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Paulson OB, Schousboe A, Hultborn H. The history of Danish neuroscience. Eur J Neurosci 2023; 58:2893-2960. [PMID: 37477973 DOI: 10.1111/ejn.16062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/04/2023] [Accepted: 05/29/2023] [Indexed: 07/22/2023]
Abstract
The history of Danish neuroscience starts with an account of impressive contributions made at the 17th century. Thomas Bartholin was the first Danish neuroscientist, and his disciple Nicolaus Steno became internationally one of the most prominent neuroscientists in this period. From the start, Danish neuroscience was linked to clinical disciplines. This continued in the 19th and first half of the 20th centuries with new initiatives linking basic neuroscience to clinical neurology and psychiatry in the same scientific environment. Subsequently, from the middle of the 20th century, basic neuroscience was developing rapidly within the preclinical university sector. Clinical neuroscience continued and was even reinforced during this period with important translational research and a close co-operation between basic and clinical neuroscience. To distinguish 'history' from 'present time' is not easy, as many historical events continue in present time. Therefore, we decided to consider 'History' as new major scientific developments in Denmark, which were launched before the end of the 20th century. With this aim, scientists mentioned will have been born, with a few exceptions, no later than the early 1960s. However, we often refer to more recent publications in documenting the developments of initiatives launched before the end of the last century. In addition, several scientists have moved to Denmark after the beginning of the present century, and they certainly are contributing to the present status of Danish neuroscience-but, again, this is not the History of Danish neuroscience.
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Affiliation(s)
- Olaf B Paulson
- Neurobiology Research Unit, Department of Neurology, Rigshospitalet, 9 Blegdamsvej, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Arne Schousboe
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hans Hultborn
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Yang SH, Yeh PS, Chen TY. Epilepsia Partialis Continua as the First Presenting Symptom in Probable Sporadic Creutzfeldt-Jacob Disease: A Case Report and Literature Review. Case Rep Neurol 2018; 10:193-198. [PMID: 30140219 PMCID: PMC6103350 DOI: 10.1159/000490909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 06/12/2018] [Indexed: 01/19/2023] Open
Abstract
We present the case of a middle-aged man suffering from epilepsia partialis continua 3 weeks before the start of cognition decline, visual disturbance, and pyramidal dysfunction. The epilepsia partialis continua was difficult to control, and the underlying cause was uncertain even after thorough surveys for infection, inflammation, autoimmunity, and neoplasm. However, progressive signal intensity changes were noted over the involved cortical gyri, bilateral caudate, and putamen on serial magnetic resonance diffusion-weighted images, which were compatible with sporadic Creutzfeldt-Jacob disease. Therefore, we tested for 14-3-3 protein in the cerebrospinal fluid, and the results were positive. Multifocal myoclonus jerks, severe mental decline, akinetic mutism, and typical periodic sharp wave complexes on electroencephalogram developed late in his disease course. He died under the hospice care, and his total disease duration was approximately 5 months. This case highlights that epilepsia partialis continua can be the first presenting symptoms of sporadic Creutzfeldt-Jacob disease, and that magnetic resonance imaging abnormalities can be helpful to identify the disease.
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Affiliation(s)
- Sheng-Hsiang Yang
- Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan, ROC
| | - Poh-Shiow Yeh
- Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan, ROC.,Department of Neurology, Taipei Medical University, Taipei, Taiwan, ROC
| | - Tai-Yuan Chen
- Division of Neuroradiology, Department of Radiology, Chi-Mei Medical Center, Tainan, Taiwan, ROC
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3
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Abstract
Refractory and super-refractory status epilepticus (SE) are serious illnesses with a high risk of morbidity and even fatality. In the setting of refractory generalized convulsive SE (GCSE), there is ample justification to use continuous infusions of highly sedating medications-usually midazolam, pentobarbital, or propofol. Each of these medications has advantages and disadvantages, and the particulars of their use remain controversial. Continuous EEG monitoring is crucial in guiding the management of these critically ill patients: in diagnosis, in detecting relapse, and in adjusting medications. Forms of SE other than GCSE (and its continuation in a "subtle" or nonconvulsive form) should usually be treated far less aggressively, often with nonsedating anti-seizure drugs (ASDs). Management of "non-classic" NCSE in ICUs is very complicated and controversial, and some cases may require aggressive treatment. One of the largest problems in refractory SE (RSE) treatment is withdrawing coma-inducing drugs, as the prolonged ICU courses they prompt often lead to additional complications. In drug withdrawal after control of convulsive SE, nonsedating ASDs can assist; medical management is crucial; and some brief seizures may have to be tolerated. For the most refractory of cases, immunotherapy, ketamine, ketogenic diet, and focal surgery are among several newer or less standard treatments that can be considered. The morbidity and mortality of RSE is substantial, but many patients survive and even return to normal function, so RSE should be treated promptly and as aggressively as the individual patient and type of SE indicate.
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Affiliation(s)
- Samhitha Rai
- KS 457, Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Frank W Drislane
- KS 457, Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
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Atmaca MM, Bebek N, Kocasoy-Orhan E, Gürses C. Epilepsia partialis continua: Correlation of semiology, outcome and electrophysiologic features. Clin Neurol Neurosurg 2018; 171:143-150. [PMID: 29909187 DOI: 10.1016/j.clineuro.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/31/2018] [Accepted: 06/09/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Epilepsia partialis continua (EPC) is a special form of cortical epilepsy. Several studies have described the ictal and interictal electroencephalography (EEG) findings in patients with EPC; however, lateralizing and localizing values of these findings have been evaluated rarely. This study investigated the correlation of semiologic and EEG findings, and outcomes in patients with EPC. PATIENTS AND METHODS Clinical and EEG findings and outcomes, and their correlations were studied prospectively in 15 patients who were diagnosed as having EPC upon presentation to Istanbul Medical Faculty Hospital between January 2010 and April 2014, and retrospectively in 5 previously evaluated patients. RESULTS EEG findings were lateralizing in 11 (47.8%) of the overall 23 EEG recordings, 7 (30.4%) of which were also localizing. Eleven (55%) of the 20 patients had poor prognosis. Patients with interictal lateralizing EEG findings had better outcomes compared with patients who had interictal non-lateralizing EEG findings (P = 0.016). Periodic epileptiform discharges (PEDs) were noted in the 6 EEGs (3 ictal EEGs and 3 interictal EEGs) of 5 patients, all of whom had poor outcomes (P = 0.04). All four patients with false lateralizing EEG findings had poor outcomes. CONCLUSION EEG has low lateralizing and localizing value in EPC but patients with interictal lateralizing EEG findings have better outcomes, which may be used as a prognostic tool in EPC. The presence of PEDs and false lateralizing findings in EEG might be associated with poor prognosis in EPC.
