De Novo Aphasic Status Epilepticus

Abstract

Summary:The literature contains only a handful of reports of patients with aphasia as the principal or only obvious manifestation of partial status epilepticus. Even fewer patients of this type have been well documented both clinically and by ictal EEG monitoring. We studied an otherwise healthy woman with abrupt onset of aphasia initially thought to be the result of an infarct of the left temporoparietal area. We were able to document partial status epilepticus involving the left temporoparieta1 area with EEGhideo monitoring and showed rapid reversal of the aphasic disorder with antiepileptic drug (AED) treatment. The case is presented with a review of previous reports to underscore the importance of considering this diagnosis in patients with abrupt onset of aphasia.

Transient Ischemic Attacks and Inhibitory Seizures in Elderly Patients

“…Although, overall, inhibitory seizures are considered to be infrequent, when reviewing the literature, a rather considerable number of IS cases can be found which deal with epileptic aphasia [26,27,28,29,30,31,32,33]. This indirectly confirms that, from a clinical point of view, sudden temporary speech disturbances should evoke a differential diagnosis between an IS and a TIA.…”

De novo aphasic status epilepticus as presenting symptom of multiple sclerosis

“…At times it is difficult to distinguish between ictal aphasic symptoms, postictal dysphasia and aphasia due to an underlying structural lesion. In previous reports some patients responded very poorly to antiepileptic treatment suggesting that the underlying structural lesion may have contributed to the prolonged language disturbance [1,3,4]. Rosenbaum and co-workers proposed a strict definition of ASE [3]: "the patient must be speaking during the ictus, and the speech produced must be aphasic" during the ASE.…”

Focal Hyperperfusion on ^99m Tc ECD SPECT in a Patient with Epileptic Aphasia

“…Admittedly, there are several findings that are against the diagnosis of epilepsy: gradual recovery after antiepileptic treatment, no response to intravenous diazepam and failure to demonstrate epileptiform discharges on EEG. However, 8 of the 12 patients with aphasic status reported by Grimes and Guberman [1] showed gradual improvement over days and weeks like our patient. Earlier studies also suggested that scalp EEG has limitations in diagnosing epileptic aphasia [6].…”

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Aphasia is commonly associated with epilepsy, manifesting as an aura, ictal or postictal event [1,2]. Although the diagnosis of ictal aphasia is based on EEG in most cases [3,4], ictal scalp EEG often fails to demonstrate epileptiform discharges [5], especially in nonmotor simple partial seizures such as aphasic seizure [6].

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