Sporadic Creutzfeldt-Jakob disease mimicking nonconvulsive status epilepticus
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To the Editor: Lapergue et al.1 report on sporadic Creutzfeldt-Jakob disease (sCJD) mimicking refractory nonconvulsive status epilepticus (NCSE) and concluded that the diagnosis of NCSE in sCJD could not be justified. However, NCSE as a presentation form of sCJD is not completely resolved by the authors.
The patients of Lapergue et al. were admitted to the neurologic intensive care unit (ICU),1 yet their consciousness impairment was not mentioned. EEG anomalies were not reported and the authors only briefly mention EEG traces as diffuse continuous activities. In figure 1, typical periodic spike wave complexes (PSWC) can be seen. This EEG pattern may support the diagnosis of NCSE only in those presenting with profound alteration of level consciousness or coma.
I agree that the diagnosis of NCSE in a patient with PSWC is probably incorrect. However, ambulatory patients with diffuse epileptiform EEG anomalies may be diagnosed with NCSE. Lapergue et al. did not cite cases where EEG characteristics in ambulatory subjects were different from PSWC.2,–,4 It is difficult to assess whether these episodes were genuine epileptic confusional states or if the EEG anomalies were alterations associated with the sCJD.2,5 …
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