Neurology Service, Epilepsy Unit, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
Neurology Department, Hospital de Viladecans, Barcelona, Spain.
Acta Neurol Scand. 2022 May;145(5):579-589. doi: 10.1111/ane.13586. Epub 2022 Feb 7.
De novo aphasic status epilepticus (ASE) in patients without a previous history of epilepsy and without cerebral lesions (aphasic NOSE) is rare. The aim of the study is to describe its clinical characteristics, etiologies, and outcome.
MATERIALS & METHODS: Single-center study including consecutive patients presenting to the emergency department between 2011 and 2019 with acute aphasia, which was finally diagnosed as aphasic NOSE. Subsequent episodes of aphasia (>5 min) were recorded and divided into confirmed ASE and postictal aphasic episodes (non-ASE). Clinical characteristics of the two types of episodes were compared.
Nineteen patients were included, suffering fifty episodes of epileptic aphasia, episodes per patient 2.6 (range 1-7). Fifteen patients (71.4%) were women, mean age at ASE onset was 66.05 years old (SD 6.3). Nine (47%) patients died, 6 of them (66.7%) during the aphasic episode. Ictal EEG was available in 37 episodes, confirming the diagnosis of ASE in 12 episodes; in 8 episodes, the EEG fulfilled the criteria of possible ASE. The most frequent etiologies were inflammatory and vascular. Comparing ASE with non-ASE episodes, ASE was longer than non-ASE (225 vs 65 h, p .024) and was treated more frequently with BZD (76 vs 24%, p .001) but with a longer delay (22.2 vs 1.5 h, p .06).
ASE is a treatable, highly relapsing emergency, with the subsequent relapses ASE or postictal aphasia. EEG is diagnostic in half of the patients, while in others imaging techniques are also useful. Benzodiazepines should be administered. Persistent aphasia, of more than 65 hours' duration, is highly suggestive of ASE.
无癫痫既往史和脑病变的新发失语性癫痫持续状态（ASE）患者（无失语性NOS）罕见。本研究旨在描述其临床特征、病因和结局。
这是一项单中心研究，纳入了 2011 年至 2019 年期间因急性失语症就诊于急诊科的连续患者，最终诊断为失语性 NOS。记录随后持续时间超过 5 分钟的失语发作，并将其分为确诊 ASE 和发作后失语发作（非-ASE）。比较两种发作类型的临床特征。
共纳入 19 例患者，共发生 50 次癫痫性失语发作，每位患者发作 2.6 次（范围 1-7）。15 例（71.4%）为女性，ASE 发作时的平均年龄为 66.05 岁（SD 6.3）。9 例（47%）患者死亡，其中 6 例（66.7%）在失语发作期间死亡。37 次发作时可获得发作期脑电图，其中 12 次确诊为 ASE；8 次脑电图符合可能 ASE 的标准。最常见的病因是炎症性和血管性。与非-ASE 发作相比，ASE 发作时间更长（225 小时与 65 小时，p=0.024），更常使用苯二氮䓬类药物（76%与 24%，p=0.001），但起始治疗时间延迟更长（22.2 小时与 1.5 小时，p=0.06）。
ASE 是一种可治疗的、高复发的急症，随后可能会复发 ASE 或发作后失语。脑电图在一半的患者中具有诊断价值，而在其他患者中，影像学技术也很有用。应给予苯二氮䓬类药物。持续时间超过 65 小时的持续性失语高度提示 ASE。