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Affiliation(s)
- Murat Mert Atmaca
- Sultan Abdulhamid Han Training and Research Hospital, Department of Neurology, Istanbul, Turkey.
| | - Nerses Bebek
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Turkey
| | - Elif Kocasoy-Orhan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Turkey
| | - Candan Gürses
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Turkey
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Kim H, Byun JS, Hallett M, Shin HW. Multifocal Myoclonus as a Manifestation of Acute Cerebral Infarction Recovered by Carotid Arterial Stenting. J Mov Disord 2017; 10:64-66. [PMID: 28122425 PMCID: PMC5288662 DOI: 10.14802/jmd.16040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/26/2016] [Accepted: 11/07/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hyangkyoung Kim
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jun Soo Byun
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Hae-Won Shin
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.,Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
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Mameniškienė R, Wolf P. Epilepsia partialis continua: A review. Seizure 2017; 44:74-80. [DOI: 10.1016/j.seizure.2016.10.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/12/2016] [Accepted: 10/13/2016] [Indexed: 11/24/2022] Open
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Abstract
Status epilepticus is a neurologic and medical emergency manifested by prolonged seizure activity or multiple seizures without return to baseline. It is associated with substantial medical cost, morbidity, and mortality. There is a spectrum of severity dependent on the type of seizure, underlying pathology, comorbidities, and appropriate and timely medical management. This chapter discusses the evolving definitions of status epilepticus and multiple patient and clinical factors which influence outcome. The pathophysiology of status epilepticus is reviewed to provide a better understanding of the mechanisms which contribute to status epilepticus, as well as the potential long-term effects. The clinical presentations of different types of status epilepticus in adults are discussed, with emphasis on the hospital course and management of the most dangerous type, generalized convulsive status epilepticus. Strategies for the evaluation and management of status epilepticus are provided based on available evidence from clinical trials and recommendations from the Neurocritical Care Society and the European Federation of Neurological Societies.
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Affiliation(s)
- M Pichler
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - S Hocker
- Division of Critical Care Neurology, Mayo Clinic, Rochester, MN, USA.
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Bedarf JR, Marek M, Bien CG, Elger CE, Paus S. Sustained Effect of Botulinum Neurotoxin in Myoclonus Owing to Epilepsia Partialis Continua. Mov Disord Clin Pract 2015; 2:402-406. [PMID: 30838240 DOI: 10.1002/mdc3.12216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/25/2015] [Accepted: 05/29/2015] [Indexed: 11/07/2022] Open
Abstract
Background Epilepsia partialis continua (EPC) is defined as continuous myoclonic jerking of a body part of cortical origin and often resembles a movement disorder. Unfortunately, anti-epileptic therapy is frequently ineffective. Currently, the effect of botulinum neurotoxin (BoNT) therapy in EPC is controversial. Methods We analyzed case histories, treatment protocols, and video documentation of 5 patients with EPC, who received BoNT therapy in our movement disorders unit. The Unified Myoclonus Rating Scale was used to document treatment effects. Results In all patients, BoNT treatment significantly reduced severity and frequency of myoclonus and led to pronounced improvement of speech and arm utilization, regardless of etiology or duration of EPC. Conclusion BoNT represents a safe, effective treatment in EPC, offering long-term abatement of myoclonus. The substantial functional profit may hint at mechanisms beyond local impairment of neuromuscular transmission, such as modulation of maladaptive cortical plasticity, as observed in dystonia and poststroke spasticity.
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Affiliation(s)
| | - Milena Marek
- Department of Neurology University of Bonn Bonn Germany
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Parker T, Freilich S, Tidswell T, Angus-Leppan H. Hepatic encephalopathy with epilepsia partialis continua: A case report. Seizure 2012; 21:813-5. [DOI: 10.1016/j.seizure.2012.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 08/29/2012] [Accepted: 08/29/2012] [Indexed: 12/01/2022] Open
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Etiology, clinical features and outcome of epilepsia partialis continua in cohort of 51 children. Epilepsy Res 2012; 104:112-7. [PMID: 23036655 DOI: 10.1016/j.eplepsyres.2012.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 08/16/2012] [Accepted: 09/02/2012] [Indexed: 11/24/2022]
Abstract
The objective of the study was to evaluate etiology, clinical characteristics and outcome in children with epilepsia partialis continua (EPC). The investigation included 51 children with EPC aged 0.2-18 years treated in the period 1993-2009. The median period from the onset of underlying disorder to EPC was 6 months (0-72 months). EPC was caused by different pathologies: inflammatory and immune-mediated (52%), metabolic (13.7%), structural brain abnormalities (11.8%), cryptogenic (7.8%), vascular (5.9%), dual (5.9%), postoperative (2%). Median duration of EPC was 15 days (1-200 days). EPC involved more frequently the right side of the body comparing to the left one. The outcome was assessed at the end of the follow up period (mean 6.5 years, ranged 0.2-16 years). Unchanged neurological status was observed in 10 (19.6%) children, neurological consequences in 33 (64.7%) children and lethal outcome in 8 (15.7%) children. The most frequent etiology in our cohort was inflammatory and immune-mediated disease of central nerve system including Rasmussen's encephalitis. The duration of EPC was prolonged, most frequently involving the right upper limb. The outcome of EPC in children was unfavorable.
