  CONCLUSIONS
  Postictal language testing accurately identifies patients with non-left language dominance and may be useful in selecting appropriate patients for IAT.
authors.affiliation: Department of Neurology, University of Cincinnati Medical Center 45267-0525, USA.
authors.forename: M
authors.initials: M
authors.lastname: Privitera
authors.forename: C
authors.initials: C
authors.lastname: Kohler
authors.forename: W
authors.initials: W
authors.lastname: Cahill
authors.forename: H S
authors.initials: HS
authors.lastname: Yeh
mesh_terms: D000328:Adult; D000368:Aged; D000654:Amobarbital / Q000494:pharmacology; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007802:Language; D007806:Language Disorders / Q000175:diagnosis / Q000503:physiopathology; D007807:Language Tests; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D013060:Speech; D013702:Temporal Lobe / Q000601:surgery; D014743:Videotape Recording
chemical_list: D000654:Amobarbital