ABSTRACT

Epilepsia partialis continua (EPC) is defined as ongoing relentless clonic muscle twitching, that is mainly confined to one side of the body and can last for weeks or months, associated with progressive pyramidal weakness. We report an association of epilepsia partialis continua with inferior frontal cortical dysplasia because of rarely seen, and review of literatüre on this condition.

35 years old male patient was admitted with frequently short-lasting clonic movement that involved right upper extremity and face for 15 days. His neurologic examination revealed right hemiparesis (+4/5), motor aphasia, right central facial weakness. Magnetic resonance imaging (MRI) revealed cerebral cortical lesion in the left inferior frontal cortex and contrast enhancement was observed af ter gadolinium administration in this area. Magnetic resonance spectroscopy (MRS) revealed increased glutamine/glutamate peakat 2.2 ppm. Electroencephalography demonstrated diffuse spikes especially över the left frontal region. We made a diagnosis of EPC. Treatment with phenytoin, midazolam and mannitol failed to stop the jerks. Secondary generalized epileptic seizures occurred, which necessitated general anesthesia. 36 hours after the onsetof the status epilepticus, his convulsions were controlled with pentothal infusion. Levatiracetam and oxcarbazepine treatments were added. As the focal seizures stopped, glutamate/glutamine peak was not seen on MRS. During nine months follow up, his seizures did not recur. inferior frontal cortical lesion did perssist on follow up MRI. it was considered as inferior frontal cortical dysplasia.

Our report supports that EPC may be due to inferior frontal cortical dysplasia and may concomitantly increase glutamine/glutamate peak on MRS.

Keywords: cortical dysplasia, epilepsia partialis continua, MR spectroscopy