Aphasic status epilepticus: Electroclinical correlation

Abstract

Summary Purpose: Aphasic status epilepticus (ASE) in otherwise awake patients is a rare phenomenon. We present a series of nine consecutive patients with ASE to characterize clinical, electrophysiologic, and imaging findings. Methods: Nine patients in ASE were identified between July 2006 and December 2009 at our institution. Each was evaluated by the neurology service and monitored with video‐electroencephalography (EEG) for at least 24 h. Thorough, repeated language testing was correlated with EEG findings. Key Findings: All nine patients were right‐handed with subacute or chronic left hemispheric lesions on magnetic resonance imaging (MRI). All patients had mixed aphasia, three presenting with persistent aphasia from onset and six with episodic speech impairment, which became persistent in five of the six. The initial 30‐min EEG demonstrated electrographic seizure in only five patients (56%), despite the presence of aphasia during the recording. Left hemispheric periodic lateralized epileptiform discharges (PLEDS) were seen in two patients, and left hemispheric slowing in two patients. Continuous video‐EEG monitoring confirmed electrographic seizure activity in all nine patients. Peak electrographic seizure frequency varied from continuous to once every 2 h and was not associated with fluctuations in the speech deficit. EEG seizures resolved abruptly in three patients and gradually over up to 4 days in six patients. Clinical improvement was delayed in eight of the nine patients, and four patients retained some aphasia at discharge, 2–4 days after EEG seizure resolution. Significance: Standard EEG is sensitive for detection of abnormalities in the dominant hemisphere in patients with ASE. However, continuous EEG is necessary to confirm the diagnosis and monitor treatment, since clinical symptoms do not correlate with electrographic seizure activity and do not provide sufficient information to guide treatment decisions.

Stroke‐like migraine attacks after radiation therapy: A misnomer?

“…Although negative neurologic symptoms are more classically associated with migraine, these symptoms, including aphasia, may also be associated with epilepsy. 12 The pathophysiology of SMART syndrome remains intensely debated. Radiation-induced vascular dysfunction may lead to transient, episodic symptoms seen at presentation, and may well explain the radiographic changes seen in SMART.…”

Isolated Aphasic Status Epilepticus as a Manifestation Induced by Hyperglycemia Without Ketosis

“…Continuous EEG is necessary to make a definite diagnosis of ASE and monitor subsequent treatment [7]. EEG abnormalities of ASE include epileptiform discharges, periodic lateralized epileptiform discharges, and slow waves in the left frontal, temporal, and parietal cortex [7]. Although most patients with ASE have organic brain lesions, such as tumor, vascular abnormalities, stroke, or herpes simplex virus infection, NKH-related ASE is rare, especially if isolated without other clinical seizure features [7,8].…”

“…Patients with ASE seem to have a symptomatic, often highly localized, cause for their seizures. Continuous EEG is necessary to make a definite diagnosis of ASE and monitor subsequent treatment [7]. EEG abnormalities of ASE include epileptiform discharges, periodic lateralized epileptiform discharges, and slow waves in the left frontal, temporal, and parietal cortex [7].…”

De novo status epilepticus with isolated aphasia

“…Hirsch et al [18] described apparent postictal aphasia in a patient without scalp EEG correlate as an ongoing seizure was proven by intracranial depth electrodes. Ericson et al [19] found standard EEG (30 min) in aphasic status epilepticus to be sensitive in only 5/9 (56%) patients, while continuous EEG confirmed seizure activity. Dong et al [20] showed aphasic NCSE in 5 patients with (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET), while EEG failed to show clear ictal activity.…”