Ictal swearing primarily manifests as involuntary cursing detached from social and emotional contexts, representing an exceptionally rare form of speech automatism during epileptic seizures. In this case report, we describe a patient with refractory focal temporal lobe epilepsy associated with bilateral hippocampal sclerosis, where epileptic activity originated from the right hippocampus and led to swearing when the left hippocampus and amygdala were secondarily activated. We aim to analyze the role of the bilateral paralimbic temporal network in ictal swearing and propose potential pathways for the expression of ictal swearing.
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