When aphasia is due to aphasic status epilepticus: a diagnostic challenge

Abstract

Aphasic status epilepticus is an uncommon entity that should be included in the differential diagnosis of persistent and sudden language disorders. In our study, we describe seven patients admitted with clinical and electroencephalographic diagnosis of aphasic status, who were studied with both neuroimaging and electroencephalogram. The mean age was 65.9 years (range of 39-89). Three of the patients had previously been diagnosed of epilepsy. The aphasia was global in six patients. In one case, we found foci of the left hemorrhagic contusions. The initial electroencephalogram (EEG) was not conclusive of status in two patients. In one patient, neuroimaging showed left hemispheric hypoperfusion, compatible with postictal changes. Six out of seven patients required at least two antiepileptic drugs. Three patients died of systemic complications (infectious causes), whereas the other four cases had a complete recovery. Our study highlights that a second EEG study might be necessary to confirm epileptiform activity, when clinical features and other tests suggest an epileptic origin. An early and specific treatment, avoiding or diminishing comorbidities, might significantly improve the prognosis of these patients.

Three Cases of Aphasic Status Epilepticus: Clinical and Electrographic Characteristics

“…In non-lesional cases, metabolic disturbances, such as nonketotic hyperglycemia (NKH) and aggravated uremia, or drugs, such as cefepime, are reportedly the cause of ASE. [4][5][6]13 There are some reports of cases with combined factors, that is, epileptogenic lesions along with metabolic disturbances. 10,[13][14][15] Metabolic disturbances may act as acute triggering factors for status epilepticus, lowering the seizure threshold in the epileptogenic area.…”

“…1,2 ASE can arise from various neurological or metabolic disorders. [3][4][5][6] It should be differentiated from prolonged postictal aphasia or organic brain disorders, such as stroke. ASE is usually treatable with antiepileptic drugs, but diagnostic delays may cause irreversible neuronal damage.…”

The ADAN scale: a proposed scale for pre‐hospital use to identify status epilepticus

“…We had to keep in mind that the development of ictal speech and language dysfunction, as well as eye deviation, could first suggest an acute vascular condition. However, the presence of fluctuating aphasia and additional symptoms suggestive of an epileptic etiology and the fact that the eye deviation is contralateral to the likely affected hemisphere should lead us to suspect the presence of epileptic activity. Furthermore, due to the more widespread use of multiparameter computed tomography of the brain to evaluate acute stroke, reports have emerged describing hyperperfusion in cases that actually have an epileptic origin .…”

Lateralized periodic discharges in insular status epilepticus: A case report of a periodic EEG pattern associated with ictal manifestation

“…In those contexts, routine EEG were not always conclusive for SE (Flügel et al, 2015) even though itctal EEG patterns have been reported (Patil and Oware, 2012). LPDs have been sometimes described but they have never been marked as ictal pattern even though, in some cases, a clear electro-clinical correlation was described with patient’s good clinical response to the anti-seizure therapy (Quintas et al, 2018). In the largest clinical records (Ericson et al, 2011) nine patients affected by aphasic status epilepticus have been described of whom LPDs were reported in five.…”