Abstracts

Rationale: 1- Isolated aphasia as the sole manifestation of non-dominant temporal lobe seizures was rarely described, especially in the absence of apparent structural lesions. 2- Although cyclic seizures are frequently reported in women during menstruation, such periodicity of seizures was not described in men. Methods: Clinical and video-EEG data study of an elderly man with periodic aphasic seizures. Results: An-83-year-old right-handed man with a two-year history of recurrent episodes of speech arrest preceded by very brief tingling sensation in the abdomen. The spells lasted for few seconds and were not associated with impairment of awareness. He has a cluster of several spells in one day; which recurs exactly every three weeks. The spells are followed by depression for several days. His symptoms were attributed to emotional stress and he was treated with antidepressants for several months without improvement. His neurological examination was normal. Work-up: He underwent prolonged video-EEG monitoring on his expected symptomatic day. Six clinical events of brief expressive aphasia were observed within seven hours. EEG recording during these events showed 4-5 Hertz rhythmic activity of right temporal lobe onset(1). Ictal EEG discharges lasted 20 to 45 seconds. No interictal EEG abnormalities were recorded. Brain MRI scan showed moderate cerebral atrophy and white matter small vessel disease(2). Treatment and follow-up: He was placed on lamotrigine and was initially seizure-free for two months after initiation of treatment. Then, seizures recurred in the same cyclic pattern, but with reduced intensity for the two following months. Lamotrigine dose was subsequently increased to 200 mg twice daily, after that, he was seizure-free for 6 weeks at the time of last follow-up visit. Conclusions: 1- Isolated aphasia can be the sole manifestation of non-dominant temporal lobe seizures in the absence of structural brain lesions. 2- Although the causes are not clear, men can experience periodic seizures.