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Epileptic encephalopathy with continuous spikes and waves in the occipito‐temporal region during slow‐wave sleep in two patients with acquired Kanji dysgraphia
Author(s) -
Kuki Ichiro,
Kawawaki Hisashi,
Okazaki Shin,
Ikeda Hiroko,
Tomiwa Kiyotaka
Publication year - 2014
Publication title -
epileptic disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.673
H-Index - 53
eISSN - 1950-6945
pISSN - 1294-9361
DOI - 10.1684/epd.2014.0698
Subject(s) - psychology , temporal lobe , dysgraphia , neuroscience , temporal cortex , audiology , medicine , epilepsy , dyslexia , reading (process) , political science , law
We encountered two patients with acquired Kanji dysgraphia in whom continuous spikes and waves, dominant in the occipito‐temporal region, were recorded during slow‐wave sleep. Electrical status epileptics during sleep (ESES) was demonstrated on overnight electroencephalography, and dipoles clustered in and around the posterior inferior temporal cortex on magnetoencephalography. Functional neuroimaging suggested dysfunction in the left posterior temporal lobe, including the posterior inferior temporal cortex. The patients had normal intelligence with no problems in reading and writing Kana, as well as copying, reading aloud, and identifying Kanjis, but showed Kanji dysgraphia (morphological, phonemic, and semantic error) accompanied by impaired visual processing. ESES was resolved by sodium valproate, clonazepam, and acetazolamide in Patient 1, and by adrenocorticotropic hormone, sodium valproate, and clorazepate in Patient 2. The present cases had the unique cognitive dysfunction of Kanji dysgraphia, which is distinct from that of Landau‐Kleffner syndrome and continuous spikes and waves during slow‐wave sleep. However, the present cases also share common features with these two encephalopathies in terms of the clinical course, pathophysiology, neuroimaging, and response to steroids and antiepileptic drugs. In the context of the Japanese language, acquired Kanji dysgraphia may occur due to electrical dysfunction of left posterior inferior temporal cortex in patients with ESES.