Abstracts

RATIONALE: Partial seizures usually last less than 5 minutes. We report the electroclinical features of 2 patients with usual partial non convulsive prolonged seizures. METHODS: We admitted for presurgical evaluation two patients with drug-resistant epilepsy. Their usual partial seizure episodes lasted more than 10 minutes ending frequently with secondary generalization. RESULTS: Both had hyperthermic convulsions but no family history of epilepsy. Their interictal neuropsychological examination and social adaptation were normal. MRI revealed unilateral hippocampal atrophy. Video-EEG monitoring showed "short" seizures that lasted less than 5 minutes and several prolonged seizures with a variation of morphology, spreading and of ictal discharges frequency. These discharges did not stop compared to a cluster of short lasting seizures. In one case, the seizure onset was in left temporal lobe and the longest episode lasted 23 minutes. In the second one, the seizure onset was the right perisylvian area and the longest recorded seizure lasted 12 minutes. The ictal single photon emission computed tomographies (SPECT) revealed increased perfusion in the temporal lobe. The stereoelectroencephalographies recorded seizures with a typical pattern of temporal lobe epilepsy. The patients had a surgical treatment with a good evolution. These patients continuous seizure activity lasts more than 5 minutes. No major differences are observed between the long and the short episodes in terms of clinical seizure manifestations, of scalp and intracranial interictal and ictal electrographic findings, of ictal SPECT characteristics. The prolonged seizures do not seen to impair gradually the neurological status. The anatomopathology results do not show specific abnormalities that can explain seizure duration variability. In prolonged seizures, the neurochemical cortical mechanisms of seizure persistence and termination are certainly different from those involved in status epilepticus. Different genetic factors might contribute to these disturbance. CONCLUSIONS: The prolonged seizures exist. It is worth studying them thoroughly in order to better define partial status epilepticus.