Abstracts

RATIONALE:Although studies have been done to evaluate the localizing significance of both ictal and immediate post-ictal language changes, there is little information available regarding the clinical course of language dysfunction that persists beyond the immediate post-ictal period. METHODS: The clinical recovery of language of three patients with prolonged post-ictal aphasia is described. Available information regarding their seizure pattern prior to admission, the initial type and severity of their aphasia, EEG and/or imaging correlates and outcomes is included. The literature describing recovery of post-ictal neurologic deficits is then briefly reviewed, with special attention to deficits involving language. RESULTS: Case 1: 59 yo female with metastatic mucoepidermoid carcinoma admitted for evaluation of a new global aphasia after multiple seizures at home. Case 2: 59 yo man admitted with a profound expressive aphasia after 6 pre-hospital seizures. Case 3: 61 yo man admitted with a worsening of his baseline expressive aphasia following a flurry of seizures. Each patient demonstrated a progressive course of functional recovery of language, regardless of the initial type or density of his/her aphasia. In each case, naming was the last element of language to recover, especially naming of low-frequency objects. The observed patterns of recovery of language function fit previously described patterns of post-ictal recovery, with the exception of these patients' prolonged recovery times. In each case, the total recovery time to baseline language function was longer than 48 hours, more than 12 hours greater than that seen in a prior study. CONCLUSIONS: Documentation of the course of recovery of post-ictal neurologic deficits provides clinically useful information to the practitioner, but it may also have larger significance. Although the exact etiology of post-ictal dysfunction remains unclear, future analyses of larger series of patterns of recovery may help distinguish between multiple competing theories of post-ictal dysfunction by creating a clinical timeline which must be met by each proposed mechanism.