Aphasic status epilepticus as the sole symptom of epilepsy: A case report and literature review

Qiu, Jiqing; Cui, Yu; Sun, Lichao; Zhu, Zhanpeng

doi:10.3892/etm.2017.4979

Cited by 13 publications

(13 citation statements)

References 27 publications

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“…While NCSE with coma or impaired awareness is notorious for poor neurological prognoses, verbal disturbance caused by ASE normally resolves, even if improvement is gradual. [2,4,12] However, in a recent study, approximately 30% of patients with ASE developed mild-to-moderate aphasia, which is consistent with our case. [1] Given that the etiology of ASE includes malignant brain tumors, stroke, and encephalitis, it is usually difficult to determine whether verbal disturbance is solely due to epileptic activities.…”

Section: Discussionsupporting

confidence: 92%

Verbal and memory deficits caused by aphasic status epilepticus after resection of a left temporal lobe glioma

Kamogawa¹,

Ikegaya²,

Miyake³

et al. 2021

Surgical Neurology International

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Background: Nonconvulsive status epilepticus (NCSE) is induced by common neurosurgical conditions, for example, trauma, stroke, tumors, and surgical interventions in the brain. The aggressiveness of the treatment for NCSE depends on its neurological prognosis. Aphasic status epilepticus (ASE) is a subtype of focal NCSE without consciousness impairment. The impact of ASE on neurological prognosis is poorly documented. We describe a case of postoperative ASE resulting in verbal and memory deficits. Case Description: A 54-year-old, right-handed man with focal impaired awareness seizures underwent partial resection for a left temporal lobe tumor. No neurological deficits were observed immediately after surgery. Three days later, however, a focal to bilateral tonic-clonic seizure (FBTCS) occurred, followed by aphasia. Electroencephalography revealed 1.5 Hz left-sided periodic discharges. He was diagnosed with ASE. Multiple anti-seizure drugs were ineffective for the resolution of the patient’s verbal disturbance. Nine days after the FBTCS, deep sedation with intravenous anesthetics was performed and the ASE stopped. Thereafter, his symptoms gradually improved. However, the prolonged ASE resulted in verbal and memory deficits. Automated hippocampal volumetry revealed an approximate decrease of 20% on the diseased side on magnetic resonance imaging 3 months after surgery. Conclusion: Prolonged ASE can induce verbal and memory deficits. Early intervention with intravenous anesthetics is required to obtain a favorable neurological prognosis.

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Section: Discussionsupporting

confidence: 92%

Verbal and memory deficits caused by aphasic status epilepticus after resection of a left temporal lobe glioma

Kamogawa¹,

Ikegaya²,

Miyake³

et al. 2021

Surgical Neurology International

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“…The types of aphasia are variable: Broca's, Wernicke's, or global aphasia are all possible types of ASE. [10][11][12][13] Lesional cases constitute most instances of ASE, but non-lesional cases, though rare, have also been reported. 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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…[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. Most patients respond well to antiepileptic drugs, but some are intractable to antiepileptic drugs and need other treatment, such as resective surgery.…”

Section: Discussionmentioning

confidence: 99%

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Three Cases of Aphasic Status Epilepticus: Clinical and Electrographic Characteristics

Lee

Park

Kang

et al. 2021

Clin Med Insights Case Rep

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Aphasic status epilepticus (ASE) is unusual and has clinical characteristics similar to those of other disorders. Herein, we report 3 cases of ASE. A left-handed man (patient 1) showed continuous aphasia after the administration of flumazenil. He had underlying alcoholic liver cirrhosis and traumatic brain lesions in the right hemisphere. Electroencephalography (EEG) revealed periodic epileptiform discharges in the right frontotemporal area, which were intervened by rhythmic activity with spatiotemporal evolutions. A right-handed woman (patient 2) showed recurrent aphasia. Blood tests revealed a high blood glucose level (546 mg/dL) and high serum osmolality (309 mMol/L). Her EEG showed rhythmic activity in the left frontotemporal area with spatiotemporal evolutions on a normal background rhythm. She became seizure-free after the administration of an antiepileptic drug and strict glucose regulation. A right-handed woman (patient 3) developed subacute aphasia a week before hospital admission. She had a gradual decline of cognition 1 year before. Her EEG showed intermittent quasi-rhythmic fast activity in the frontotemporal area bilaterally, with fluctuating frequency and amplitude. The patient became seizure-free after the administration of an antiepileptic drug. Brain single-photon emission tomography performed after seizure control showed decreased perfusion in the left frontotemporal area. After discharge, her cognitive function gradually declined to a severe state of dementia. ASE can be caused by diverse etiologies; it is usually caused by cerebral lesions and less frequently by non-lesional etiologies or degenerative disorders. Adequate treatment of underlying disorders and seizures is critical for curing the symptoms of ASE.

