Ictal Forced Repetitive Swearing in Frontal Lobe Epilepsy: Case report and review of the literature


Share / Export Citation / Email / Print / Text size:

Journal of Epileptology

Foundation of Epileptology

Subject: Medicine


eISSN: 2300-0147





Volume / Issue / page

Related articles

VOLUME 22 , ISSUE 2 (December 2014) > List of articles

Ictal Forced Repetitive Swearing in Frontal Lobe Epilepsy: Case report and review of the literature

Marjan Dolatshahi * / Alexei Yankovsky

Keywords : ictal swearing, frontal lobe epilepsy, lateralization

Citation Information : Journal of Epileptology. Volume 22, Issue 2, Pages 113-119, DOI: https://doi.org/10.1515/joepi-2015-0019

License : (CC BY 4.0)

Received Date : 27-August-2014 / Accepted: 05-November-2014 / Published Online: 14-November-2014



Introduction. Dominant presentation of ictal forced repetitive swearing has been rarely addressed and could be misdiagnosed.

Case report. We report a 45-year-old man with a long history of right frontal lobe epilepsy (FLE) who developed forced repetitive swearing during hypermotor seizures. His seizures were refractory to different antiepileptic drugs (AEDs). Scalp video-EEG telemetry suggested a right frontal epileptic focus. Magnetic resonance imaging (MRI) suggested focal cortical dysplasia (FCD) in the right mesial frontal lobe. Intracranial implantation with video-EEG recordings confirmed seizures originating from the MRI lesion. Patient underwent right frontal lobe resection followed by seizure freedom in the last five years on a single AED. Neuropathology confirmed FCD type IIB.

Discussion. The following aspects of the case are discussed: FLE and ictal vocalization, swearing, FLE and aggression. We emphasize the differences among ictal vocalisation, verbal automatism and ictal speech. We propose that ictal swearing might fit a verbal automatism definition.

Conclusion. Ictal forced repetitive swearing can be a manifestation of hypermotor seizures in FLE and should not be misdiagnosed.

Content not available PDF Share



Bonelli S.B., Lurger S., Zimprich F., Stogmann E., Assem-Hilger E., Baumgartner C.: Clinical seizure lateralization in frontal lobe epilepsy. Epilepsia, 2007, 48: 517–523.


Birca V., Tayah T., Saint-Hilaire J.M., Nguyen D.K.: Ictal swearing: a case series and review. Epileptic Disord., 2013, 15: 377–381.


Chase R.A., Cullen J.K., Niedermeyer E.F.L., Stark R.E., Blumer D.P.: Ictal speech automatisms and swearing: studies on the auditory feedback control of speech. Journal of Nervous & Mental Disease, 1967, 144: 406–420.


Delgado-Escueta A.V., Mattson R.H., King L., Goldensohn E.S., Spiegel H., Madsen J. et al.: Special report. The nature of aggression during epileptic seizures. N. Engl. J. Med., 1981, 305: 711–716.


Georgiou N., Bradshaw J.L., Phillips J.G., Bradshaw J.A., Chiu E.: Advance information and movement sequencing in Gilles de la Tourette’s syndrome. J. Neurol., Neurosurg. & Psychiatry, 1995, 58: 184–191.


Harlow J.M.: Recovery from a passage of an iron bar through the head. Publications of the Massachusetts Medical Society, 1868, 2: 328–347.


Janszky J., Fogarasi A., Jokeit H., Ebner A.: Are ictal vocalizations related to the lateralisation of frontal lobe epilepsy? J. Neurol. Neurosurg. & Psychiatry, 2000, 69: 244–247.


Jobst B.C., Seigel A.M., Thadani V.M., Roberts D.W., Rhode N.H.C., Williamson P.D.: Intractable seizures of frontal lobe origin: clinical characteristics, localizing signs, and results of surgery. Epilepsia, 2000, 41: 1139–1152.


Manford M., Fish D.R., Shovron S.D.: An analysis of clinical seizure patterns and their localizing value in frontal and temporal lobe epilepsies. Brain, 1996, 119: 17–40.


Marsh L., Krauss G.L.: Aggression and violence in patients with epilepsy. Epilepsy Behav., 2000, 1: 160–168.


Mula M.: Epilepsy-induced behavioral changes during the ictal phase. Epilepsy Behav., 2014, 30: 14–16.


Shih J.J., LeslieMazwi T., Falcao G., Van Gerpen J.: Directed aggressive behavior in frontal lobe epilepsy: a video-EEG and ictal spect case study. Neurology, 2009, 73: 1804–1806.


Speedie L.J., Wertman E., Ta’ir J., Heilman K.M.: Disruption of automatic speech following a right basal ganglia lesion. Neurology, 1993, 43: 1768–1774.


Stephens R., Atkins J., Kingston A.: Swearing as a response to pain. Neuroreport, 2009, 20: 1056–1560.


Sumer M.M., Atik L., Unal A., Emre U., Atasoy H.T.: Frontal lobe epilepsy presented as ictal aggression. Neurol. Sci., 2007, 28: 48–51.


Treiman D.M.: Epilepsy and violence: medical and legal issues. Epilepsia, 1986, 27 (Suppl. 2): 77–104.


Van Lancker D., Cummings J.L.: Expletives: neurolinguistics and neurobehavioral perspectives on swearing. Brain Res. Rev., 1999, 31: 83–104.


Van Lancker D., Nicklay C.: Comprehension of personally relevant (PERL) versus novel language in two globally aphasic patients. Aphasiology, 1992, 6: 37–61.


Williamson P.D., Thadani V.M., French J.A., Darcey T.M., Mattson R.H., Spencer S.S. et al.: Medial temporal lobe epilepsy: videotape analysis of objective clinical seizure characteristics. Epilepsia, 1998, 39: 1182–1188.


Williamson P.D., Spencer D.D., Spencer S.S., Novelly R.A., Mattson R.H.: Complex partial seizures of frontal lobe origin. Ann. Neurol., 1985, 18: 497–504.


Yen D., Su M.S., Yiu C.H., Shih Y.H., Kwan S.Y., Tsai C.P. et al.: Ictal speech manifestations in temporal lobe epilepsy: A video- EEG study. Epilepsia, 1996, 37: 45–49.