Abstracts

Rationale: Complex partial status epilepticus (CPSE) is a major diagnostic and therapeutic challenge for the modern neurologist. Clinical features of this disorder may be very subtle and hard to recognize causing misdiagnoses and improper treatment. The diagnosis is mainly dependent on EEG. When EEG is equivocal, clinical and electrographic response to medications can be helpful. Methods: In this study, we retrospectively reviewed the incidence, management, efficacy of medical treatment and outcome of CPSE and ARCPS in our institution over the last 3 months. Results: Fifteen subjects were identified. Most were admitted because of seizures (65%). For 20%, the reason of admission was documented as 'change in mental state' and included descriptions of transient unresponsiveness, staring, aphasia and 'inappropriate behavior'. Fifty-seven percent of patients had prior epilepsy or seizures. In most subjects CPSE was recognized at admission (79%). Others developed CPSE later, ranging from within 2 days (7%) to 2 weeks (14%) from admission. Brain Imaging revealed the presence of acute stroke (22%), anoxic brain Injury (22%), Intracranial hemorrage (14%), tumor (14%), mesiotemporal sclerosis (7%), foreign body (7%) or no pathology (14%). All subjects were placed on long term monitoring (LTM), on the floors (43%) or in the ICU (57%). In most cases (10 out of 15 patients) CPSE was managed with phenytoin, phenobarbital and levetiracetam. Other AEDs included valproate and carbamazepine. In 3 cases adjunctive therapy with topiramate was necessary for resolution of the status. For 1 subject add on therapy with zonisamide was preferred. Complete electrographic resolution of seizures was achieved within an average of 5 days from onset. Sixty-two percent of patients were discharged home and 2 patients expired, both of multi-organ failure, not of brain pathology. This cluster of 15 subjects resulted in a doubling of long term EEG monitoring usage in comparison to previous quarters. Conclusions: Many patients with CPSE and ARCPS present with vague symptoms generally labelled as 'change in mental state'. A higher index of suspicion is needed to identify these cases earlier. LTM was necessary for establishing a diagnosis and was helpful in diagnosis of unclear cases. Most individuals responded to one or two AEDs. CPSE and ARCPS comprise a diverse group with multiple etiologies for brain pathology. Some subjects respond rapidly to therapy but better therapeutic strategies for those with refractory seizures are needed. Additional prospective studies will help in determining the best therapeutic strategy.