Department of Neurology, Northwestern University, Chicago, Illinois 60611, USA.
Epilepsia. 2011 Aug;52(8):1452-8. doi: 10.1111/j.1528-1167.2011.03084.x. Epub 2011 May 31.
Aphasic status epilepticus (ASE) in otherwise awake patients is a rare phenomenon. We present a series of nine consecutive patients with ASE to characterize clinical, electrophysiologic, and imaging findings.
Nine patients in ASE were identified between July 2006 and December 2009 at our institution. Each was evaluated by the neurology service and monitored with video-electroencephalography (EEG) for at least 24 h. Thorough, repeated language testing was correlated with EEG findings.
All nine patients were right-handed with subacute or chronic left hemispheric lesions on magnetic resonance imaging (MRI). All patients had mixed aphasia, three presenting with persistent aphasia from onset and six with episodic speech impairment, which became persistent in five of the six. The initial 30-min EEG demonstrated electrographic seizure in only five patients (56%), despite the presence of aphasia during the recording. Left hemispheric periodic lateralized epileptiform discharges (PLEDS) were seen in two patients, and left hemispheric slowing in two patients. Continuous video-EEG monitoring confirmed electrographic seizure activity in all nine patients. Peak electrographic seizure frequency varied from continuous to once every 2 h and was not associated with fluctuations in the speech deficit. EEG seizures resolved abruptly in three patients and gradually over up to 4 days in six patients. Clinical improvement was delayed in eight of the nine patients, and four patients retained some aphasia at discharge, 2-4 days after EEG seizure resolution.
Standard EEG is sensitive for detection of abnormalities in the dominant hemisphere in patients with ASE. However, continuous EEG is necessary to confirm the diagnosis and monitor treatment, since clinical symptoms do not correlate with electrographic seizure activity and do not provide sufficient information to guide treatment decisions.
意识清醒的失语性癫痫持续状态（ASE）较为罕见。我们报告了连续 9 例 ASE 患者，以明确其临床、电生理和影像学表现。
2006 年 7 月至 2009 年 12 月，我院共确诊 9 例 ASE 患者。所有患者均由神经内科评估，并进行至少 24 小时的视频-脑电图（EEG）监测。全面、反复的语言测试与 EEG 结果相关联。
9 例患者均为右利手，磁共振成像（MRI）显示亚急性或慢性左侧半球病变。所有患者均有混合性失语，3 例从发病开始即持续失语，6 例为间歇性言语障碍，其中 5 例最终发展为持续性言语障碍。初始 30 分钟 EEG 仅在 5 例患者（56%）中显示出电临床发作，尽管记录期间存在失语症。2 例患者出现左侧半球周期性偏侧癫痫样放电（PLEDS），2 例患者出现左侧半球缓波。连续视频-EEG 监测证实所有 9 例患者均存在电临床发作。电临床发作的峰值频率从连续发作到每 2 小时发作 1 次不等，与言语障碍的波动无关。3 例患者的电临床发作迅速终止，6 例患者的电临床发作逐渐缓解，持续时间长达 4 天。9 例患者中有 8 例临床改善延迟，4 例患者在 EEG 发作终止后 2-4 天仍有一定程度的失语症。
标准 EEG 对检测 ASE 患者优势半球异常较为敏感。然而，连续 EEG 对于确诊和监测治疗是必要的，因为临床症状与电临床发作活动不相关，并且不能提供足够的信息来指导治疗决策。