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11
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Guerrini R. Physiology of epilepsia partialis continua and subcortical mechanisms of status epilepticus. Epilepsia 2009; 50 Suppl 12:7-9. [DOI: 10.1111/j.1528-1167.2009.02356.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Epilepsia partialis continua and defects in the mitochondrial respiratory chain. Epilepsy Res 2008; 78:1-6. [DOI: 10.1016/j.eplepsyres.2007.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2007] [Revised: 09/30/2007] [Accepted: 10/04/2007] [Indexed: 11/23/2022]
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Donmez B, Cakmur R, Men S, Oztura I, Kitis A. Coexistence of movement disorders and epilepsia partialis continua as the initial signs in probable Creutzfeldt-Jakob disease. Mov Disord 2005; 20:1220-3. [PMID: 15895425 DOI: 10.1002/mds.20502] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Movement disorders and epilepsy rarely occur in the early stage of Creutzfeldt-Jakob disease (CJD) but have not been reported concurrently. We report on a 47-year-old patient with probable CJD who presented with generalized chorea and focal dystonia with myoclonic jerks on the right hand. Myoclonic jerks progressed to epilepsia partialis continua within 5 days of admission to the hospital. The diagnosis of our patient was compatible with probable CJD on the basis of clinical course, electroencephalogram, and diffusion-weighted magnetic resonance imaging findings, and presence of 14-3-3 protein in cerebrospinal fluid. To our knowledge, this is the first report of a case developing both movement disorders and epilepsia partialis continua in the early stage of the disease.
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Affiliation(s)
- Berril Donmez
- Department of Neurology, Medical School of Dokuz Eylül University; Izmir, Turkey
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Kipps CM, Fung VSC, Grattan-Smith P, de Moore GM, Morris JGL. Movement disorder emergencies. Mov Disord 2005; 20:322-34. [PMID: 15584031 DOI: 10.1002/mds.20325] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Movement disorders may present acutely, and failure to recognize and exclude important differential diagnoses can result in significant morbidity or mortality. Unfortunately, much of the literature pertaining to this topic is scattered and not easily accessible. This review aims to address this deficit. Movement disorder emergencies are discussed according to their most likely mode of presentation. Diagnostic considerations and early management principles are reviewed, along with appropriate pathophysiology where relevant.
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Berciano J, Leno C, Figols J, García A, Polo JM, Berciano MT, Ariza A. Epilepsia partialis continua in progressive multifocal leukoencephalopathy: A motor cortex isolation syndrome. Mov Disord 2003; 18:1559-64. [PMID: 14673902 DOI: 10.1002/mds.10599] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We describe the clinical and neuropathological features in a patient aged 45 years with progressive multifocal leukoencephalopathy with epilepsia partialis continua. The motor cortex and basal ganglia were preserved. Our findings lend support to the notion of isolation of the motor cortex as the cause of this particular type of focal status epilepticus.
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Affiliation(s)
- José Berciano
- Service of Neurology, University Hospital Marqués de Valdecilla, Santander, Spain.
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Pandian JD, Thomas SV, Santoshkumar B, Radhakrishnan K, Sarma PS, Joseph S, Kesavadas C. Epilepsia partialis continua--a clinical and electroencephalography study. Seizure 2002; 11:437-41. [PMID: 12237069 DOI: 10.1053/seiz.2001.0646] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Epilepsia partialis continua (EPC) is a rare type of localization-related motor epilepsy. Clinical spectrum, electroencephalography (EEG) characteristics and various prognostic factors in EPC were studied in 20 patients. Patients who fulfilled the criteria for EPC between the years 1985 and 1999 were included in this retrospective and prospective study. The mean age was 18 years (range 5 months-70 years). Eleven patients (55%) had Type 1 EPC and in the remaining nine (45%) patients there were features of Type 2 EPC. Among children Rasmussen's encephalitis and viral encephalitis were the commonest cause for EPC. Encephalitis and vascular aetiology were frequently observed in adults. Tuberculous meningitis and tuberculomas occurred evenly in both the groups. The cause was unknown in two cases. Focal EEG abnormalities commonly consisted of discrete spikes, sharp waves (or) slow wave activity and periodic lateralized epileptiform discharges. The mean duration of follow up was 9.6 months with a range between 1 month and 4 years. Cognitive decline, motor deficits and pharmacoresistance to drugs were significantly seen among children with Type 2 EPC. Patients with Type 1 EPC had mild impairment of functional status with good response to treatment. The long-term prognosis depends upon the underlying cause.
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Affiliation(s)
- J D Pandian
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, Kerala, India
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Gurer G, Saygi S, Ciger A. Epilepsia partialis continua: clinical and electrophysiological features of adult patients. CLINICAL EEG (ELECTROENCEPHALOGRAPHY) 2001; 32:1-9. [PMID: 11202134 DOI: 10.1177/155005940103200103] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study we reviewed the clinical, electrophysiological and neuroimaging data of 21 patients with epilepsia partialis continua (EPC), which is a rare form of epilepsy with focal motor seizures persisting hours to years. We found infections, cerebrovascular events and tumors as the most common causes of EPC in adults. SSPE was also shown as a cause of EPC. EPC in SSPE patients was resistant to therapies and persisted more than 1 year. EPC is usually a predictor of poor outcome and 29% of patients died after EPC in this study. As prognosis is usually bad and as response to treatment is poor in patients who had EPC, early diagnosis and treatment of the underlying cause is important. Although the most common etiologies are infections, cerebrovascular events and tumors, if EPC persists several months SSPE should be kept in mind as a rare cause of EPC. MRI should be repeated in chronic cases to show dysplastic cortex, which was shown in 1 patient in this study.
