Primary Antiphospholipid Antibody Syndrome Manifesting as Refractory Partial Status Epilepticus Unrelated to a Structural Brain Abnormality (P02.155)

The diagnosis of nonconvulsive status epilepticus (NCSE) largely relies on electroencephalography (EEG) findings, but the existing diagnostic criteria for EEG results are sometimes inconsistent. Much debate has centered on periodic epileptic discharges (PEDs) and their relationship with seizures. The recently published Salzburg Consensus Criteria for diagnosis of NCSE, which consider PEDs to be ictal findings under several conditions, have been proven to have high diagnostic accuracy. However, the criteria do not include periodic slow waves (PSWs) and do not consider these as overall ictal electrographic changes. Here, we report 2 cases of complex partial status epilepticus in which routine EEG showed PSWs without epileptiform activity during the clinical ictal phase. Both patients were elderly males who had histories of seizures and presented with impaired consciousness and signs such as aphasia or tongue automatism that indicated a temporal lobe origin. After we administered antiepileptic drugs (AED), the clinical signs and periodic EEG slow waves disappeared. These cases show that PSWs may appear as ictal electrographic changes in NCSE. When PSWs accompany clinical signs suggestive of NCSE, they should be considered ictal findings, and physicians should administer AED.

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Consultation with the Specialist

Pediatrics in Review ◽

10.1542/pir.16.10.386 ◽

1995 ◽

Vol 16 (10) ◽

pp. 386-389

Author(s):

Margaret C. McBride

Keyword(s):

Status Epilepticus ◽

Primary Care Physicians ◽

Seizure Activity ◽

Medical Emergency ◽

Partial Status Epilepticus ◽

Primary Generalized Epilepsy ◽

Generalized Epilepsy ◽

Static Encephalopathy ◽

Prolonged Absence ◽

Partial Status

Status epilepticus has been defined as continuous seizure activity or intermittent seizure activity without recovery of consciousness between seizures that lasts for more than 30 minutes. However, if a seizure has continued unabated for 5 minutes, status epilepticus should be presumed and therapy initiated. Status epilepticus is a medical emergency, and all primary care physicians should know how to initiate its treatment. Usually status epilepticus consists of generalized or asymmetric clonic activity with unconsciousness. However, prolonged absence or partial seizures comprise 10% of episodes. Absence status epilepticus usually occurs in children who have severe primary generalized epilepsy or Lennox-Gastaut syndrome. Partial status epilepticus occurs in children who have focal brain pathology. The initial treatment of both is like that for generalized status epilepticus, with only slightly less urgency. The remainder of this review concerns generalized status epilepticus. Etiology It is important to obtain both remote and recent histories from the child's family or attendant as soon as possible so that an appropriate differential diagnosis may be developed. In 25% of cases, status is idiopathic. In another 25% it is provoked only by fever (febrile status). In the 20% of children who have a static encephalopathy, the condition is termed remote symptomatic status epilepticus. In another 20%, status is termed acute symptomatic and is an expression of an acute encephalopathy or brain injury.

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