Abstracts

Rationale: Epilepsia partialis continua (EPC) is partial somatomotor status epilepticus which may persist for months or years. EPC is notoriously pharmacoresistant. We report two cases of EPC in which levetiracetam was used successfully. Methods: CASE 1 A 28 year old woman underwent a cadaveric renal transplant and started a combination antirejection regimen of mycophenolate, tacrolimus, and prednisone. She developed diffuse myoclonus, followed by repetitive muscle jerks in her left torso and abdominal muscles. Muscle jerks occurred every 4-5 seconds, interfered with vocalization, and were present during waking and sleep states. MRI brain was normal. An EEG showed mild, diffuse slowing. Tacrolimus toxicity was suspected, but focal muscle jerks persisted when the drug was discontinued and did not stop after valproate was administered with serum valproic acid levels of 125 micrograms/ml. Levetiracetam was begun and increased to 2000 mgs/24 hrs., with serum level at 55 micrograms/ml. AED's were tapered several months later, and the patient has remained free of seizures for two years. CASE 2 A 78 year old man suffered abrupt onset of nonfluent aphasia and continuous focal jerks of right lower facial muscles. The patient was alert and there was no other neurological abnormality. An MRI showed an acute, ischemic cerebral infarct involving left insula cortex and frontal operculum. Intravenous lorazepam had no effect on the seizures. Levetiracetam was started at that point to an eventual dose of 3000 milligrams/24 hrs, and seizures were fully controlled (Table 2). The patient remained seizure-free and was discharged on maintenance levetiracetam. Results: Levetiracetam successfully aborted EPC in two patients after failure of other antiepileptic drugs. Conclusions: Levetiracetam is an effective treatment of EPC.