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Affiliation(s)
- G Gurer
- Hacettepe University, Ankara, Turkey
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Antunes NL, Boulad F, Prasad V, Rosenblum M, Lis E, Souweidane M. Rolandic encephalopathy and epilepsia partialis continua following bone marrow transplant. Bone Marrow Transplant 2000; 26:917-9. [PMID: 11081396 DOI: 10.1038/sj.bmt.1702637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Epilepsia partialis continua (EPC) is a condition defined by prolonged focal myoclonus. Often resistant to therapy, EPC in children is frequently present in Rasmussen encephalitis, a form of chronic encephalitis of uncertain etiology. We discuss a child who developed bilateral EPC 5 months after a bone marrow transplant. Neuroimaging studies showed signal abnormalities on both sensory-motor areas. An extensive search failed to reveal the etiology of the disorder, but treatment with a broad-spectrum anti-viral agent was associated with resolution of the process. An unidentified infectious agent may be responsible for an encephalitis of the motor strip in immunosuppressed patients.
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Affiliation(s)
- N L Antunes
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Castro-Costa CM, Vale OC, Leitão V, Teixeira CA, Arruda JA, Bruin VS, Horta WG, Cunha FM, D'Almeida JA, Alencar MR. Epilepsia partialis continua (Koshevnikov): a preliminary case report. ARQUIVOS DE NEURO-PSIQUIATRIA 2000; 58:916-8. [PMID: 11018833 DOI: 10.1590/s0004-282x2000000500021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report on the preliminary clinical and electrophysiological aspects of an in-patient possibly presenting epilepsia partialis continua (Koshevnikov). We discuss the different etiologies and emphasize on the possible idiopathic form in this case.
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Affiliation(s)
- C M Castro-Costa
- Service of Neurology, University Hospital, Federal University of Ceará, Brazil.
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Shigeto H, Tobimatsu S, Morioka T, Yamamoto T, Kobayashi T, Kato M. Jerk-locked back averaging and dipole source localization of magnetoencephalographic transients in a patient with epilepsia partialis continua. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1997; 103:440-4. [PMID: 9368488 DOI: 10.1016/s0013-4694(97)00040-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In order to localize the generator site of epileptiform discharges, we applied the techniques of jerk-locked back averaging (JBA) of magnetoencephalographic (MEG) activities and dipole source localization in a patient with epilepsia partialis continua (EPC), who showed continuous, focal myoclonic jerks in the right arm. The myoclonic discharges in the right thenar muscle were used as a trigger pulse. JBA revealed consistent EEG and MEG transients that coincided consistently and constantly preceded the myoclonic jerks. The estimated dipoles of MEG were localized in a restricted area in the left precentral area, which closely correlated with the area of epileptic discharges recorded in electrocorticography. Therefore, JBA of MEG is considered to be a useful non-invasive method for localizing the epileptogenic area in EPC.
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Affiliation(s)
- H Shigeto
- Department of Clinical Neurophysiology, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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Terao Y, Ugawa Y, Hanajima R, Yumoto M, Kawahara Y, Yamamoto T, Shirouzu I, Kanazawa I. Motor cortical reflex myoclonus: a case study with MEG. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1997; 102:505-11. [PMID: 9216483 DOI: 10.1016/s0013-4694(97)96122-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cortical reflex myoclonus usually depends for its generation on the hyperexcitability of sensory cortex, which manifests itself as an enhanced somatosensory evoked potential (SEP). A 25-year-old female, presenting with involuntary jerky dorsiflexion of the left foot, was found to have cortical reflex myoclonus which was aggravated during intended movements. The jerks were also elicited by electrical stimulation of the posterior tibial nerve, although the SEP evoked by the same stimulus was normal in latency and amplitude. Both the spontaneous spikes and the premyoclonus spike demonstrated by jerk-locked back averaging were localized to the superior frontal gyrus, just anterior to the paracentral sulcus. Paired-pulse magnetic stimulation disclosed lack of inhibition in the right hemisphere leg motor area, whereas the excitability of sensory cortex as studied by paired SEP testing was normal. This suggests that the myoclonus was caused mainly by enhanced excitability of the motor cortex and that this alone was enough for the production of long loop reflexes. We propose to designate this type of cortical myoclonus as motor cortical reflex myoclonus. It is generated in the motor cortex, but is at the same time stimulus-sensitive.
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Affiliation(s)
- Y Terao
- Department of Neurology, School of Medicine, University of Tokyo, Japan
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Legatt AD, Lasala PA, Mitnick RJ, Zacharowicz L, Llena JF, Fray CI, Shinnar S. Electrophysiologic Studies and Intraoperative Localization in a Child with Epilepsia Partialis Continua. ACTA ACUST UNITED AC 1996. [DOI: 10.1016/0896-6974(96)00031-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Scholtes FB, Renier WO, Meinardi H. Simple partial status epilepticus: causes, treatment, and outcome in 47 patients. J Neurol Neurosurg Psychiatry 1996; 61:90-2. [PMID: 8676168 PMCID: PMC486465 DOI: 10.1136/jnnp.61.1.90] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A retrospective case note review was conducted of 47 patients of 15 years and older who had sustained simple partial status epilepticus (SPSE) in The Netherlands between 1980 and 1987. In 46 patients the type of SPSE was somatomotor (in four adversive), and in one aphasic with visual and auditory hallucinations. SPSE was more common over the age of 50. Six of 27 patients with previous epilepsy had an acute symptomatic cause. In 20 patients without previous epilepsy stroke was the most frequent cause (75%). Outcome was determined by the underlying cause. In one patient the continuing epileptic activity may have caused neuronal damage.
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24
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Abstract
Although most children with epilepsy have a good prognosis, a small but significant minority have seizures that either do not respond to conventional antiepileptic drugs (AEDs) or have significant adverse reactions to AEDs. Many children may benefit from epilepsy surgery. Surgical treatment of epilepsy is becoming a well-established therapy for infants and young children with severe, medically intractable seizures. As in older children and adults, the presurgical evaluations of possible surgical candidates typically consist of a detailed history, neurologic and neuropsychologic examination, and anatomic and functional neuroimaging. The "gold standard" test, however, is the recording of ictal events by using simultaneous EEG and videomonitoring. Although temporal lobe resection is the most commonly performed surgery in older children and adults, nontemporal lobe resection, corpus callosotomy, and hemispherectomy are commonly performed in younger children. Efficacy of surgery in children compares favorably with results from adult patients. In addition, because the immature brain is more plastic than the mature brain, recovery of function is often greater after surgery in children than in adults. Early surgery in children with intractable epilepsy is recommended.
