Ictal Coprolalia in a Patient With Temporal Lobe Epilepsy ( C )

Background: The association between epilepsy and behavioral symptoms has attracted the attention of neurologists and psychiatrists since the nineteenth century, however many aspects of this relationship remain controversial. We report the case of an 8-year-old girl with temporal lobe epilepsy who presented with ictal coprophenomena, as well as multimodal hallucinations and aggressive behaviors. Case history: “A.B.” was referred to the Department of Pediatrics and Child Neuropsychiatry at the age of 8 years for pharmaco-resistant epilepsy. Following normal psychomotor development, at the age of 6 she developed polymorphic seizures, mainly characterized by absences and drop attacks. One year later, A.B.’s epilepsy worsened, as she developed ictal coprolalia and copropraxia, occasionally associated with visual and auditory hallucinations, plus prolonged motor manifestations, including forced touching and aggressive outbursts. Electroencephalographic video monitoring documented the association between temporal sharp-waves and ictal coprolalia. Magnetic Resonance Spectroscopy revealed an increase of Cho (Cho/Cr) at the level of both temporal lobes and a peak of mI in the right temporal lobe, without significant reductions in the concentration of NAA. Following anti-epileptic medication review, A.B.’s seizures gradually improved with the introduction of lamotrigine. Conclusions: A.B.’s clinical phenomenology, neurophysiological abnormalities, and metabolite profiles alterations suggest an evolving pathological process affecting the mesial temporal lobe and resulting in an unusual clinical presentation. Specifically, the presence of coprolalia and copropraxia as ictal epileptic phenomena has rarely been reported in middle childhood. This case highlights possible shared pathways for the expression of complex partial seizures, ictal alterations of consciousness, and socially inappropriate behaviors.