Recurrent aphasic status epilepticus after prolonged generalized tonic-clonic seizures versus a special feature of Todd's paralysis |
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| Authors: | Rösche J Schley A Schwesinger A Grossmann A Mach H Benecke R Walter U |
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| Institution: | 1. Neurophysiology and Experimental Neuroethology Laboratory, Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, USP, Ribeirão Preto, Brazil;2. Epilepsy Surgery Center, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, USP, Ribeirão Preto, Brazil;3. Physics Department, Ribeirão Preto School of Philosophy, Science and Letters, University of São Paulo, USP, Ribeirão Preto, Brazil;1. Departments of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA;2. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA |
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| Abstract: | Postictal aphasia may be a feature of Todd's paralysis or the presentation of aphasic nonconvulsive status epilepticus (NCSE). We describe a 74-year-old woman with three episodes of aphasic status epilepticus after prolonged generalized tonic-clonic seizures. In the first episode, the NCSE was not definitively diagnosed, but an increase in the epileptic medication led to resolution of the epileptic activity within 2 weeks. During the second episode, NCSE was terminated within 7 days under intensified antiepileptic treatment. In the third episode, phenytoin treatment led to intoxication and resulted in further treatment on an intensive care unit. The patient required several months to recover from this episode. NCSE in the elderly is difficult to recognize, especially when it presents as a prolonged postictal deficit like aphasia. Once diagnosed it has to be treated carefully, because in the elderly, aggressive treatment strategies may be associated with a high risk of adverse events. |
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