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Affiliation(s)
- G L Holmes
- Department of Neurology, Harvard Medical School, Children's Hospital, Boston, Massachusetts 02115, USA
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25
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 7-1996. An eight-year-old boy with intractable seizures. N Engl J Med 1996; 334:586-92. [PMID: 8569828 DOI: 10.1056/nejm199602293340908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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26
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Tarsy D, Schachter SC. Botulinum toxin treatment is not effective for epilepsy partialis continua. Mov Disord 1995; 10:357-8. [PMID: 7651461 DOI: 10.1002/mds.870100326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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27
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Farrell MA, Droogan O, Secor DL, Poukens V, Quinn B, Vinters HV. Chronic encephalitis associated with epilepsy: immunohistochemical and ultrastructural studies. Acta Neuropathol 1995; 89:313-21. [PMID: 7610762 DOI: 10.1007/bf00309624] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Chronic encephalitis has been recognized as a cause of epilepsy since the work of Rasmussen et al. in the late 1950s. Despite this, few immunohistochemical studies of the affected brain tissue have been attempted. We have studied specimens of brain tissue from seven patients with this condition who underwent therapeutic multilobar cortical resection or hemispherectomy. Immunohistochemical studies were carried out using antibodies to glial fibrillary acidic protein (GFAP), proliferating cell nuclear antigen (PCNA, PC10), T lymphocytes (UCHL-1), B lymphocytes (L26), macrophages and microglia (HAM-56), and major histocompatibility complex molecules (LN3 and beta 2-microglobulin). Additionally, the results of preliminary immunohistochemical and ultrastructural investigation of possible immune complex deposition in blood vessel walls of affected brain tissue are presented. The pattern of GFAP immunoreactivity suggested a patchy and/or laminar disease process in most patients. GFAP immunoreactive cells were especially prominent around microvessels in some cases, suggesting an abnormality and perivascular collections of inflammatory cells, seen to a variable extent in all cases, contained abundant cells immunolabelled with UCHL-1, LN3 and beta 2-microglobulin. L26-labelled B lymphocytes were extremely sparse. Anti-PCNA frequently labelled microvascular endothelial cells, rare pericytes and occasional cells with microglial/macrophage morphology. The data suggest that chronic encephalitis found in patients with epilepsy results from patchy but widespread parenchymal brain injury, in the course of which cells of both microglial and lymphocyte series accumulate or proliferate within brain.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M A Farrell
- Department of Pathology (Neuropathology), Beaumont Hospital, Dublin, Ireland
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28
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Antozzi C, Franceschetti S, Filippini G, Barbiroli B, Savoiardo M, Fiacchino F, Rimoldi M, Lodi R, Zaniol P, Zeviani M. Epilepsia partialis continua associated with NADH-coenzyme Q reductase deficiency. J Neurol Sci 1995; 129:152-61. [PMID: 7608730 DOI: 10.1016/0022-510x(94)00267-r] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We report the clinical, neuroradiological and biochemical features of a patient with epilepsia partialis continua (EPC). MRI studies disclosed multiple cortico-subcortical areas of abnormal signal intensity. The activity of complex I of the mitochondrial respiratory chain was markedly reduced in skeletal muscle. The biochemical defect was reflected in vivo by a failure of brain and skeletal muscle bioenergetics, as shown by exercise and phosphorus magnetic resonance spectroscopy (31P-MRS) studies. Muscle morphology was repeatedly normal, and molecular genetic analysis of mitochondrial DNA was not informative. On the basis of in vivo and in vitro findings, the observed defect of the mitochondrial respiratory chain was considered the underlying biochemical pathogenesis of the disease. The observation of an oxidative defect in the brain and skeletal muscle of a patient with EPC emphasizes the importance of studying mitochondrial energy metabolism in patients with EPC not associated with primary CNS lesions when clinical and morphological findings suggesting a mitochondrial disorder are lacking. 31P-MRS can be a useful method to uncover deficits of CNS mitochondrial function and provide the indication for further biochemical studies.
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Affiliation(s)
- C Antozzi
- Divisione Malattie Neuromuscolari, Istituto Nazionale Neurologico C. Besta, Milan, Italy
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29
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Abstract
We report 3 cases of opercular myoclonic status epilepticus (OMASE), characterized by fluctuating cortical dysarthria without true aphasia associated with epileptic myoclonus involving bilaterally the glossopharyngeal musculature. In this syndrome, the inferior rolandic area of either one or the other hemisphere is involved by an epileptogenic lesion of various etiology. Ictally, clonic expression was consistent with epilepsia partialis continua (EPC) and bilaterally and symmetrically involved palatal muscles (cases 1-3), tongue (cases 2 and 3), lips and chin (case 3), and inferior jaw (case 1) due to bilateral projections of the inferior corticonuclear pathways. Postictally, the main clinical sign was pseudobulbar palsy, consistent with Todd's palsy. In our cases, OMASE was either of vascular (cases 1 and 2) or tumoral origin (case 3). In adulthood, early recognition of OMASE, although nonspecific, may be important for early management of carotid occlusive disease because it usually indicates an acute opercular infarction.
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Affiliation(s)
- P Thomas
- Service de Neurologie, Hôpital Pasteur, Nice, France
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30
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Veggiotti P, Colamaria V, Dalla Bernardina B, Martelli A, Mangione D, Lanzi G. Epilepsia partialis continua in a case of MELAS: clinical and neurophysiological study. Neurophysiol Clin 1995; 25:158-66. [PMID: 8524210 DOI: 10.1016/0987-7053(96)80168-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
There are few reports in the literature dealing with the association between mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) and epilepsia partialis continua (EPC) in children. We report the case of a child presenting with numerous stroke-like episodes associated with EPC which, despite therapy, were not controlled and aggravated the clinical condition of our patient. We present the neuroradiological, biochemical, genetic and muscle biopsy findings, and EEG characteristics, with attention to polygraphic recordings which were done during wake and sleep periods. We consider the correlation with other possible etiological factors relating to EPC and in particular coinvolvement of the basal ganglia as a cause of EPC in our patient.
