Epileptiform activity in aphasia of childhood: an epiphenomenon?

Isolated aphasia with associated EEG epileptiform activity is a recognized syndrome in children. The relationship of the EEG abnormality and the type and severity of the speech impairment has not been well described. This relationship was studied in two children with severe expressive and receptive aphasia with generalized spike-wave discharges on EEG using prolonged EEG FM radiotelemetry and video recording (TEEG-VR). Speech was compared with 10 children with absence seizures with similar EEG abnormalities also evaluated using TEEG-VR. In addition, 43 cases of aphasia with epileptiform activity on the EEG reported in the English literature were reviewed. Speech abnormalities in absence seizures consisted of speech arrest, decreased speed of speech, and brief periods of partial or complete receptive and expressive aphasia, always directly associated with a spike-wave ictus. Speech abnormalities in acquired or congenital aphasia were not related to epileptiform activity and were characterized by severe articulation difficulties, syntactic transformation, paraphasia, and receptive and expressive aphasia. Anticonvulsants did not alter speech. Based on these two cases and the 43 others reviewed in the literature, it is proposed that epileptiform activity in this syndrome is an epiphenomenon reflecting underlying abnormalities of speech areas rather than the cause of the aphasia.