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“…In Germany, it is assumed that about 70,000 people suffer from aphasia (8). Aphasic syndromes are frequently seen in stroke caused by lesions of the dominant hemisphere (3); however, they can also be caused by trauma, epilepsy, or degenerative diseases (9). The effect of "standard" speech therapy in patients with aphasia is already scientifically proven (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Follow-Up in Aphasia Caused by Acute Stroke in a Prospective, Randomized, Clinical, and Experimental Controlled Noninvasive Study With an iPad-Based App (Neolexon®): Study Protocol of the Lexi Study

Thunstedt

Young²,

Küpper

et al. 2020

Front. Neurol.

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Rationale: Treatment of aphasia is still challenging for clinicians and patients. So far, there is proven evidence for "face-to-face" speech therapy. However, the digital age potentially offers new and complementary strategies that may add to treatment outcome in a cost-effective way. Neolexon ® is a commercial tablet-based software for treatment of aphasia, which can be applied with the help of a therapist or as self-training by the patient. Aims and hypothesis: In the Lexi study, we aim to determine whether treatment with Neolexon ® is superior to standard therapy in acute post-stroke aphasia. Sample size estimates: A sample size of 180 patients, 90 for each group, will be included with an assumed dropout rate of ∼20%. Methods and design: Prospective, randomized, parallel group, open-label, blinded-endpoint clinical, and experimental controlled non-invasive trial (PROBE). Adult German native speakers with acute aphasia after stroke are included. Computer-generated, blocked, and stratified randomization by aphasia severity will assign patients to one of two groups: 4 weeks of either standard logopedic speech therapy or logopedic speech therapy with the app version of Neolexon ®. Both groups will be instructed in self-training: the frequency and duration of self-training will be documented. Screening for aphasia will be performed using the Language Screening Test (LAST). The severity of aphasia in general and in subitems will be assessed using the Bielefelder Aphasie Screening (BIAS) and the Aphasia Check List (ACL). Follow-up will be assessed after 3 months. Study outcomes: Based on the consensus in our study team, we considered a 10% mean difference in the change of percentile rank (PR) of BIAS to be a minimal and clinically Thunstedt et al. The Tablet-Based Lexi Study important difference. The primary endpoint is defined as a significant difference in BIAS comparing the two groups. Differences in quality of life, Beck Depression Inventory (BDI), and modified Ranking Scale (mRS) will be evaluated as secondary outcome parameters. Discussion: This trial will determine whether speech therapy with the use of Neolexon ® is superior to standard logopedic therapy. Subgroups with the greatest response to Neolexon ® will be described. The trial was prospectively registered on the "EU Clinical Trials Register" (NCT04080817) 1 .

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Aphasic status epilepticus as the sole symptom of epilepsy: A case report and literature review

Cited by 13 publications

References 27 publications

Verbal and memory deficits caused by aphasic status epilepticus after resection of a left temporal lobe glioma

Verbal and memory deficits caused by aphasic status epilepticus after resection of a left temporal lobe glioma

Three Cases of Aphasic Status Epilepticus: Clinical and Electrographic Characteristics

Follow-Up in Aphasia Caused by Acute Stroke in a Prospective, Randomized, Clinical, and Experimental Controlled Noninvasive Study With an iPad-Based App (Neolexon®): Study Protocol of the Lexi Study

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