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Affiliation(s)
- P Veggiotti
- Divisione di Neuropsichiatria Infantile, Fondazione Istituto Neurologico C Mondino IRCCS, Pavia, Italy
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31
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Barontini F, Maurri S, Amantini A. "Epilepsia partialis continua" due to multifocal encephalitis: favourable outcome after immunoglobulin treatment. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1994; 15:157-61. [PMID: 8056563 DOI: 10.1007/bf02339208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The case of a young woman with EPCK is described in which neoplastic and vascular disorders were excluded. Supported by EEG and PET, EPCK was imputed to multifocal encephalitis notwithstanding serological and CSF negativity. Cerebral biopsy confirmed the inflammatory nature of the affection, although the etiologic agent was not identified. High dose intravenous immunoglobulin therapy was followed by the prompt disappearance of EPCK and the remission of the other neurological deficits.
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Affiliation(s)
- F Barontini
- Clinica Neurologica III, Università di Firenze
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32
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Abstract
Focal status epilepticus and epilepsia partialis continua (FSE-EPC) are most frequently seen with chronic focal progressive encephalitis of Rasmussen and Russian spring-summer encephalitis. FSE-EPC may be the presenting feature of nonketotic hyperglycemic diabetes mellitus but is more often noted as a late complication especially if there is a coexistent cerebral lesion such as cerebral infarction. FSE-EPC may be related to multiple sclerosis, primary or metastatic brain tumors, the MERRF-MELAS syndrome, benign epilepsy of childhood with rolandic spikes, and in some adults with acquired aphasia. The physiological origin of the myoclonic jerks seen in EPC is cortical and may be either spontaneous or provoked by the joint position of the affected limb. The treatment of FSE-EPC is influenced by the underlying disorder.
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Affiliation(s)
- D L Schomer
- Department of Neurology, Beth Israel Hospital, Harvard University, Boston, MA 02215
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33
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Abstract
Neuronal migration anomalies commonly cause seizures that are partial in type and generally refractory to medical treatment. Epilepsia partialis continua (EPC), an unusual form of epilepsy commonly related to acute damage of the cerebral cortex or to a chronic lesion, has never been described in a patient with neuronal migration anomalies. In 50 children with epilepsy due to neuronal migration anomalies, we observed two cases of EPC. These two children had unilateral neuronal migration abnormalities with partial seizures other than EPC and contralateral hemiparesis. Epilepsia partialis continua appeared two to three years after the onset of partial attacks and was accompanied by a worsening of the children's previous hemiparesis. Although a rare seizure manifestation in children with neuronal migration anomalies, when it does appear, EPC can aggravate the clinical neurological condition and should always be investigated for in these cases. Because its clinical appearance is often subtle, as in these two children, EPC may easily remain undiagnosed.
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Affiliation(s)
- L Fusco
- Section of Neurophysiology, Bambino Gesù Children's Hospital, National Medical Research Institute, Rome, Italy
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34
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Velasco M, Velasco F, Alcalá H, Díaz de León AE. Wakefulness-sleep modulation of EEG-EMG epileptiform activities: a quantitative study on a child with intractable epilepsia partialis continua. Int J Neurosci 1990; 54:325-37. [PMID: 2125031 DOI: 10.3109/00207459008986652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Continuous all night recordings of epileptiform EEG activities from right frontal scalp and thalamic Centromedian regions and EMG activities from left deltoid muscular region were performed on a child with intractable epilepsia partialis continua, with depth stimulating-recording electrodes used for neuroaugmentive seizure control. In addition, "normal" and "mature" sleep indicators in the same child were simultaneously recorded according to the International Procedures. During wakefulness (W), type B seizures consisted of isolated, high amplitude, negative-positive EEG sharp waves recorded from the right Centromedian region (RCM sharp) correlated with isolated bursts of high amplitude EMG potentials recorded from the left deltoid muscle (LEMG jerks). Type C seizures consisted of clusters of repetitive RCM sharp and LEMG jerks, where individual EEG-EMG activities showed poor correlations. Number and amplitude of type B RCM sharp and LEMG jerks significantly decreased when patient directly shifted from W to slow wave sleep I and II (SWSI and II). Number and amplitude of RCM sharp increased while those of LEMG jerks decreased directly from SWS I and II to slow wave sleep III (SWS III); all forms of EEG-EMG epileptiform type B activities significantly decreased directly or indirectly from W and SWS to paradoxical sleep (PS). Scalp EEG spikes from right frontal and central regions showed almost parallel changes to those of RCM sharp, except during SWS II, when amplitude increased in the former and decreased in the later. Occurrence of type C seizures only decreased during PS and duration decreased directly from SWS I to II and indirectly from SWS I to SWS II and PS; and from W to SWS II and III and PS.
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Affiliation(s)
- M Velasco
- Unit of Neurology and Neurosurgery, General Hospital SSA, Mexico City, Mexico
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35
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Abstract
Epilepsia partialis continua (EPC) in multiple sclerosis is extremely rare. We report a case of a patient with clinically definite multiple sclerosis who developed EPC. Magnetic resonance imaging (MRI) depicted high signal in subcortical white matter and basal ganglia. A combination of lesions may be important in the generation of EPC.
