Abstracts

Rationale: Aphasia as sole clinical manifestation of epilepsy is a rare phenomenon. We aim to study the epileptic aphasias diagnosed in our hospital. Methods: Ictal aphasia was considered as language production with aphasic features in conscious patients. Episodes were classified as status epilepticus or simple partial seizures according to ILAE guidelines, and may present as Broca, Wernicke or mixed aphasia. All patients were diagnosed based on clinical features plus EEG findings or clear response to antiepileptic drugs (AED), with exclusion of acute stroke on MRI. We analyzed demographic, clinical and EEG features, response to treatment and evolution. Results: Ten women (100%), mean age of 66.6 years old (±12,84). Three had history of epilepsy. Five patients presented with mixed aphasia, 4 with Broca and 1 with Wernicke aphasia. In 9 cases an EEG was obtained during the episode: 4 demonstrated left electroencephalographic seizure activity and other 4, left hemisphere slowing. 6 patients met the clinical definition of status epilepticus. MRI was normal in 40%. Benzodiazepines were used as first-line AED in all cases, with clinical response in 4, EEG response in 1 and both in 2. All patients clinically improved with AEDs (LEV 70%). In the follow-up, 7 cases achieved an excellent control and 3 recurred. Conclusions: The diagnosis of epileptic aphasia is challenging. An epileptic etiology should be considered in the differential diagnosis of episodic speech errors. Ictal EEG findings and response to AEDs are useful in the diagnosis and management.