Nonconvulsive Status Epilepticus of Frontal Origin: 2 Cases

ABSTRACT

Nonconvulsive status epilepticus (NCSE) of frontal origin is rare. The symptoms are unusual and different from that of temporal origin which makes it difficult to be diagnosed. We report two cases with NCSE of frontal origin. The first case was a 17-year-old girl who presented indifference and reduced word fluency, responsiveness, and facial expres-sion daylong with intermittent unresponsiveness and slight rightward eye and head deviations. Confusion was not noted. Electroencephalogram (EEG) showed the recurrent 2 Hz spike-wave ictal discharges on the left frontal area, sometimes spreading to the opposite side. The second case was a 57-year-old woman who had a medically intractable epilepsy. During long-term Video/EEG monitoring, the continuous 2 Hz spike-and-wave complexes were noted on the right hemisphere and the left frontal area. At that time, neurological examination including cognitive functions was normal except for a mild jaw tremor. No confusion was noted. However, she looked depressed, inactive, and affectively indifferent. Intravenous lorazepam injection abolished status EEG activities as well as clinical symptoms. Ictal single photon emission computed tomography (SPECT) showed an increased perfusion in the right frontal lobe. Cortical dysplasia was pathologically diagnosed after a right frontal lobectomy.