Cognitive Deficits during Status Epilepticus and Time Course of Recovery: A Case Report

Abstract

Summary:We describe a young woman with progressive cognitive and neurological deficits during a parietal lobe status epilepticus (SE). Ictal FDG-PET showed left parietal lobe hypermetabolism and frontal lobe hypometabolism with concomitant EEG slowing. Cognitive and neurological deficits fully reversed more than 1 year after seizure remission, and were associated with normalization of FDG-PET and EEG. Our findings suggest that ictal hypometabolism and EEG delta activity at a distance from the epileptic focus were seizure-related phenomena, possibly representing inhibition in seizure propagation pathways, which could be responsible for the epileptic encephalopathy. Key Words: Epileptic encephalopathyCognition-Epilepsy-Surround inhibition-FDG-PET.An epileptic encephalopathy is characterized by uncontrolled epileptic seizures associated with cognitive deterioration, and can occur both in children (Wirrell et al., 2005) and adults (Dodrill 2002;Helmstaedter et al., 2003;Thompson and Duncan 2005). The cause of the cognitive deterioration is unknown and may be due to antiepileptic drugs (AEDs), neuronal cell loss, the underlying etiology of the epilepsy or as a direct effect of seizures and epileptic activity. We describe a patient with prolonged status epilepticus (SE) and progressive cognitive deterioration, which slowly reversed after the control of epileptic seizures. We present evidence that this cognitive decline may be a seizure-related phenomenon, characterized by FDG-PET hypometabolism and EEG delta activity at a distance from the ictal onset zone, which we have called the surround inhibition zone (Nelissen et al., 2006;Van Paesschen et al., 2007). CASE DESCRIPTIONThe patient was a 25-year-old right-handed woman. Her gestation and birth were uneventful. She did not have a his-

Severe Hemispatial Neglect as a Manifestation of Seizures and Nonconvulsive Status Epilepticus

“…EEG recordings in our patients did not localize the seizures unequivocally, but the clinical manifestations suggest that the right parietal lobe was involved, possibly by spread from the "epileptogenic" to the "symptomatogenic" region (Tufenkjian and Lüders, 2012). Even with deficits that are localized clearly by clinical evaluation, the causative lesions, as shown by MRI scans, can be at a distance (van Paesschen et al, 2007;Toledo et al, 2008), and radiologic, and EEG findings may be modest in proportion to the severity of the clinical syndrome at the time.…”

“…Most begin with somatosensory auras though they may spread to become tonic seizures or complex partial seizures (Williamson et al, 1992). Some include by symptoms of abnormal lateralized somatosensory perception (van Paesschen et al, 2007;Williamson et al, 1992), body image, or even ictal pain syndromes (Salanova et al, 1995;Siegel et al, 1999). Some have vertiginous sensations, complex visual or auditory hallucinations, aphasia, or tonic posturing (Salanova et al, 1995).…”

“…Some have vertiginous sensations, complex visual or auditory hallucinations, aphasia, or tonic posturing (Salanova et al, 1995). Recovery can be quite prolonged, with cognitive deficits lasting up to months after the seizures cease, possibly related to long-lasting hypometabolism (van Paesschen et al, 2007). The slow recovery could be the cognitive or sensory equivalent of a "Todd paralysis."…”

The First Record of Biological Activities of the Egyptian Red Algal Species Compsopogon helwanii

“…The genome is constantly exposed to agents, both exogenous and endogenous that damage DNA leading to mutations involving different base substitution, chromosome breaks, deletions---etc [30]. Consequently it is very important to determine these agents and other agents that protect against them.…”

The uncontrollable shaking arm

“…It is not unexpected that FDG would accumulate in seizure foci if the duration of the seizure is sufficiently prolonged (e.g. status epilepticus) and there are case reports to testify to this phenomenon [4].As opposed to photopenia, which is typically associated with seizure foci in FDG PET brain imaging, increased uptake is the norm in many FDG PET brain tumour evaluations [5]. Moreover, the degree of FDG avidity has been useful in assessing brain tumour grade; the degree of uptake serves as a marker of the grade and potential aggressiveness of at least some brain neoplasms.…”