ABSTRACT
A specific cognitive status epilepticus (e.g. aphasic status epilepticus) can occur occasionally, but the commoner and best known of purely or mainly cognitive manifestations are those subsumed under the term nonconvulsive status epilepticus (NCSE). This corresponds to a prolonged alteration of the mental state with continuous or sub-continuous generalized spikes or spike-wave discharges on the EEG. The prototype is absence status (petit mal status, spike-wave stupor, minor epileptic status),13,14 where there is clouding of awareness but, presumably, no specific cognitive deficit. Apathy, drowsiness, slowness, inattention, perplexity, strange affect, amnesia, slow speech are the most obvious abnormal behaviors. It is not clear to what degree higher-level mental functions are truly preserved and what new memories can be formed during these episodes: detailed studies are rare.15
These NCSE can be phases in primary generalized epilepsies, but may be manifestations of complex partial status epilepticus of temporal or frontal origin.15 In temporal partial status epilepticus, only limited purposeful organized activity and responses to outside stimuli are possible and there is usually a total amnesia for the period. The epileptic nature is recognized by the presence, often subtle, of automatic motor behavior and vegetative phenomena.16,17 A special form of frequent refractory nonconvulsive partial status epilepticus, associated with ring chromosome 20, is probably of frontal origin and, because it is so frequent, should allow exploration of the affected and preserved behaviors and memories during seizures.18,19
