Speech and the dominant superior frontal gyrus: Correlation of ictal symptoms, EEG, and results of surgical resection

Two patients with seizures characterized by speech arrest had astrocytoma in the superior frontal gyrus (SFG) of the left hemisphere. Preoperative video EEG monitoring of seizures using subdural electrode arrays showed that comprehension, crude vocalization, and limb and tongue movements were preserved during speech arrest. One patient had difficulty writing during seizures. Ictal EEG onset was localized to the SFG without involvement of Broca's area. Electrical stimulation of SFG electrodes reproduced the speech arrest and writing difficulty. Resection of this region reduced seizures but did not result in lasting speech deficit. Cessation of speech with electrical stimulation of the superior frontal gyrus occurs by interrupting control of muscles required for speaking, which occurs independently of simple 'negative' motor effects. We postulate that functional redundancy is the basis for resection of this region without producing significant speech deficits.