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Affiliation(s)
- D C Hess
- Department of Neurology, Medical College of Georgia, Augusta 30912-3200
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36
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Perniola T, Sforza E, Rodriguez M, Margari L. Neurophysiological follow-up in a case of chronic progressive epilepsia partialis continua of childhood. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1989; 10:369-76. [PMID: 2767945 DOI: 10.1007/bf02333785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We report the waking and sleeping polygraphic and evoked potential data recorded during the follow-up of a child with chronic progressive epilepsia partialis continua of childhood (Bancaud's type II). The findings that emerged from these investigations coupled with the clinical pattern enabled us to delineate the course of this rare condition and provided clues for a tentative interpretation of the pathogenesis of the repetitive myoclonic jerks typical of epilepsia partialis continua, on which there is as yet no consensus. In our case involvement of cortico-subcortical systems seems probable.
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Affiliation(s)
- T Perniola
- Sezione di Neuropsichiatria Infantile, Clinica Neurologica I, Università di Bari
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37
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Colamaria V, Marradi P, Merlin D, Moser C, Dulac O, Dompieri P, Dalla Bernardina B. Acute measles encephalitis of the delayed type in an immunosuppressed child. Brain Dev 1989; 11:322-6. [PMID: 2817298 DOI: 10.1016/s0387-7604(89)80061-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The authors described a case of an immunosuppressed child with acute measles encephalitis of the delayed type (AMED). The authors also discussed the relationship between the AMED, epilepsia partialis continua and the neuroradiological picture, in which bilateral putaminal lucency was evident.
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Affiliation(s)
- V Colamaria
- Clinica Pediatrica, Università di Verona, Policlinico di Borgo Roma, Italy
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38
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Colamaria V, Plouin P, Dulac O, Cesaro G, Dalla Bernardina B. Kojewnikow's Epilepsia Partialis Continua: two cases associated with striatal necrosis. Neurophysiol Clin 1988; 18:525-30. [PMID: 3148849 DOI: 10.1016/s0987-7053(88)80069-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The authors report two cases of children suffering from Epilepsia Partialis Continua (EPC). The first case concerned a boy primarily affected by abdominal neuroblastoma and secondarily by bilateral EPC; "pallidal posture" was the prominent clinical feature. An acute measles encephalitis was diagnosed and the CT scan showed necrosis of the putamina. The second case concerned a girl suffering from increased intracranial pressure due to suprasellar craniopharyngioma. Seven days after intervention, Diabetes Insipidus and EPC appeared. Enlargement of rolandic and sylvian spaces and lacunar necrosis of the putamen on the left side were also evident on the CT scan. The authors emphasize the significance of occasional metabolic disturbances, especially natremia, in the development of EPC.
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Affiliation(s)
- V Colamaria
- Servizio EEG Clinica Pediatrica, Universita di Verona, Italy
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39
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Kuzniecky R, Berkovic S, Andermann F, Melanson D, Olivier A, Robitaille Y. Focal cortical myoclonus and rolandic cortical dysplasia: clarification by magnetic resonance imaging. Ann Neurol 1988; 23:317-25. [PMID: 3132890 DOI: 10.1002/ana.410230402] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Focal cortical myoclonus is rare. Obvious causes include tumor or atrophy involving the motor strip, but in some cases no cause is apparent. We present 4 patients who started to have focal myoclonus in childhood. All had focal motor seizures as well, and one had recurrent focal motor status epilepticus. All 4 had a mild progressive hemiparesis. Electrographic investigations showed focal epileptic discharges in the contralateral rolandic areas. Radiological studies were unrevealing, but magnetic resonance showed rolandic lesions in 3 patients. At surgery, abnormally wide gyri were found in the distribution demonstrated by magnetic resonance. The pathological substrate was focal cortical dysplasia. All patients have improved considerably following surgery. These findings suggest that focal myoclonus may be due to a rolandic neuronal migration disorder. Visualization of these lesions by magnetic resonance permits development of a surgical strategy leading to optimal treatment of these medically intractable epileptic disorders.
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Affiliation(s)
- R Kuzniecky
- Montreal Neurological Hospital and Institute, McGill University, Quebec, Canada
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40
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Verhagen WI, Renier WO, ter Laak H, Jaspar HH, Gabreels FJ. Anomalies of the cerebral cortex in a case of epilepsia partialis continua. Epilepsia 1988; 29:57-62. [PMID: 2828019 DOI: 10.1111/j.1528-1157.1988.tb05099.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Morphological and biochemical findings are described from the brain biopsy of an 11-year-old girl with intractable type II epilepsia partialis continua. Computerized tomography scan showed severe progressive central and cortical atrophy, mainly of the right hemisphere. Brain biopsy revealed microangiopathy of the cortex-penetrating arteries, patchy necrosis of the cortex, and small loose infiltrates of lymphocytic cells. Biochemical analysis showed normal pyruvate metabolism and citric acid cycle in gray and white matter.
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Affiliation(s)
- W I Verhagen
- Department of Child Neurology, St. Radboud University Hospital, Nijmegen, The Netherlands
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41
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Abstract
Epilepsia partialis continua with Sjögren's syndrome is reported. The patient had extensive involvement of the nervous system with left middle cerebral artery occlusive stroke, mononeuritis multiplex, right partial sensory motor seizures and epilepsia partialis continua involving the right big toe and foot. The EEG showed nonspecific bilateral theta slowing. The epilepsia partialis continua did not respond to antiepileptic drugs.
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42
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Gray F, Serdaru M, Baron H, Daumas-Duport C, Loron P, Sauron B, Poirier J. Chronic localised encephalitis (Rasmussen's) in an adult with epilepsia partialis continua. J Neurol Neurosurg Psychiatry 1987; 50:747-51. [PMID: 3112310 PMCID: PMC1032082 DOI: 10.1136/jnnp.50.6.747] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A 29 year old male presented with epileptic fits, progressive left sided focal seizures and epilepsia partialis continua, increasing left hemiparesis and mental slowing. Death occurred 2 years after the onset of the illness. Lesions were limited to the right cerebral hemisphere. Hypertrophic astrocytosis was diffuse throughout the gray and white matter but was more severe in the deep cortical layers and U fibres, where it was associated with vacuolar changes and capillary proliferation. Sparse perivascular lymphocytic cuffs, rod shaped microglia and microglial nodules were present. No inclusion bodies were found. These clinico-pathologic features were similar to the cases described by Rasmussen. Only five necropsy cases of this rare disease have been reported previously, all in children. The aetiology is unknown.
