Elsevier

Epilepsy Research

Volume 74, Issue 1, April 2007, Pages 55-59
Epilepsy Research

Epilepsia Partialis Continua over last 14 years: Experience from a tertiary care center from south India

https://doi.org/10.1016/j.eplepsyres.2006.12.003Get rights and content

Summary

Epilepsia Partialis Continua (EPC), a subtype of status epilepticus has varied etiology and the outcome depends on the cause. The aim of this study was to analyze the demographic, semiology, etiology, radiological findings, therapeutic response and outcome of EPC.

This is a retrospective analysis of 76 patients (M:F: 46:30; mean age: 30.2 ± 23.4 years; median age: 26 years) evaluated at our center over last 14 years. Twenty-three subjects (30.3%) had epilepsy for a mean of 25.8 ± 52.3 months (range: 1–81 years; median: 14) before developing EPC and in half of them, seizures were controlled with anti-epileptic drugs (AEDs). Rest 53 (69.3%) manifested as de novo. The mean duration of EPC was 47.02 ± 188.2 days (range: 1 h to 48 months; median: 3 days). One patient of generalized convulsive SE (GCSE) evolved into EPC while five patients of EPC evolved into GCSE. CT scan of brain (n  76) was abnormal in 53 (69.7%) while all the 11 MRI scans which were available were abnormal. EEG (n  21) was abnormal in all but one, however it was non-specific in 7. The diagnoses were—idiopathic: 17, ischemic stroke: 15, meningo-encephalitis: 8, Rasmussen's encephalitis (RE): 7, granuloma: 6, diabetic-non-ketotic-hyperosmolar-coma (DNKHC): 6, CNS malignancies (primary/secondary): 4, birth injury: 4, cerebral venous thrombosis: 3, CNS tuberculosis: 2, and cerebritis, HIV-related, toxemia of pregnancy, and MERRF one each. Patients of >40 years (n = 21) had stroke (10), idiopathic (6), DNKHC (4) and metastasis (1) as common causes. Only 12 of them received single AED, while others required 2 or more AEDs to control the seizures. The outcome (n = 72) was—controlled: 43 (59.7%); uncontrolled: 26 (36.1%) (RE: 7, idiopathic: 5, birth injury: 4, encephalitis: 3, malignancy: 2, granuloma and MERRF: 1 each) and three patients succumbed (encephalitis: 2, idiopathic: 1). Causes of EPC are varied and it depends on age. Underlying cause determined the outcome and could be refractory in RE, idiopathic, and when associated with birth injury, malignancy and encephalitis. Treatment of underlying cause is essential in addition to AEDs.

Introduction

Abnormalities close to the central sulcus may give rise to long duration focal motor seizures. This condition is called Epilepsia Partialis Continua (EPC). It has varied underlying etiologies, which determines the outcome of EPC (Cockerell et al., 1994, Cockerell et al., 1996). It may be rewarding as in diabetic-non-ketotic-hyperosmolar coma (DNKHC) where prompt correction of altered metabolic state helps or it could be frustrating in Rasmussen's encephalitis (RE), to both the patients and treating physician, where most forms of treatment fails (Dawson, 1947a, Dawson, 1947b). Reports of large series with clinical profile, underlying causes and therapeutic outcome of patients with EPC from the Indian subcontinent are lacking.

The aim of this study was to analyze the demographic, clinical manifestations, radiological findings, underlying causes and short-term outcome of EPC seen at a tertiary neurological center from south India over last 14 years.

Section snippets

Patients and methods

In this descriptive retrospective study, analysis of case records of patients with Epilepsia Partialis Continua (EPC) who were evaluated at National Institute of Mental Health and NeuroSciences (NIMHANS), Bangalore, India, a university teaching hospital and a major referral center. Patients seeking neurological services over last 14 years (1992–2005) with definite manifestation of EPC were included for the study. EPC was defined as spontaneous regular or irregular clonic twitching of cerebral

Results

There were 46 males and 30 females. Their mean age at presentation was 30.2 ± 23.4 years (range: 1–81 years) with median age of 26 years. The mean duration of EPC was 47.02 ± 188.2 days (median: 3 days, range: 1 h to 48 months). The mean duration of seizures in RE was 219.1 ± 497.3 (median: 18.5 days) while it was much shorter in illnesses due to other underlying causes (Table 1). Twenty-three patients (30.3%) with EPC at the time of evaluation, had history of recurrent seizures for a mean period of

Discussion

In 1895, Kojewnikoff coined the term Epilepsia Partialis Continua (EPC) and it may be caused by tumor, abscess, syphilis, embolism, or localized encephalitis. Since then, EPC has been ascribed to under nosological entities: variation of jacksonian epilepsy, jacksonian status epilepticus, myoclonus epilepsy, or continuous localized myoclonia (Gastaut, 1983). In 1972, Gastaut defined EPC as a subtype of somatomotor simple partial status epilepticus (SE), which was itself a form of elementary

Conclusion

This is one of the largest series of EPC reported in literature. Varied causes of EPC were observed with definite age predilection. Underlying cause determined the outcome and could be frustrating in RE, idiopathic, birth injury, malignancy and encephalitis. Treatment of underlying cause is essential component in addition to the use of appropriate AEDs.

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