Aphasic or amnesic status epilepticus detected on PET but not EEG.
OBJECTIVE
To describe five patients with ictal aphasia and one patient with ictal amnesia, who had focal positron emission tomography (PET) hypermetabolism but no clear ictal activity on electroencephalography (EEG).


METHODS
(18)F-Fluorodeoxyglucose (FDG)-PET scans with concomitant EEG were obtained in five patients with suspected ictal aphasia or ictal amnesia without ictal activity on EEG. We reviewed medical history, EEG, imaging data, and treatment outcome.


RESULTS
Brain magnetic resonance imaging (MRI) showed no structural abnormalities in any of the patients. EEG showed left temporal irregular delta activity in three patients, with aphasia and nonspecific abnormalities in two other patients, all without clear ictal pattern. All patients demonstrated focal hypermetabolism on PET scan. The hypermetabolism was in the left frontotemporal region in patients with ictal aphasia and in the bilateral hippocampal region in the patient with amnesia. Three patients who received intravenous benzodiazepines during their episodes had transient clinical improvement. With antiepileptic drug (AED) treatment, symptoms gradually resolved in all patients. Concomitant resolution of PET hypermetabolism was documented in three patients who had follow up scans. One patient with ictal aphasia later developed recurrent episodes, each with recurrent PET hypermetabolism. This patient and one other patient required immune-modulating therapy in addition to AEDs.


CONCLUSIONS
FDG-PET imaging should be considered as a diagnostic tool in patients with suspected ictal aphasia or amnesia, who fail to show clear evidence of ictal activity on EEG.
Dong
Christine
C
Department of Neurology, Vanderbilt University, Nashville, Tennessee 37232, USA.
Sriram
Subramaniam
S
Delbeke
Dominique
D
Al-Kaylani
Muhammad
M
Arain
Amir M
AM
Singh
Pradumna
P
McLean
Michael J
MJ
Abou-Khalil
Bassel
B
D000328:Adult; D000368:Aged; D000647:Amnesia / Q000000981:diagnostic imaging* / Q000188:drug therapy; D000927:Anticonvulsants / Q000627:therapeutic use; D001037:Aphasia / Q000000981:diagnostic imaging* / Q000188:drug therapy; D001786:Blood Glucose / Q000378:metabolism*; D004292:Dominance, Cerebral / Q000502:physiology; D004569:Electroencephalography; D004834:Epilepsy, Post-Traumatic / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000187:drug effects; D006624:Hippocampus / Q000000981:diagnostic imaging / Q000187:drug effects; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D049268:Positron-Emission Tomography; D013226:Status Epilepticus / Q000000981:diagnostic imaging* / Q000188:drug therapy; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000187:drug effects
D000927:Anticonvulsants; D001786:Blood Glucose; D019788:Fluorodeoxyglucose F18