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Tardive Seizure With Postictal Aphasia: A Case Report

Felkel II, W. Carson MD*; Wagner, Gerhardt MD, PhD*; Kimball, James MD*; Rosenquist, Peter MD*; McCall, W. Vaughn MD, MS*; Arias, Lorraine MD; and the Prolonging Remission in Depressed Elderly (PRIDE) Group

doi: 10.1097/YCT.0b013e318255a8d4
Case Reports

Abstract: Electroconvulsive therapy (ECT) is a highly effective treatment for certain psychiatric disorders with relatively few serious adverse effects or complications. Tardive seizures are one of these rare but potentially fatal complications. Recognizing and treating tardive seizures is essential to prevent prolonged postictal confusion, progression to status epilepticus and associated soft tissue injury, anoxia, aspiration, and death. Currently, there is an unknown prevalence of their occurrence and an overall lack of clinical description of their phenomenology. We describe a case in which a patient develops a tardive seizure followed by a receptive and expressive aphasia, thought to be a variant of Todd’s postictal paralysis. This case is further unique in that there was a lateralization of a motor seizure presumably to the hemisphere contralateral to the right unilateral electrode placement.

From the Departments of *Psychiatry and Behavioral Medicine and †Anesthesia,Wake Forest University School of Medicine, Winston Salem, NC.

Received for publication January 25, 2012; accepted March 14, 2012.

Reprints: W. Carson Felkel II, MD, Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, One Medical Center Boulevard, Winston Salem, NC 27157 (e-mail: Wfelkeli@wakehealth.edu).

This work was supported by NIMH 1U01MH086127-01.

The authors have no conflicts of interest or financial disclosures to report.

The PRIDE Group is: NIMH Scientific Liaison, M. Rudorfer, U01 Mechanism

Clinical Coordinating Centers:

Mt. Sinai School of Medicine, New York, NY (Charles H. Kellner, MD, Study Co-PI);

Duke University, Durham, NC (Sarah H. Lisanby, MD, Study Co-PI)

Data Management and Statistical Coodinating Center:

Medical University of SC, Charleston SC (Rebecca G. Knapp, PhD, Data Center PI)

Clinical Centers:

Mount Sinai School of Medicine, New York, NY (C. Kellner, Site PI)

*Duke University, Durham, NC (S.H. Lisanby, Site Co-PI; R. Weiner, Site Co-PI) (*as of March 21, 2011)

The Zucker Hillside Hospital/Northshore LIJ Health System (G. Petrides, Site PI)

University of Texas Southwestern Medical School (M. Husain, Site PI)

Mayo Clinic (S. Sampson, Site PI)

Wake Forest University Medical Center (V. McCall, Site PI)

Weill Cornell Institute for Geriatric Psychiatry (R. Young, Site PI)

*Columbia University/New York State Psychiatric Institute (S. Lisanby, Site Co-PI; J. Prudic, Site Co-PI)

(*Discontinued as Clinical Center July 27, 2010)

© 2012 by Lippincott Williams & Wilkins