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43
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Chauvel P, Liegeois-Chauvel C, Marquis P, Bancaud J. Distinction between the myoclonus-related potential and the epileptic spike in epilepsia partialis continua. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1986; 64:304-7. [PMID: 2428578 DOI: 10.1016/0013-4694(86)90154-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Neurophysiological analysis of spontaneous and reflex-triggered myoclonus in a case of epilepsia partialis continua is reported. A central positive wave (P1), part of the high voltage evoked potential and of the spontaneous spike, is held to be responsible for the myoclonic jerk. It is demonstrated that P1 is a distinct phenomenon from both the evoked potential and the epileptic spike, and so should be identified as a myoclonus-related potential (MRP).
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44
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Kuroiwa Y, Tohgi H, Takahashi A, Kanaya H. Epilepsia partialis continua: active cortical spike discharges and high cerebral blood flow in the motor cortex and enhanced transcortical long loop reflex. J Neurol 1985; 232:162-6. [PMID: 3928827 DOI: 10.1007/bf00313893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We report a patient suffering from persistent myoclonic jerks in the right forearm without any definite EEG abnormality under routine recording conditions. By computer summation, using the jerk-locked averaging technique, a sharp spike was recognized as a precisely time-locked event in relation to myoclonic twitches. A cranial CT scan revealed a small cortical lesion, which was found very close to the sensorimotor cortex of the right arm. Cerebral blood flow study using the xenon inhalation method revealed a discrete focus of high flow, which corresponded well with the CT lesion. On electrical stimulation of the right median nerve, a large somatosensory evoked potential and an enhanced transcortical long loop reflex were observed. Electrocorticogram showed active focal spike discharges localized at the left precentral gyrus. We postulate that an epileptogenic focus in the motor cortex and an enhanced transcortical long loop reflex appear to be important for the occurrence of epilepsia partialis continua in this patient.
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45
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Komsuoğlu SS, Liman O, Gürkan H. Epilepsia partialis continua following pertussis infection. CLINICAL EEG (ELECTROENCEPHALOGRAPHY) 1985; 16:45-7. [PMID: 3928208 DOI: 10.1177/155005948501600108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Clinical, electrophysiological and CT findings of a patient with epilepsia partialis continua following pertussis infection are presented. The EEG showed lateralized abnormal slow waves and CT revealed global atrophy around the Sylvian fissure. The findings favor the primary role of the cerebral cortex in EPC.
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46
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47
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Singh BM, Strobos RJ. Epilepsia partialis continua associated with nonketotic hyperglycemia: clinical and biochemical profile of 21 patients. Ann Neurol 1980; 8:155-60. [PMID: 6775582 DOI: 10.1002/ana.410080205] [Citation(s) in RCA: 122] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In 21 patients, epilepsia partialis continua (EPC) was an early symptom of nonketotic hyperglycemia and occurred during an initial phase of hyponatremia and mild hyperosmolality. EPC persisted for an average of 8 days, and its duration correlated predominantly with the degree of hyponatremia. Depression of consciousness and cessation of seizures occurred with increasing severity of hyperglycemia and hyperosmolality. In 9 patients, EPC was the first symptom leading to the diagnosis of diabetes mellitus. Four patients died of serious associated illness. The majority of the patients had evidence of a localized structural cerebral lesion. Metabolic disturbances including hyperglycemia, mild hyperosmolality, hyponatremia, and lack of ketoacidosis contribute to the development of EPC in areas of focal cerebral damage.
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48
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Chu NS. Acute subdural hematoma and the periodic lateralized epileptiform discharges. CLINICAL EEG (ELECTROENCEPHALOGRAPHY) 1979; 10:145-50. [PMID: 476967 DOI: 10.1177/155005947901000303] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Focal motor seizures associated with periodic lateralized epileptiform discharges (PLEDs) were observed in two patients with acute subudral hematoma. Following the surgery, one patient continued to exhibit PLEDs but clinical seizures were absent PLEDs recurred in the second patient due to inadequate anticonvulsant medication. Autopsy study in one patient suggests that underlying cerebral contusion was not responsible for the occurrence of PLEDs.
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49
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Wieser HG, Graf HP, Bernoulli C, Siegfried J. Quantitative analysis of intracerebral recordings in epilepsia partialis continua. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1978; 44:14-22. [PMID: 74322 DOI: 10.1016/0013-4694(78)90101-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A 14-year-old female with epilepsia partialis continua was explored stereo-electroencephalographically (SEEG). SEEG, EEG and EMG were recorded synchronously on a 32-channel machine and stored on magnetic tape for off-line analysis. The beginning of the myoclonus was used as trigger for the analysis of the intracerebral activity, which was analysed by averaging. Thereby the generating potentials of the jerks became evident. They had different maxima and latencies relative to the facial and hand muscles: that for m. orbicularis oculi was located in the precentral gyrus, the beginning of its positive deflection was 17 msec earlier than the muscle action potential; that for the thenar muscles had a latency of 24 msec, appeared at first in the premotor cortex and with a slight delay, but with greater amplitude in the corona radiata and capsula interna. Stimulation of the lateral area 4 elicited myoclonus which corresponded to the spontaneous one in distribution and latency. Stimulation of the thalamic VL nucleus had no effect. During deep sleep the frequency of the myoclonus was diminished. REM sleep was preceded and followed by a definite increase of jerking. The pattern, topography and latency of the generating potentials in waking and sleeping were very similar. In this way quantitative evidence of the neocortical origin of Epc is given and therefore a precise delineation of the epileptogenic focus.
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Knopman D, Margolis G, Reeves AG. Prolonged focal epilepsy and hypoxemia as a cause of focal brain damage: a case study. Ann Neurol 1977; 1:195-8. [PMID: 407832 DOI: 10.1002/ana.410010218] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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