Ictal swearing, as an epileptic manifestation, has rarely been reported. Despite its poor localization value and unclear mechanism, several previous studies have reported that it frequently originates from the temporal lobe and more often from the non-dominant hemisphere. Herein, we report a case of a 41-year-old right-handed man with a history of stereotypical manifestation of ictal swearing with a left (dominant) hemisphere origin, confirmed by video electroencephalography monitoring. Reasonable suspicion that repetitive swearing could be a manifestation of seizures is important for clinicians not to misdiagnose the disease.
Ictal swearing, a culturally taboo offensive utterance
A 41-year-old right-handed man presented with episodes of ictal swearing with loss of consciousness lasting for approximately 1 minute and occurring mostly during daytime naps at his workplace. These stereotypic episodes had started 2 months before his visit to the epilepsy clinic. He had no other significant medical history, including perinatal complications, febrile convulsions, central nervous system infections or trauma, or a family history of epilepsy.
During the 3 days of scalp video-EEG monitoring (VEM), three episodes of stereotypic seizures were recorded. Each ictal episode lasted for approximately 1 minute, and the longest was approximately 2 minutes. The seizures started with sudden awakening, followed by stereotypical swearing with “ssibal” (“fuck” in Korean) (
Ictal swearing is more common among males, with lateralization to the non-dominant hemisphere.
Ictal swearing is a verbal automatism associated with negative emotion,
In our patient, FLAIR MRI showed a high signal intensity in the left amygdala, which is thought to be a seizure-related change. Despite the lack of further imaging studies, including functional MRI, considering all the findings of symptomatic semiology, ictal EEG discharges, and MRI scans, the amygdala might be an important candidate for the pathophysiological mechanism of ictal swearing. Our case provides evidence for a possible neurophysiological process of ictal swearing. Further neuroimaging studies, including functional MRI and positron emission tomography, should be conducted to clarify the underlying mechanism.
To the best of our knowledge, this is the first case report of repetitive ictal swearing originating from the dominant hemisphere, which was concordantly localized by VEM recording and MRI findings. Our case showed that a detailed history of the presence of stereotypy of ictal events could improve diagnostic accuracy for epilepsy and reduce the probability of misdiagnosis of vocal tics or violent profanity.
Supplementary data to this article can be found online at
The seizure started with ictal swearing, followed by fumbling of the left hand and immobile posturing of the right arm. Ictal oroalimentary automatism was observed during the ictal event, followed by postictal nose wiping.
The seizure began with ictal swearing, and the automatic behavior of lip-smacking occurred during the ictal event.
The authors declare that they have no conflicts of interest.
(A) Ictal discharge started with theta activities from the left temporal area (blue arrow), followed by rhythmic delta activities in the left hemisphere. (B) Coronal sections of a T2 fluid-inversion recovery magnetic resonance imaging scan revealed a high signal intensity in the left amygdala (yellow arrow).