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Cognitive Manifestations of Focal Status Epilepticus

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Status Epilepticus

Part of the book series: Current Clinical Neurology ((CCNEU))

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Abstract

The cognitive manifestations of focal status epilepticus can vary widely, ranging from narrow deficits in specific cognitive domains (e.g., hemineglect, alexia, or acalculia) to seemingly pure psychiatric symptoms (such as psychosis or unrelenting fear) that offer greater challenges for precise localization. Recognizing that focal status epilepticus may underlie acute or subacute neurocognitive symptoms requires a high index of suspicion: a history of associated seizure symptoms (such as recent convulsions or paroxysmal psychic features) may or may not be obtained. Accurate diagnosis requires the timely confirmation of simultaneous epileptiform findings on electroencephalography (EEG) (usually on continuous video EEG), a test that is often considered only after focal ischemia is effectively ruled out. Associated EEG changes may span the ictal–interictal continuum from frequent definite focal seizures to diffuse intermittent rhythmic slowing. In certain situations, EEG may be complemented by other neuroimaging modalities that can show focal hypermetabolism, such as positron emission tomography. Ultimately, demonstrating symptom resolution with an anticonvulsant trial may be the only clue to the presence of a potentially deep-seated active and symptomatic ictal focus. This chapter provides a broad overview of the cognitive manifestations of focal status epilepticus by summarizing illustrative examples of case reports and case series. Particular emphasis is placed on the prototypical examples of “ictal” aphasia, amnesia, and psychosis.

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Authors and Affiliations

  1. Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Neurology, 330 Brookline Avenue, Boston, MA, 02210, USA

    Vaishnav Krishnan, Frank W. Drislane & Michael G. Benatar

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  1. Vaishnav Krishnan
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  2. Frank W. Drislane
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  3. Michael G. Benatar
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Correspondence to Vaishnav Krishnan .

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Editors and Affiliations

  1. Department of Neurology, Harvard Medical School, Comprehensive Epilepsy Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Frank W. Drislane

  2. Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA

    Peter W. Kaplan MBBS

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Krishnan, V., Drislane, F.W., Benatar, M.G. (2018). Cognitive Manifestations of Focal Status Epilepticus. In: Drislane, F., Kaplan MBBS, P. (eds) Status Epilepticus. Current Clinical Neurology. Springer, Cham. https://doi.org/10.1007/978-3-319-58200-9_21

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  • DOI: https://doi.org/10.1007/978-3-319-58200-9_21

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