Persisting aphasia as the sole manifestation of partial status epilepticus

Abstract

Objectives: Persisting aphasia presenting as an isolated inability to vocalize is an uncommon presentation of simple partial status epilepticus and only eight such cases have been reported over the past 40 years. Methods: We studied a patient with a 5-year history of recurrent episodes of inability to talk, without any other motor or cognitive impairments. Episodes lasted as long as 24 h, interictal EEGs were normal and she was diagnosed as a conversion disorder. Results: EEG recordings during one of the episodes showed continuous discharges in the right frontal and parasagital areas demonstrating the ictal nature of the deficits. During the episode the patient had no deficits of strength, or in her ability to perform skilled movements to command, imitation or manipulation of objects. Comprehension of complex verbal commands was preserved and she would make attempts to articulate words and correctly answered questions with head nodding or monosyllables, yes or no. She could hum but had no other vocalizations. Conclusions: This is the first case of aphasic status epilepticus secondary to epileptogenic discharges of the right hemisphere. The case is also unique for the isolated involvement of production of language during the seizure.