Speech arrest as sole presenting symptom of midline seizures – A case report

Speech arrest without impaired awareness poses diagnostic challenges with a broad differential. We describe the case of a 63-year-old male with chronic alcohol use, HIV, and diabetes who presented with speech arrest episodes with midline seizures identified on the electroencephalogram despite normal imaging. The patient’s condition was successfully managed with anti-epileptic medications. This case highlights the diagnostic complexity of midline seizures, particularly in patients with ambiguous clinical presentations. • Central lead epileptiform discharges are rare without clear clinical presentations. • Midline seizures can present solely as speech arrest without impaired awareness. • Speech arrest localizes to the supplementary motor area and inferior frontal gyrus.