Abstracts

Rationale: Epilepsia partialis continua (EPC) is defined as a continuous focal seizure with variable electrographic correlate. Etiology is reportedly the strongest predictor of treatment refractoriness. It remains largely unknown if any variable within the subset of ischemic EPC can predict outcome. We present 2 adult patients with EPC due to ischemia with differing ages of onset to demonstrate our experience with age of onset in adults as a prognostic variable. We then present our review of the EPC literature. Methods: Clinical data including continuous video EEG, electrocorticogram and imaging, were extracted from the electronic medical records. Review of literature was done by searching PubMed for articles published from 1950-2014. Results: Patient 1 is a 34 year old woman with an occult intrauterine stroke which was not discovered until age 24, when she started to experience seizures that shortly evolved to become refractory to treatment within two years. Her seizures were of different semiologies. She rarely had secondary generalization. She was treated over the years with multiple combinations of antiepileptic drugs (AEDs) with variable response until there was a crescendo of seizures, and onset of disabling focal motor seizures arising from the right central region. This became continuous left lower extremity EPC associated with right centroparietal 1-4Hz rhythmic activity. She required ICU admission for recurrent generalization and aggressive management. She underwent a comprehensive surgical evaluation with MRI, PET, MEG, and continuous EEG, transcranial magnetic stimulation, and electrocorticography (EcoG). She underwent intraoperative EcoG-guided resection of the right frontal pole‎‎, anterior temporal lobe and posterior superior temporal gyrus‎‎, and a discrete part of the postcentral gyrus. Pathology demonstrated mild to moderate gliosis‎. She had immediate decrease in number of events, with only infrequent focal motor twitching in left shoulder 10 months after surgery. Patient 2 is a 77 year old man who presented with a generalized tonic-clonic seizure two years after thalamocapsular infarctions. His first seizure was described as a generalized tonic clonic seizures followed by a prolonged right arm twitching and right gaze deviation. He was admitted multiple times and tried on multiple AED regimens. EEG showed nearly continuous left-sided LPDs and frequent electrographic and electro-clinical seizures with right side jerking. He progressed to EPC and required ICU stay. MRI showed white matter disease and thalamic strokes. CSF studies were normal. He developed he eventually returned to his baseline function on a stable AED regimen 1 month after this presentation. Conclusions: Our case reports suggest that comorbidities, age of onset, size and nature of underlying lesion in adult-onset EPC may be associated with treatment outcome. Despite a larger infarction and more aggressive interventions, patient did just as well as the older patient. We also review the literature on ischemic EPC and factors that may affect treatment outcomes.