Reply to letter from Dr Privitera

CORRESPONDENCE Dear Sir, I was pleased to see Lebrun's ~ review of the important topic of ictal verbal behaviour. However , I believe he did not emphasize enough how careful analysis of ictal and postictal language can assist in seizure focus localization. Koerner et al 2, and later Gabr et al 3, showed that careful review of ictal and postictal language during video/EEG recorded seizures provided important lateralizing data in temporal lobe complex partial seizures (CPS). My colleagues and I extended these findings by using a simple repeatable test: we present a card with a single test phrase to patients as soon as a seizure is detected and ask them to continue reading it aloud until it is clear and correct. The time from the end of the EEG discharge to correct reading of the test phrase is <60 seconds in nondominant temporal lobe CPS and >60 second in dominant temporal lobe CPS 4. In our initial series the test accurately lateralized 104 of 105 temporal lobe seizures in 26 patients. We have now used this technique in over 1000 seizures and contrary to Lebrun's belief, postictal 'confusion' uncommonly interferes with test interpretation. In this larger series, the test has shown >90% accuracy in lateralizing temporal lobe CPS. We have published abstracts of data indicating: (1) 'atypical' patterns of postictal reading delay identified 10 of 11 patients who had right or bilateral language demonstrated by amobarbital testS; (2) frontal lobe CPS may produce ictal reading arrest, but uncommonly produce postictal reading delay >60 seconds unless there is spread to the temporal lobe6; and (3) CPS from the nondominant temporal lobe may produce nonverbal language changes such as increased pitch and flattened intonation 7. I encourage all epilepsy centres to routinely test ictal and postictal language because patterns of language impairment contain important seizure localizing information. Further study of these phenomena may also lead to better understanding of language organization and seizure pathophysiology. manifestations in lateralization of temporal lobe seizures. language dysfunc-tion in patients with atypical hemispheric language localization. The introduction by Privitera and colleagues of a simple and reliable test to assess the lateralization of the epileptogenic focus in complex partial seizures will no doubt be greatly appreciated by epileptologists. Yet, when interpreting the results of such a test with a view to gaining a better insight into the cerebral organization of language, it is desirable to make sure that …