Prolonged complex partial status epilepticus: a case report

Non-convulsive status epilepticus in adults: clinical forms and treatment

Non-convulsive status epilepticus (NCSE) is one of the great diagnostic and therapeutic challenges of modern neurology. Because the clinical features of this disorder may be very discrete and sometimes hard to differentiate from normal behaviour, NCSE is usually overlooked and consequently not treated properly. It is important to be familiar with the clinical subtypes such as absence, simple and complex partial, and subtle status epilepticus because each requires tailored management. In order to improve overall care of patients with NCSE, strict diagnostic criteria are needed that should be based on clinical alterations and ictal electroencephalographic changes. NCSE should be terminated rapidly to prevent patients from serious injuries, particularly if consciousness is impaired.

[Morbidity and mortality of status epilepticus]

The outcome of status epilepticus (SE) depends on its cause, clinical presentation, duration, treatment, and the patient's age. It has been estimated that in nearly all cases (about 98%), mortality is directly or indirectly due to the underlying disorder. It is particularly significant in generalized tonic-clonic SE. The clinical presentation of SE is strongly cause-dependent, and its etiology is markedly age-dependent in infants, children, young adults and the elderly. When SE is of long duration, due to its etiology, delayed treatment, or inappropriate drug administration, it results in brain lesions and the accompanying risk of sequelae or death. The highest mortality rates in SE are those at the extremes of the average life-span, i.e., in infants and young children and in the elderly. Possible SE sequelae are neurologic deficits or cognitive impairment, and/or unprovoked seizures. The outcome in cases of SE has considerably improved due to the early prescription of effective antiepileptic drugs.

Permanent hemiparesis due to partial status epilepticus

Partial status epilepticus (SE) produces permanent focal neurologic deficits if it lasts for months or is associated with systemic illness or CNS inflammation. We describe a patient in focal SE for just 5 days. Attacks were her habitual frontal lobe seizures. When SE stopped, permanent contralateral hemiparesis was present. There was no new cause for the weakness except the SE itself. We conclude that partial SE requires prompt and effective treatment, since it can lead to permanent neurologic dysfunction.

Complex partial status epilepticus: a recurrent problem

Twenty patients with complex partial status epilepticus were identified retrospectively from a specialist neurology hospital. Seventeen patients experienced recurrent episodes of complex partial status epilepticus, often occurring at regular intervals, usually over many years, and while being treated with effective anti-epileptic drugs. No unifying cause for the recurrences, and no common epilepsy aetiologies, were identified. In spite of the frequency of recurrence and length of history, none of the patients showed any marked evidence of cognitive or neurological deterioration. Complex partial status epilepticus is more common than is generally recognised, should be differentiated from other forms of non-convulsive status, and is often difficult to treat.