Ictal speech, postictal language dysfunction, and seizure lateralization

Koerner, Michael M.; Laxer, Kenneth D.

doi:10.1212/wnl.38.4.634

Cited by 69 publications

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“…2 The appearance and disappearance of aphasia, with corresponding EEG findings, confirm ictal but not post-ictal manifestations. 7 On literature review, NKH-related ASE seems to have its initial presentation as mixed aphasia, 6 the same as in our case. This kind of aphasia is similar to that of patients with left middle cerebral artery infarction, which is the leading cause of isolated aphasia, making it more difficult to establish accurate diagnosis of NKH-related ASE.…”

Section: Discussionsupporting

confidence: 69%

Isolated Aphasic Status Epilepticus as Initial Presentation of Nonketotic Hyperglycemia

et al. 2013

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Diagnosis of aphasic status epilepticus is sometimes not easy because of its rarity and electroclinical dissociation. Although most cases are associated with organic brain lesions, nonketotic hyperglycemia (NKH)-related aphasic status epilepticus is rare, especially if it is isolated (without other clinical seizure activity). On the other hand, unlike other metabolic disorders, or hypoglycemia-related generalized seizures, focal motor seizure and epilepsia partialis continua can occur in 25% of NKH, with seizures being the initial manifestation in up to 50% of patients. However, the presentation of epileptic aphasia is rare in NKH patients. We report a rare case of NKH presenting initially as persistent and isolated aphasic status epilepticus. Brain magnetic resonance imaging did not reveal any focal lesion, but ictal electroencephalography (EEG) disclosed left frontotemporal continuous theta to delta waves, intermingled with epileptiform discharges. Correcting the hyperglycemia failed to improve the language disorder, and the seizure was controlled only by the addition of carbamazepine. Patients with NKH may initially present with isolated aphasic status epilepticus. Unlike stroke-related aphasia, accurate diagnosis is difficult if based solely on neurologic examination and brain neuroimaging. Use of EEG and blood sugar determination should be helpful in this special condition.

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Section: Discussionsupporting

confidence: 69%

Isolated Aphasic Status Epilepticus as Initial Presentation of Nonketotic Hyperglycemia

et al. 2013

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“…Postictal dysphasia has repeatedly been demonstrated to be consistent with a seizure onset in the dominant hemisphere [22, [34][35][36][37]. Our results confirmed these reports.…”

Section: Discussionsupporting

confidence: 90%

The Lateralizing Value of Ictal Clinical Symptoms in Uniregional Temporal Lobe Epilepsy

Steinhoff

Schindler²,

Herrendorf³

et al. 1998

Eur Neurol

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In order to assess the lateralizing value of several ictal and postictal clinical symptoms in temporal lobe epilepsy (TLE), we analyzed 89 seizures of 20 left dominant patients with intractable left (n = 9) versus right (n = 11) TLE who had undergone successful anterior temporal lobectomy. In left TLE, movement arrest at seizure onset, postictal dysphasia >120 s and postictal dyslexia >180 s were the most typical findings and associated with a sensitivity of 94, 94, and 100%, respectively. The highest specificity of 100% each was evident for contralateral versions of eyes and head and dystonic posturing. In right TLE, the highest sensitivity was seen for whole-body movements at seizure onset, postictal dysphasia <120 s and postictal dyslexia <180 s with figures of 82, 87, and 93%, respectively. As compared to left TLE, contralateral version and dystonic posturing, ictal speech, and postictal dyslexia <180 s each had a specificity of 100%. The careful combined analysis of certain ictal clinical signs combined with consistent findings of interictal EEG and neuroimaging studies may be often sufficient to proceed with epilepsy surgery without invasive recordings even if ictal scalp EEG is not unambiguous.

