Abstract Details

Title Neuro-Tongue: Tongue Signs in Clinical Epilepsy

Topic Epilepsy

Presentation(s) P07 - (-)

Poster/Presentation
Number 178

Objective

Background BACKGROUND: Case 1: A 43 year old man with left fronto-parietal oligodendroglioma, grade II, resected 11 years prior, presents with dysarthria without aphasia after gastro-intestinal illness. Anticonvulsant therapy had been tapered off over two years. Last seizure was 2009. After a pot-luck dinner, vomiting and diarrhea continued for 36 hours. In the ED, baseline right hemi-paresis was denser and he had new dysarthria. Levetiracetam was restarted, but dysarthria persisted. He sought neurological consultation due to dysarthria preventing him from working as an attorney. Case 2: A 37 year old woman presents with uncontrolled complex partial seizures and longstanding tongue lesions despite many specialist evaluations and biopsies.

Design/Methods DESIGN/METHODS: Two clinical cases are described along with pertinent EEG's, photos, and pathology. Detailed clinical notes and examinations are described.

Results RESULTS: Case 1: The attorney's exam was similar to his baseline with more prominent right facial and right hemiparesis. He was alert,and able to name, read,and write.His tongue was curled in a dystonic "S" position. EEG recorded focal status epilepticus over the left parietal spreading to left temporal regions. The patient was effectively treated with anti-epilepsy medications. Dysarthria and tongue dystonia remitted. Follow up EEG returned to post-operative baseline of left temporal-parietal slowing. Case 2: After stopping primidone, tongue lesions resolved.

Conclusions CONCLUSIONS: Case 1: Focal status epilepticus in an alert patient may have an unusual presentation as in this dystonic tongue. EEG confirms epileptiform activity and is a useful tool for following patient complaints of "lazy" tongue. Seizures should be considered in differential diagnosis of unusual tongue dystonia. Case 2: Primidone has been associated rarely with tongue lesions. When confronting historic anti-epilepsy medications it is useful to research adverse effects which may have a different spectrum than modern therapies.

Authors/Disclosures
Linda R. Kaplan, MD (Linda R. Kaplan MD) PRESENTER	No disclosure on file
	No disclosure on file

��ɫ��

��ɫ��