Abstract Details

Title A Case of Super-Refractory Epilepsia Partialis Continua Successfully Treated with Repetitive Transcranial Magnetic Stimulation

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) Epilepsy/Clinical Neurophysiology (EEG) Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 060

Objective NA

Background Epilepsia partialis continua (EPC) is a rare focal status epilepticus that is usually resistant to medications and causes significant morbidity for patients. Repetitive transcranial magnetic stimulation (rTMS) may be successful in medically refractory cases of EPC.

Design/Methods A 33-year old male with a generalized tonic-clonic seizure disorder since childhood, alcohol use disorder, and withdrawal seizures presented with unilateral continuous jerking, weakness, and sensory loss involving left face, arm, and leg. His jerking had started a few months prior and progressively worsened. On examination, he had left homonymous hemianopia, dysarthric speech, and rhythmic, synchronous jerking of the left face, arm, and leg. MRI revealed T2/FLAIR hyperintensities in right paracentral, occipital, and left cerebellar regions. Continuous EEG showed frequent bursts of spikes corresponding to the areas of MRI abnormality. ESR was 79 mm/h and CRP was 4.1 mg/dL. CSF revealed normal glucose, elevated protein at 74 mg/dL, 21 nucleated cells/mm³ with histiocytic predominance. An extensive workup for infectious, autoimmune, and paraneoplastic etiologies was unrevealing. Patient was diagnosed with EPC secondary to a presumed autoimmune etiology and was empirically treated with IV methylprednisolone, plasma exchange, rituximab, and oral prednisone for maintenance with partial improvement of his symptoms. He was also treated with multiple antiepileptic medications without success. After his initial improvement, his focal motor seizures worsened. He developed additional symptoms of dysautonomia and psychosis. Neither immunotherapy nor antiepileptic treatment achieved satisfactory control over his symptoms. He was eventually treated with 7 sessions of rTMS which achieved complete resolution of his focal seizures.

Results NA

Conclusions Treatment of EPC should focus on the underlying etiology. New-onset refractory status epilepticus, antiepileptic drug-resistance, and lab and imaging findings suggesting inflammation should raise suspicion for an autoimmune etiology for seizures. rTMS is a safe and noninvasive treatment modality which seems to be effective and promising in super-refractory EPC.

Authors/Disclosures
Busranur Agac, MD (National Institutes of Health) PRESENTER	Dr. Agac has nothing to disclose.
Kanika Sharma, MD (Rutgers- RWJMS)	Dr. Sharma has nothing to disclose.
	No disclosure on file
Tracey Cho, MD, F�鶹��ýӳ��	Dr. Cho has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kyverna. Dr. Cho has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Delve Bio. Dr. Cho has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. The institution of an immediate family member of Dr. Cho has received research support from NIH. Dr. Cho has received publishing royalties from a publication relating to health care.

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