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“…Useful ictal lateralizing signs in patients with temporal lobe CPS include contralateral dystonic posturing (13-16), ipsilateral manual aUtOmatisms (14) [possibly only in combination with contralateral dystonic posturing (1 5 ) 1 7 nonforced ipsilateral head deviation ( l 7)7 forced contralateral head deviation before secondarily generalized activity (13)(14)(15)17,18), contralateral immobile limb (13, 16,19), ictal speech (14,18,20,21) (nondominant hemisphere), and ictal vomiting (1 1,22) (right hemisphere). However, many patients with temporal lobe epilepsy (TLE) manifest none of these features (14,23).…”

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confidence: 99%

“…However, it is rare in TLE (23). Other postictal signs with potentially useful lateralizing information include flattened affect and prolonged disorientation to place (26) (right hemisphere), unilateral extensor plantar response (27), and postictal aphasia (14,18,20,21,23,28,30) (dominant hemisphere). Some investigators have reported that postictal aphasia appears to reflect the site of origin of the seizure independent of the subsequent spread (26,28).…”

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confidence: 99%

Postictal Nosewiping Lateralizes and Localizes to the Ipsilateral Temporal Lobe

Hirsch

Laín²,

Walczak

1998

Epilepsia

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Summary: Purpose:We observed many patients with temporal lobe epilepsy (TLE) wiping their nose postictally, usually with the hand ipsilateral to their seizure focus. We wished to determine if this had lateralizing or localizing significance.Methods: We retrospectively studied 87 patients: 47 with unilateral TLE defined by successful surgical outcome [30 with medial TLE (MTLE) and 17 with neocortical TLE (neoTLE)]; and 40 with extratemporal epilepsy (ExTLE). Videotapes of 319 complex partial seizures (CPS) without generalization were reviewed by 1 neurologist, blinded to patient identity, who recorded each episode of nosewiping and the hand with which it was performed.Results: With regard to localizing potential, postictal nosewiping (PINW) was significantly more common in patients with unilateral TLE than in those with ExTLE. In the TLE group, PINW within 60 s of electrographic seizure offset occurred in 60% of patients (28 of 47) and 43% of seizures (74 of 171). In the ExTLE group, PINW was noted in 33% of patients (13 of 40; p < 0.05 as compared with TLE) and 15% of seizures (22 of 148; p < 0.001). Similar results were obtained with PINW within 30 s of seizure offset. Although PINW was more frequent in MTLE than in neoTLE (67% of patients vs. 47%), this finding did not reach significance. With regard to lateralizing potential, in the TLE group, unilateral PINW (performed with a single hand only) within 60 s of seizure offset was observed in 53% of patients (25 of 47) and was performed with the hand ipsilateral to the seizure focus in 92% (23 of 25). Thirteen patients (9 with TLE) wiped their nose more than once with the same hand in a single seizure within 60 s of offset in 18 seizures; this was done with the hand ipsilateral to the seizure focus in all 18 instances (predictive value = 100%).Conclusions: PINW is more common in unilateral TLE, particularly MTLE, than in ExTLE. PINW performed exclusively with one hand occurs in -50% of patients with TLE and is highly predictive (92%) of seizure onset ipsilateral to the hand used, especially when it occurs repetitively. We hypothesize that ictal activation of the central autonomic nervous system, particularly the amygdala, results in ictal nasal secretions and causes nosewiping as the patient regains awareness postictally. The ipsilateral hand is used due to contralateral neglect or weakness. Key Words: Postictal nosewiping-Temporal lobe epilepsy-Semiology-Automatisms.Clinical behavior during epileptic seizures has intrigued neurologists for many years, and its study has led to the elucidation of many important clinicoanatomic correlations (1-8). The recent increase in epilepsy surgery and video/EEG (VEEG) monitoring has allowed careful study of ictal and postictal behavior in patients with well-defined seizure foci. Such studies have shown that certain features of epileptic seizures have localizing and lateralizing significance . This information is important in evaluation of patients for epilepsy surgery.Most attempts to correlate clinical behavior during compl...

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Ictal speech, postictal language dysfunction, and seizure lateralization

Cited by 69 publications

References 0 publications

Isolated Aphasic Status Epilepticus as Initial Presentation of Nonketotic Hyperglycemia

Isolated Aphasic Status Epilepticus as Initial Presentation of Nonketotic Hyperglycemia

The Lateralizing Value of Ictal Clinical Symptoms in Uniregional Temporal Lobe Epilepsy

Postictal Nosewiping Lateralizes and Localizes to the Ipsilateral Temporal Lobe

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