Ictal neuropsychological findings in focal nonconvulsive status epilepticus

Abstract

Objective This study was intended to describe the neuropsychological phenomenology of focal nonconvulsive status epilepticus (NCSE). Methods Ictal, postictal, and interictal neuropsychological testing (NPT) was performed on six patients who developed NCSE during video/electroencephalographic monitoring in the context of presurgical evaluation. Results Neuropsychological impairments were marked in four of six and discrete in two of six patients. The majority of patients had selective rather than global neuropsychological deficits. The most important deficits involved consciousness, speech, praxis, cognitive functions, and affect. Impairment of consciousness was characterized by reduced vigilance, reactivity, and orientation. Some patients exhibited combined deficits of several higher cognitive functions (apraxia, acalculia, alexia, and aphasia with or without additional memory disturbance). Several patients had relatively subtle expressive or receptive aphasia. More severe language deficits were associated with reduced vigilance. Speech deficits may have caused poor performance in other areas evaluated with NPT. Conclusion NPT demonstrated that focal NCSE can be associated with pleomorphic but often discrete neuropsychological deficits.