Persisting aphasia as the sole manifestation of partial status epilepticus

Objectives: Persisting aphasia presenting as an isolated inability to vocal ize is an uncommon presentation of simple partial status epilepticus and on ly 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 con version disorder. Results: EEG recordings during one of the episodes showed continuous discharges in the right frontal and parasagital areas demonstra ting the ictal nature of the deficits. During the episode the patient had n o deficits of strength, or in her ability to perform skilled movements to c ommand, imitation or manipulation of objects. Comprehension of complex verb al commands was preserved and she would make attempts to articulate words a nd 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 dischar ges of the right hemisphere. The case is also unique for the isolated invol vement of production of language during the seizure. (C) 2000 Elsevier scie nce B.V. All rights reserved.